3D Scanners in Orthodontics—Current Knowledge and Future Perspectives—A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Eligibility Criteria
2.3. Data Extraction
2.4. Quality Assessment
3. Results
3.1. Study Selection
- 3Shape (n studies: 12; 3Shape Trios -n 7- and 3Shape TriPod -n 5-);
- iTero Element (n studies: 4);
- Carestream 3600 (n studies: 4);
- OrthoinSight 3D*-extraoral scanner (n studies: 3)
- Other (n studies: 5)
3.2. Quality Assessment and the Risk of Bias
4. Discussion
4.1. Determining the Accuracy of Scanning and Measurement on Digital Models of Different Scanning Devices
4.2. The Innovative Approaches in Use of Intraoral Scanners
- (a)
- New improvements in general use
- -
- proposing a new training to maximize the efficiency of dental hygienist [16]
- -
- orthodontic movement monitoring in quicker and much more comfortable way than before [17]
- -
- finding that full intraoral scans are perfectly reliable for orthodontic cases, but still not useful for prosthetic cases, where up to 3 segments should be scanned [21]
- -
- using the digital scans as exact for documentation of palatal soft tissue [23]
- -
- the innovative method of scanning the palate, ensuring its most faithfully reproduction on the digital model [24]
- -
- finding that when clinician depend on digital models, it is best to use ceramic brackets as they provide the lowest discrepancy of measurements [28]
- -
- finding that scanning method, which provides most accurate digital casts is when scanning begins from tooth #12 up to tooth #17, and then from tooth #12 up to tooth #27 [25]
- (b)
- Completely new applications in the use of scanners
- -
- use rugae palatine patterns on digital scans in order to identify individuals [18]
- -
- determine the occlusal contacts in a novel way [20]
- -
- display in more accurate way the interdental areas in periodontal patients directly in patients’ mouth [29]
- -
- finding centric relation only by using intraoral scanner [30]
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
RCT | randomized control trial |
RCCT | randomized control clinical trial |
3D | three dimensional; |
CT | computed tomography |
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Author, Year [Reference] | Type of Study | Study Objective | Study Material | Number of Subjects | Test Group | Control Group | Intraoral Scanner Model | Results |
---|---|---|---|---|---|---|---|---|
Jacob et al. 2015 [15] | Case—control study | Comparison of the accuracy of two intraoral scanners and one extraoral scanner | 3D intraoral and extraoral scans | 15 subjects | Intraoral scans, extraoral scans of dental cats | Intraoral scans, extraoral scans of dental cats | iTero element, Lythos Ortho Insight 3D, | While all three scanners produced reliable measurements, Ortho Insight 3D systematically underestimated arch length and canine height. Measurements taken from all three scanners were highly reliable, with intraclass correlations ranging from 0.926 to 0.999. Method errors were all less than 0.25 mm |
Park et al. 2015 [16] | RCCT | Evaluation of the influence of proper training in intraoral scanning among dental hygienists. | Questionnaires before and after the training | 34 hygienists, 17 per group. The hygienists from the other group served as patients in the group using a different scanner, thus assessing the patient’s comfort during the scanning. | iTero element group | 3Shape group | iTero element, 3Shape Trios | The first preliminary questionnaire was given initially before the training sessions and the second questionnaire was completed upon the completion of all the training sessions. Both evaluated parameters as difficulties of using intraoral scanners with digital impression method compared to conventional impression-taking method, patient comfort, and degree of awareness about intraoral scanners. The parameter of awareness included anticipated accuracy, patient convenience, efficiency, clinical application, and interest in further use. Results of this study indicated that participants generally preferred Trios intraoral scanner over iTero as an operator after the training. However, participants consider iTero as easier to handle during the scan and indicated, that it provides much higher patients comfort. The usefulness of intraoral scanner could be a successful alternative to conventional impression-taking with proper training. |
Nalaci et al. 2015 [17] | RCCT | Evaluation of reliability of measurements by superimposition of 3D digital models | Digital models, classic dental casts and cephalometric radiographs of adolescent patients | 10 female and 10 male II Class subjects; (mean age: 16) | The posterior movements of the maxillary first molars evaluated on superimposed 3D models before and after treatment | (a) The distal movements of the maxillary first molars evaluated on cephalometric radiographs (b) The distal movements of the maxillary first molars evaluated on photocopies of plaster models | 3 Shape R700 model | There was no significant difference observed in values of distalization of the upper molars, premolars, or incisors among all three groups. The measurement differences among the 3D digital models, cephalometric radiography, and plaster model photocopy methods were insignificant. Cronbach’s alpha value was closest to ideal 1 for the measurement on 3D models. The use of superimposed 3D models on Orthocad Software as the evaluation of treatment results seems as valid alternative for conventional evaluation method. |
Taneva et al. 2015 [18] | Case—control study | Creation of control points on rugae palatine patterns using 3D digital models in order to identify victims | 3D intraoral scans, 2D photos | 15 subjects from the university clinic and 15 subjects from private orthodontic practices | Intraoral scans, extraoral scans of dental cats | Scans after follow-up, 2D photos | iTero element, Ortho Insight 3D | No statistically significant mean differences exist between different digital model conversion techniques, between OrthoCAD™ and Ortho Insight 3D™, and between Ortho Insight 3D™. Twelve palatal 3D landmarks could be used for human identification over time, certain landmarks showed more significant impact on the matching process |
Kim and Lagravére 2016 [19] | RCCT | Comparison of accuracy of 3D models of conventional dental casts vs. CBCT scans | Digital models, classic dental casts and CBCT scans of adolescent patients | 50 models and corresponding casts and digital models | Measurements on the 3D models using Ortho Insight 3D software | (a) Measurements of CBCT scans converted to DICOM files using Avizo Software (b) Manual measurements taken on classic dental cast | Ortho Insight 3D laser scanner | Intra-examiner measurement errors were determined by randomly selecting 10 patient records, and the mesiodistal width measurements were repeated three times 1 week apart by the same examiner. CBCT exhibited the lowest error reliability, while scanned digital models had the highest intra-examiner error reliability. The mutual compatibility of measurements deviates in the case of calculating anterior Bolton ratio at the level of agreement of 0.886. However, Bolton analysis can be accurately and reliably performed on scanned digital models using the proposed Ortho Insight system. |
Solaberrieta et al. 2016 [20] | Case—control | To locate the 3D spatial position of the mandibular cast and determine its occlusal contacts in a novel way by using an intraoral scanner as part of the virtual occlusal record procedure | 3D intraoral scans, dental casts | 4 participants | 3D intraoral scans | 3D scans from industrial scanner | Lava Cos, 3Shape Trios, Zfx Intrascan, ATOS Compact Scan 5M | Intraoral virtual occlusal recording is a valid procedure to locate a mandibular cast on a virtual articulator. The contacts observed with this procedure were accurate enough. Moreover, virtual contacts provided more objective and meaningful information. Lava Cos and Trios 3-Shape intraoral scanners showed similar characteristics, both of them being good enough to carry out this procedure. The LavaCos requires coating and has a comfortable small tip, whereas the Trios 3-Shape scanner has a larger tip and is much faster. The best results regarding the virtual occlusal record sections were obtained when the distance between the sections was maximum. Two or three sections can be required to establish perfect occlusal record. |
Wesemann et al. 2017 [21] | Case—control compa-rative study | Comparison of the accuracy and time efficiency of an indirect and direct digitalization workflow with that of a 3D printer to identify the most suitable method for orthodontic use. | 3D intraoral scans, CBCT scans, conventional dental casts | None—comparison of the scanning quality on hypothetical dental cast | Intraoral scans of master model with separately: 3Shape R700, 3Shpae R900, 3Shape Colorpod | Dental casts, CBCT scans | 3 Shape Tripod R700 3Shape Tripod R900 3Sape Trios Colorpod | The most accurate results were obtained by the R900. The R700 and the TRIOS intraoral scanner showed worse, but still comparable results. CBCT-3D-rendering revealed significantly higher accuracy with regard to dental casts than dental impressions. The chairside time required for digital impressions was 27% longer than for conventional impressions. For orthodontic demands, intraoral scanners are a useful alternative. For prosthodontic use, no more than one quadrant and three additional teeth should be provided as the scanning area on one seat. |
Lee 2018 [22] | Case—control study | Comparison of two intraoral scanners based on 3D surface analysis | 3D intraoral scans and dental casts scans | 32 adult participants | 3D intraoral scans | 3D dental casts scans | 3Shape Trios 3 iTero Element 2 | The mean deviations between two intraoral scans were 0.057 mm in the maxilla and 0.069 mm in the mandible. The histogram showed local variations between the two scanners in the posterior area. In three-dimensional deviations, intraoral scans showed a slight shift towards the models. There were no statistically significant differences between the two scanners. |
Deferm et al. 2017 [23] | Case—control study | Assessment of the feasibility of 3D intraoral scanning for documentation of palatal soft tissue by evaluating the accuracy of shape, color, and curvature. | 3D intraoral scans, dental casts | Scans of 10 participants by 2 different observers | Intraoral scans | Dental casts | 3Shape Trios | Mean average distance error between the conventional models and the intraoral scans models was 0.02 ± 0.07 mm. Mean interobserver color difference was −0.08 ± 1.49°, 0.28 ± 0.78% and 0.30 ± 1.14% for respectively hue, saturation, and value, whilethe interobserver differences for overall and maximum surface irregularity were 0.01 ± 0.03 and 0.00 ± 0.05 mm. what showed that intraoral scanner is tool, which provide reliable, reproducible and accurate results, and therefore allows to freely document the palate. |
Zhonpeng et al. 2019 [24] | Case—control study | Comparison of the differences in palatal region between indirect and direct digital models and the scanning sequences | 3D intraoral scans and dental casts scans | 35 adult participants (9 men and 26 women (24–27 years old) | (a) 3D intraoral scans with the start point behind the central incisors (b) 3D intraoral scans with the start point behind the central incisors | Scans of dental casts | 3Shape Trios 3 Pod | When evaluating accuracy of intraoral scanning in the palatal region, the superimposition method should be appropriately adjusted. It means that to obtain a certain comparison of scanning accuracy, soft tissues (palate), dentition (dental arch) and the entire scan (angulation of one to the other) must be assessed in separated evaluation. Palatal trueness is affected by scanning sequences. To get the best impression one needs to begin the scanning procedure from the palatal side of posterior teeth. |
Favero et al. 2019 [25] | Case—control study | Comparison of the accuracy of 3D digital impressions obtained using two intraoral scanners and three scanning methodologies. | 3D intraoral scans | None—comparison of the scanning quality on hypothetical dental cast | Technique A (from tooth #27 up to tooth #17); Technique B (from tooth #11 up to tooth #17 and then from tooth #21 up to tooth #27) Technique C (from tooth #12 up to tooth #17, and then from tooth #12 up to tooth #27) - scanned with Carestream 3600 | Technique A (from tooth #27 up to tooth #17); Technique B (from tooth #11 up to tooth #17 and then from tooth #21 up to tooth #27) Technique C (from tooth #22 up to tooth #17, and then from tooth #12 up to tooth #27) - scanned with Zfx Evolution | Zfx Evolution, Carestream 3600 | The scanning technique had a statistically significant effect on the quality of the scan (p < 0.0001).When scanning begins from tooth #12 up to tooth #17, and then from tooth #12 up to tooth #27 it is less volumetric whereas the scanner did not present any significant influence (p = 0.91). |
Yilmaz et al. 2019 [26] | RCCT | Comparison of Accuracy of 3D models vs. conventional dental casts | Digital and classic dental casts of adolescent patients | 20 female, 10 male subjects; (mean age: 14.36 ± 6.30) | Measurements on 3D models with 3Shape Ortho Analyzer 2013 software | Manual measurements on classic dental cast | 3 Shape TriosColor-P1 | The study checked the accuracy of measurements of the spaces between the teeth in both dental arches and also Bolton’s analysis was carried out. To increase the reliability of the measurements, they were repeated five times, and the arithmetic average value was used for the evaluation. Conventional analysis required 33% more time then the digital one. (mean 894.33 s vs. 597.73 s) There were no significant differences between the accuracy achieved p < 0.001. The digital analysis is as reliable as conventional model analysis and it seems to be more time effective. |
Winkler & Gkantidis 2020 [27] | Case—control study | Comparison of the precision of intraoral scanners and the industrial scanner | 3D scan with industrial scanner Artec Space Spider, with CS 3600, with TRIOS 3 | 12 adult volunteers (8 men, 4 women, age: 27–52 years) | 3D scans with the use of: (a) CS 3600, (b) TRIOS 3. | 3D scan with industrial scanner Artec Space Spider | Carestream 3600 3Shape Trios 3 | The precision of the intraoral scanners (TRIOS 3 and CS 3600) was tested after superimposing the dental arch surface models obtained from repeated scans. In overall, TRIOS 3 showed better precision than the CS 3600(approximately 10μm). However, looking into the detail, both devices showed a clear imprecision, especially on buccal side of anterior teeth. Both devices do not show the accuracy of an industrial scanner, however, their accuracy is completely sufficient for clinical applications. |
Jihu Song & Minji Kim 2020 [28] | Case—control study | Evaluation of scanned images of 4 clinically used intraoral scanners with different types of brackets | 3D intraoral scans | 4 different study models | (a) Study model with metal brackets (b) Study model with ceramic brackets (c) Study model with resin brackets | Study model without any brackets | Carestream CS3600, i500, 3Shape Trios3, Sirona Omnicam | Image data were analyzed with the 3D analysis software—Geomagic. Not only both scanners (p < 0.05) and brackets (p < 0.05) had a significant impact, but also interaction between scanner and brackets was statistically significant (p < 0.05). Brackets which were translucent or reflective to light such as resin and metal brackets tended to show higher discrepancy values. From the point of view of the clinician, all scanners showed acceptable deviation results, however CS3600 and Trios3 were most accurate comparing to control model. |
Schlenz et al. 2020 [29] | Case—control study | Analysis of the ability of analog and digital impression techniques to display the interdental areas in periodontal patients | 3D scans and dental casts | 30 patients, age: 48–87 | Intraoral scans | Conventional dental casts | True Definition, Carestream 3600, 3Shape Trios 3, Primescan | True definition scanner gave the most adequate results, displaying the highest percentage of interdental areas, followed by Primescan, Carestream and 3Shape. However, regardless the technique of scanning or type of scanner, intraoral scans always demonstrated the number and condition of recessions better than conventional casts. |
Stafeev et al. 2020 [30] | Case—control study | Comparison of classic method of finding centric relation to new digital method using 3D Scans | 3D scans and classic models and frontal deprogrammer | 5 patients, 20 registrations of the centric jaw relation for each patient | Intraoral scans | Conventional deprogrammation method | 3Shape Trios 3 | The reproducibility of the digital mandible position in the centric relation reached 0.119 ± 0.012 mm for frontal deprogrammer, 0.225 ± 0.028, p ≤ 0.05 for bilateral manipulation by p.E. Dawson, 0.207 ± 0.02, p ≤ 0.05 for leaf gauge, and 0.120 ± 0.013, p ≤ 0.05 for intraoral device for recording the Gothic arch angle. All methods of searching for centric relation do not coincide completely. However, the most precise were the methods using the frontal deprogrammer and the intraoral recording of gothic angle. In terms of reproducibility, the Avantis 3D program most accurately identified the mandible position, when searching for the position of centric relation. By choice of the many, many factors that should be considered such as the condition of the stomatognathic system, the manual skills of the doctor, the psychoemotional status of the patient, and the material provision. |
Author | Park et al. 2015 [16] | Nalaci et al. 2015 [17] | Kim and Lagravére 2016 [19] | Yilmaz et al. 2019 [26] |
---|---|---|---|---|
Randomization present | 1 | 1 | 1 | 1 |
Appropriate randomization used | 1 | 1 | 1 | 1 |
Blinding present | 0 | 1 * | 1 * | 1 * |
Appropriate blinding used | 0 | 1 * | 1 * | 1 * |
Appropriate long-term follow-up for all patients | 1 | 1 * | 1 * | 1 * |
Total | 3 | 5 | 5 | 5 |
Study | Jacob 2015 [15] | Taneva et al. 2015 [18] | Solaberrieta et al. 2016 [20] | Wesemann et al. 2017 [21] | |
Selection | Is the case definition adequate? | 1 | 1 | 1 | 1 |
Representativeness of the cases | 1 | 1 | 1 | 1 | |
Selection of Controls | 1 | 1 | 1 | 1 | |
Definition of Controls | 1 | 1 | 1 | 1 | |
Comparability | Comparability of cases and controls on the basis of the design or analysis | 2 | 2 | 2 | 2 |
The procedures of intraoral scanning are the same for both scanners. The choice of the extraoral scanner as a control is not objectionable. In the Ortho Insight, the mandibles were secured with double-sided tape. Each mandible was scanned twice, at least 1 week apart, using each of the three scanners. Scans were extracted in .stl format. Cases and control do not cause any doubt from methodological point of view. | To estimate the identification points on rugae palatine five cross sections in the anteroposterior dimension and four cross sections in the transverse dimension were computed which generated 18 2D variables. Both cases and control obtaining method are well described and do not cause any doubt from methodological point of view. | To make a control model, the teeth were scanned using Zfx Evolution -widely recognized as being a high precision reference scanner. Scans were extracted in .stl format. Both cases and control obtaining method are well described and do not cause any doubt from methodological point of view. Scans were extracted in .stl format. | The control model was measured with a coordinate measuring instrument. All the cases were comparable and measured with details to ensure comparability of time effectiveness and accuracy of indirect and direct workflow. Both cases and control obtaining method are well described and do not cause any doubt from methodological point of view. Scans were extracted in .stl format. | ||
Outcome | Ascertainment of exposure | 1 | 1 | 1 | 1 |
Same method of ascertainment for cases and controls | 1 | 1 | 1 | 1 | |
Non-Response rate | 1—authors described whenever the scanner did not process the data perfectly | 1—authors described whenever the scanner did not process the data perfectly | 1—authors described whenever the scanner did not process the data perfectly | 1—authors described whenever the scanner did not process the data perfectly | |
Total | 9 | 9 | 9 | 9 | |
Study | Lee 2018 [20] | Deferm et al. 2018 [21] | Zhongpeng et al. 2019 [22] | Favero et al. 2019 [23] | |
Selection | Is the case definition adequate? | 1 | 1 | 1 | 1 |
Representativeness of the cases | 1 | 1 | 1 | 1 | |
Selection of Controls | 1 | 1 | 1 | 1 | |
Definition of Controls | 1 | 1 | 1 | 0 | |
Comparability | Comparability of cases and controls on the basis of the design or analysis | 2 | 1 | 2 | 1 |
All intraoral scans with the iTero and TRIOS scanners were recorded by the same single examiner. The scanners were calibrated every 8 days according to the manufacturers’ recommendation. Both scans were performed in a predetermined sequence and analyzed in open .stl format in exterior software. | Although obtaining the scan of curvatures and distances of palatal region of the case and control group was well described, there was no special control color description, as hue, saturation, value were measured only on the case scans, as control was performed on classic cast. Scans were extracted in .stl format | Scanning in both sequences was performed with the device by experienced operators. The way the digital and classical casts were obtained is well described and did not influence the shape of the palatal folds to ensure comparability of accuracy of indirect and direct workflow. Scans were extracted in .stl format. Both cases and control obtaining methods are well described and do not cause any doubt from methodological point of view. | To make a control model, the teeth were scanned using Zfx Evolution—widely recognized as being a high precision reference scanner. However, the method of obtaining the control model was not precisely described, citing only that the laboratory that made it is highly respected. In a study comparing the effect of scanning sequences, it would be useful to explain the process of creating an image serving as a reference. Not in all of the sequences it has been described if the sequence was started from buccal or palatal side of element. | ||
Outcome | Ascertainment of exposure | 1 | 1 | 1 | 1 |
Same method of ascertainment for cases and controls | 1 | 1 | 1 | 1 | |
Non-Response rate | No description | 1—authors described whenever the scanner did not process the data perfectly | 1—authors described whenever the scanner did not process the data perfectly | No description | |
Total | 8 | 7 | 9 | 6 | |
Study | Jihu Song & Minji Kim 2020 [27] | Winkler &Gkantidis 2020 [28] | Schlenz et al. 2020 [29] | Stafeev et al. 2020 [30] | |
Selection | Is the case definition adequate? | 1 | 1 | 1 | 1 |
Representativeness of the cases | 1 | 1 | 1 | 0 | |
Selection of Controls | 1 | 1 | 1 | 1 | |
Definition of Controls | 1 | 1 | 1 | 1 | |
Comparability | Comparability of cases and controls on the basis of the design or analysis | 2 | 2 | 2 | 1 |
Every model was bonded with ceramic, metal, and resin brackets, respectively, and without brackets. Reference images were taken by scanning the models with an industrial scanner. Then artificial saliva was applied on study models and model was scanned 10 times, respectively, with 4 different intraoral scanners. All images were converted to STL file format and analyzed with 3D analysis software. | To make a control model, the teeth were scanned using Artec Space Spider-recognized as being a high precision industrial scanner. Scans were extracted in .stl format. The procedures of intraoral scanning were the same for both scanners. What is more, every tooth was divided in segment and the precision and thruthness analysis is performed. The procedures of intraoral scanning are the same in both scanners. Both cases and control do not cause any doubt from methodological point of view. | Cases were performed with intraoral scanners following manufacturers’ recommendation. A classic dental cast was used as control. Both cases and control obtaining method are well described and do not cause any doubt from methodological point of view. Scans were extracted in .stl format. | The authors tried to do the research of innovative nature, as searching for the centric relation in “virtual articulator” there are too many factors influencing the actual centric relation of the patient and the proper interpretation of actual centric relation by the program, that the representativeness of the cases remains questionable. We do not know, wherever all the effects of deprogrammation were similar in all patients as the software described. Despite all of that, research results seem promising. | ||
Outcome | Ascertainment of exposure | 1 | 1 | 1 | 1 |
Same method of ascertainment for cases and controls | 1 | 1 | 1 | 1 | |
Non-Response rate | 1—authors described whenever the scanner did not process the data perfectly | 1—authors described whenever the scanner did not process the data perfectly | 1—authors described whenever the scanner did not process the data perfectly | No proper description | |
Total | 9 | 9 | 9 | 6 |
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Jedliński, M.; Mazur, M.; Grocholewicz, K.; Janiszewska-Olszowska, J. 3D Scanners in Orthodontics—Current Knowledge and Future Perspectives—A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 1121. https://doi.org/10.3390/ijerph18031121
Jedliński M, Mazur M, Grocholewicz K, Janiszewska-Olszowska J. 3D Scanners in Orthodontics—Current Knowledge and Future Perspectives—A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(3):1121. https://doi.org/10.3390/ijerph18031121
Chicago/Turabian StyleJedliński, Maciej, Marta Mazur, Katarzyna Grocholewicz, and Joanna Janiszewska-Olszowska. 2021. "3D Scanners in Orthodontics—Current Knowledge and Future Perspectives—A Systematic Review" International Journal of Environmental Research and Public Health 18, no. 3: 1121. https://doi.org/10.3390/ijerph18031121