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The Accuracy of Different Dental Impression Techniques for Implant

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The Accuracy of Different Dental Impression Techniques for Implant Accepted: 13 March 2018 DOI: 10.1111/clr.13273 R E V I E W A R T I C L E T h e a c c u r a c y o f d i f f e r e n t d e n t a l i m p r e s s i o n t e c h n i q u e s f o r implant- supported dental prostheses: A systematic review and meta- analysis T a b e a F l ü g g e1,2 | W i c h e r J o e r d v a n d e r M e e r3,4 | B e a t r i z G i m e n e z G o n z a l e z2 | K i r s t i n V a c h5 | D a n i e l W i s m e i j e r2 | P i n g W a n g6 1 Department of Oral and Maxillofacial Surgery , Medical Center – University of A b s t r a c t Freiburg , Faculty of Medicine , University of Aim: This systematic review and meta-analysis were conducted to assess and Freiburg , Germany compare the accuracy of conventional and digital implant impressions. The review 2 Department of Oral Implantology , Academisch Centrum was registered on the PROSPERO register (registration number: CRD 42016050730). Tandheelkunde Amsterdam (ACTA) , Material and Methods: A systematic literature search was conducted adhering to Amsterdam , the Netherlands PRISMA guidelines to identify studies on implant impressions published between 3 Department of Orthodontics , University Medical Center Groningen , University of 2012 and 2017. Experimental and clinical studies at all levels of evidence published in Groningen , Groningen , the Netherlands peer- reviewed journals were included, excluding expert opinions. Data extraction 4 W.J. Kolff Institute of Biomedical Engineering and Materials Science , was performed along defined parameters for studied specimens, digital and Groningen , the Netherlands conventional impression specifications and outcome assessment. 5 Institute for Medical Biometry and Results: Seventy-nine studies were included for the systematic review, thereof 77 Statistics , Faculty of Medicine , University of Freiburg , Freiburg , Germany experimental studies, one RCT and one retrospective study. The study setting was in 6 Maurice H. Kornberg School of vitro for most of the included studies (75 studies) and in vivo for four studies. Dentistry , Temple University , Philadelphia , Accuracy of conventional impressions was examined in 59 studies, whereas digital Pennsylvania impressions were examined in 11 studies. Nine studies compared the accuracy of Correspondence conventional and digital implant impressions. Reported measurements for the Tabea Flügge, Department of Oral and Maxillofacial Surgery, University Medical accuracy include the following: (a) linear and angular deviations between reference Center Freiburg, Hugstetter Str. 55, Freiburg models and test models fabricated with each impression technique; (b) three- 79106, Germany. Email: [email protected] dimensional deviations between impression posts and scan bodies respectively; and (c) fit of implant-supported frameworks, assessed by measuring marginal discrepancy along implant abutments.) Meta-analysis was performed of 62 studies. The results of conventional and digital implant impressions exhibited high values for heterogeneity. Conclusions : The available data for accuracy of digital and conventional implant impressions have a low evidence level and do not include sufficient data on in vivo application to derive clinical recommendations. K E Y W O R D S computer-aided design , digital implant impressions, implant impressions, intraoral scanning This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd. 374 | wileyonlinelibrary.com/journal/clr Clin Oral Impl Res. 2018;29(Suppl. 16):374–392. FLÜGGE ET AL. | 375 1 | INTRODUCTION Schubinski, & Taylor, 2012 ; Papaspyridakos et al., 2016 ). With digital implant impressions, the conventional workflow for the This systematic review examines current literature on the accuracy manufacturing of implant-supported prosthesis is avoided and the of conventional and digital implant impression methods published utilization of CAD/CAM technology is initiated. Digital impression between 2012 and 2017. Conventional and digital implant impres- summarizes multiple optical technologies to attain the position sions transfer the intraoral position of dental implants to a working of dental implants in a virtual model (Giménez, Özcan, Martínez- cast. Digital impressions use optical methods to acquire implant po- Rus, & Pradíes, 2014 , 2015a , b ; Giménez, Pradíes, Martínez-Rus, & sitions and display them in a virtual model. Conventional methods Özcan, 2015 ). Analog to conventional implant impressions, scan use impression material and impressions copings to transfer implant bodies are connected to dental implants, creating an accessible positions to a stone cast with implant analogs in original implant surface for optical acquisition (Flügge, Att, Metzger, & Nelson, positions. 2017 ). The position of implant scan bodies within the dental arch The position of dental implants is recorded and transferred to is recorded with intraoral scanning devices and results in a virtual a working stone cast for the manufacturing of implant-supported stone cast displaying the scan bodies. With the knowledge of scan prosthesis (Lee, So, Hochstedler, & Ercoli, 2008 ). The correct trans- body dimensions, the spatial position of each implant connected fer of each implant position in relation to neighboring implants or to a scan body is reconstructed. Based on the virtual position of teeth is paramount for the design and fit of implant-supported pros- implants, prostheses are virtually designed and may be manufac- thesis and therefore for long-term success of implant therapy avoid- tured using CAM technology (Aktas, Özcan, Aydin, Şahin, & Akça, ing mechanical and biological complications (Kunavisarut, Lang, 2014 ; Katsoulis et al., 2013 ). Depending on the optical scanning Stoner, & Felton, 2002 ; Sahin, Cehreli, & Yalcin, 2002 ; Wang, Leu, technology, a titanium oxide powder may be required on intraoral Wang, & Lin, 2002 ). surfaces (Abdel-Azim et al., 2014 ; Karl et al., 2012 ; Vandeweghe, The conventional workflow for dental implant impressions in- Vervack, Dierens, & De Bruyn, 2017 ). volves screw-retained impression copings that are attached to To take advantage of virtual design tools and novel computer- the implant and impression trays loaded with impression material. aided production processes of implant-supported frameworks, Impression copings are either retained in the cured impression ma- stone cast with implant analogs may as well be scanned using optical terial (pick-up method) (Di Fiore et al., 2015 ; Papaspyridakos et al., scanners. In this case, a conventional implant impression is used to 2012 ; Pera, Pesce, Bevilacqua, Setti, & Menini, 2016 ) or remain in transfer the implant position from the mouth to a stone cast and the implants and are repositioned in the respective regions in the scan bodies are connected to dental implant analogs in the model. impression after it is removed from the mouth (transfer method) The model is placed in a model scanner and optically recorded (Aktas (Calesini et al., 2014 ; Ibrahim & Ghuneim, 2013 ). Replacement of et al., 2014 ; Flügge et al., 2017 ; Katsoulis et al., 2013 ; Stimmelmayr, transfer copings after removal of the impression from the mouth Guth, Erdelt, Edelhoff, & Beuer, 2011 ). may be facilitated by plastic caps seated on transfer copings that are The transfer of implant positions with conventional, intraoral retained in the impression (Abdel-Azim, Zandinejad, Elathamna, Lin, optical or extraoral optical methods is the starting point for the & Morton, 2014 ; Gökçen-Rohlig, Ongül, Sancakli, & Sermet, 2014 ). production process of implant-supported prosthesis. Multiple The pick-up method is performed with open impression trays. To studies examined and compared the accuracy of different implant remove the impression with copings, the screw retention must be impression techniques. However, intraoral implant positions must loosened. This is achieved through holes in the impression tray that be transferred to an extraoral reference model for the assess- are located on top of the impression coping. The transfer method is ment of the accuracy of intraoral impressions. The technique with performed with closed impression trays, as no access to the screw- the least assumed error is used to create a reference model and retained copings is required. Pick-up impression copings are fre- novel methods are compared with the previously created refer- quently splinted to each other with acrylic resin or other materials ence model (Andriessen, Rijkens, van der Meer, & Wismeijer, 2014 ; or structures (bars, straws or dental floss) before adding impression Papaspyridakos et al., 2016 ). Therefore, accuracy assessment of material (Martínez-Rus, García, Santamaría, Özcan, & Pradíes, 2013 ; intraoral impressions is limited to the comparison of different Ongül, Gökçen-Röhlig, Şermet, & Keskin, 2012 ; Zen et al., 2015 ). The techniques. The term accuracy refers to the trueness, describ- rigid connection of multiple impression copings is applied to avoid ing the closeness of a measurement to the actual value, and by movement of impression copings in the elastic impression material. the precision, describing the closeness of multiple measurement A higher impression accuracy with splinted impression copings com- results. pared to nonsplinted copings
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