ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10015-2231 |
Comparative Evaluation of Accuracy of Intraoral Scanners vs Conventional Method in Establishing Dental Measurements in Mixed Dentition
1-3Department of Pediatric and Preventive Dentistry, ITS Dental College, Ghaziabad, Uttar Pradesh, India
Corresponding Author: Naman Pahuja, Department of Pediatric and Preventive Dentistry, ITS Dental College, Ghaziabad, Uttar Pradesh, India, Phone: +91 8954425944, e-mail: naman.pahuja23@gmail.com
Received on: 07 April 2023; Accepted on: 09 May 2023; Published on: 02 August 2023
ABSTRACT
Introduction: With the ongoing development of digital procedures, intraoral scanning devices, and associated workflows are conquering dental practice. The intraoral scan and its digital models (DM) are being considered as a replacement for conventional impressions in pedodontics because of several potential advantages in hygienic handling, the comfort of treatment, transferring of data, analyzing and storing diagnostic models, and manufacturing orthodontic appliances.
Material and methods: A total of 22 children of age 5–11 years were divided into two groups; stone model (SM) (group I; n = 22) and DM (group II; n = 22). Two trained examiners recorded the following parameters of intercanine width, intermolar width, arch perimeter, and arch length on both stone and DMs.
Results: The present study was carried out to check the accuracy of intraoral scanners in establishing dental measurements in mixed dentition. DMs had a significantly higher intermolar width, while the differences between other parameters were found to be nonsignificant (p < 0.05). Also, SMs showed a lower arch perimeter value (p < 0.05).
Conclusion: Intraoral scanners constitute a paradigm change in the evolution of digital dentistry as an effective tool for orthodontic diagnosis and treatment planning. Additionally, intraoral scans have clinically acceptable accuracy, reliability, and reproducibility of the tooth measurements and can be a viable alternative to SMs and calipers for dental arch analysis.
How to cite this article: Pahuja N, Doneria D, Mathur S. Comparative Evaluation of Accuracy of Intraoral Scanners vs Conventional Method in Establishing Dental Measurements in Mixed Dentition. World J Dent 2023;14(5):419–424.
Source of support: Nil
Conflict of interest: None
Keywords: Digital dentistry, Digital pediatric dentistry, Intraoral scanner
INTRODUCTION
With the advents in technology in the field of dentistry, clinicians have the opportunity to render optimum dental care to their patients with an improved dental experience. In the recent decade, many such novel inventions have also emerged in pediatric dentistry to overcome the shortcomings of the existing techniques in dentistry. In order to inculcate a positive dental attitude and to enhance the compliance in children towards dentistry, we need to aim at delivering dental care to child patients in a stress-free and friendly manner.1,2
The intraoral scanner is one of the latest flairs of computer technology, which offers rapid access to three-dimensional (3D) digital dental records by directly scanning the mouth of the patient, thus, facilitating enhanced communication between dentist and patients.3 Various studies in the literature have compared the accuracy and reliability of conventional and digital methods, and it has been shown that the digital impression methods have a similar precision and are also less time-consuming in comparison to the traditional methods. Furthermore, the conventional impression methods have been reported by patients as a disturbing treatment stage because of stimulation of the gag reflex.4,5
Furthermore, the scanners provide more convenient access to study the models. Digital models (DM) eliminate the shortcomings associated with traditional, technique-sensitive, impression-taking. Moreover, no physical space is necessary to store the records, and they facilitate retrieving and sharing information with dental labs and colleagues in multidisciplinary treatments, also contributing to better practice management.
Replacement of plaster mixed dentition models with these new virtual counterparts can benefit pediatric dentists in the following areas—(1) efficacy of having patient records instantly accessible; (2) saving cost of storage space needed for the maintenance of traditional plaster models; (3) exactitude, efficacy, and ease of measurement of tooth and arch sizes; (4) objective rather than subjective model grading analysis from intraoral scanning or scanning of the plaster models for generating digital 3D models, DMs have come to be regarded as a clinically acceptable alternative to traditional plaster models; (5) a pronounced gag reflex may be a potential problem for the acceptance and delivery of dental treatments. Even if there is the availability of a range of management strategies, even simple dental procedures are not accepted by some patients, and (6) interexaminer reliability is greater when doing measurements in DMs as compared to physical plaster models.
Several researchers have assessed the applicability of 3D systems in orthodontics and pediatric treatment planning (such as space maintainers, habit breaker fabrication, and retainers),6 but no study has been conducted to gauge the accuracy of intraoral scanners in establishing dental measurements in mixed dentition.
Therefore, the present study aimed to evaluate the precision, validity, and reliability of 3D software (TRIOS®3 Wireless) in comparison to conventional impression-making techniques in mixed dentition.
MATERIALS AND METHODS
A total of 100 subjects reporting to the Outpatient Department of Pediatric and Preventive Dentistry were assessed for eligibility in the study. An ethical committee clearance was obtained priorly from the institute (ITSCDSR/IIEC/2020–2023/PEDO/04). The study was conducted for a time duration of 1 year and 2 months, from June 2021 to August 2022.
Children with mixed dentition who had no history of undergoing orthodontic treatment were included in the study, whereas patients with any congenital dental anomalies, or fractured, and carious teeth were excluded from the study.
A total of 22 children of age 5–11 years who fulfilled the selection criteria and whose parents gave informed consent were incorporated into the study. All the included individuals had their alginate impressions taken and also underwent intraoral scanning with a Trios 3 wireless intraoral scanner. The study samples were allocated into two groups (n = 22) (Flowchart 1).
Flowchart 1: Study design
Group I—Stone model (SM) (n = 22); measurements done using digital calipers.
Group II—DM (n = 22); measurements done on intraoral scan.
Measurement of Stone Cast and Digital Models
In group I (SM), a digital caliper (Panama Orthodontics Inc. United States of America) was used to record all the measurements, and in group II (DM), the measurements were repeated on DMs using Trios 3 Ortho System software. Two trained examiners who consented to participate in the study recorded the following parameters on stone and DMs (Figs 1 to 3).7
Fig. 1: Arch perimeter and arch length
Fig. 2: Intermolar width and intercanine width
Fig. 3: Stereolithography file postprocessing
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Intercanine width.
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Interfirst molar width.
-
Arch perimeter.
-
Arch length.
The primary examiner measured all the models once using both measurement methods. Replications were separated by 2 weeks (T0—initial and T1—2 weeks) to eliminate any recall bias. The secondary examiner measured all the models once using both measurement methods. Both the examiners were blinded to the identification of models by assigning them a new random number for each measurement series.
Statistical Analysis
All the data obtained was compiled on a Microsoft Office Excel Sheet (version 2019, Microsoft Redmond Campus, Redmond, Washington, United States) and was subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS version 26.0, IBM). Intergroup comparison (two groups) was done using Mann–Whitney U test and intragroup comparison was done using Wilcoxon signed-rank test (up to two observations).
RESULTS
The present study was carried out to check the accuracy of intraoral scanners in establishing dental measurements in mixed dentition. Table 1 and Figure 4 show a comparison of intercanine width, intermolar width, arch length, and arch perimeter between SM and DM. The mean of intermolar width between SM and DM shows a significant difference, that is, DMs have a higher intermolar width, while the differences between other parameters were found to be nonsignificant (p < 0.05).
| Parameters | Model | Mean (in mm) | Standard deviation | Mean difference | t-value | p-value | Result |
|---|---|---|---|---|---|---|---|
| Intercanine width | SM | 36.25 | 3.04 | 0.04 | 2.012 | 0.057 | Nonsignificant |
| Digital model | 36.21 | 3.07 | |||||
| Intermolar width | SM | 48.25 | 3.78 | 0.06 | 2.806 | 0.011 | Significant |
| Digital model | 48.31 | 3.77 | |||||
| Arch length | SM | 71.65 | 3.54 | 0.27 | 1.429 | 0.168 | Nonsignificant |
| Digital model | 71.38 | 3.48 | |||||
| Arch perimeter | SM | 81.95 | 3.97 | 0.05 | 1.011 | 0.324 | Nonsignificant |
| Digital model | 82.00 | 3.94 |
Statistical analysis, paired t-test; statistically significant if p < 0.05
Fig. 4: Stereolithography file postprocessing
Table 2 intercanine width, intermolar width, arch length, and arch perimeter between SM and DM by the second examiner. The mean of arch perimeter between SM and DM showed a significant difference, that is, SM had a lower arch perimeter (p < 0.05).
| Parameters | Model | Mean (in mm) | Standard deviation | Mean difference | t-value | p-value | Result |
|---|---|---|---|---|---|---|---|
| Intercanine width | SM | 36.30 | 3.03 | 0.09 | 2.018 | 0.057 | Nonsignificant |
| DM | 36.21 | 3.07 | |||||
| Intermolar width | SM | 48.27 | 3.81 | 0.04 | 1.283 | 0.213 | Nonsignificant |
| DM | 48.31 | 3.77 | |||||
| Arch length | SM | 71.72 | 3.54 | 0.35 | 1.718 | 0.100 | Nonsignificant |
| DM | 71.38 | 3.48 | |||||
| Arch perimeter | SM | 81.90 | 4.03 | -0.10 | 2.438 | 0.024 | Significant |
| DM | 82.00 | 3.94 |
Statistical analysis, paired t-test; statistically significant if p < 0.05
DISCUSSION
The advancements in technology have benefited every aspect of modern life; it also had a positive impact on the field of pediatric dentistry. The emergence of 3D systems has enabled the diagnostic phase in orthodontics and pediatric dentistry to be quick and efficient, with the primary aim being to replace the conventional medical record method with a digital format.8,9
Even though the application of conventional alginate impression techniques and calipers has been a gold standard for diagnosis and treatment planning in dentistry, they have the disadvantages such as their size, risk of loss or fracture, and difficulties during the fabrication of models. In addition, they are often a cumbersome clinical procedure while managing a pediatric dental patient due to increased gag reflexes and discernible taste. Murugesan and Sivakumar10 reported more gag reflexes with alginate impression whilst also making the mouth dry.
Therefore, the use of digital measurements is an excellent alternative for pediatric dentists for the evaluation of pre- and posttreatment occlusion. Digital record storage has several advantages, like easy access, the need for less physical space, including the feasibility of storage, retrieval of information, ease of transfer, and potentially equal or better diagnostic capabilities along with instant consultation. In 2017, Mangano et al.,11 observed that the digital impression technique resulted in being slightly faster in terms of time taken and hence concluded that the digital impression technique was the most preferred and accepted technique by patients (p < 0.001).
In the present study, the interexaminer reliability analysis demonstrates excellent results signifying that the measurements were accurately reproduced by both examiners for stone and digital measurements. These results for reliability are in accordance with a study done by Naidu and Freer12 and Wiranto et al.,13 who also found high reproducibility for both methods. The results of a study by Schirmer UR and Wiltshire WA14 who examined the difference between manual and computer-aided space analysis by measuring mesiodistal widths of teeth using a vernier gauge were found to be highly accurate between two examiners.
The mean comparison of intercanine width between SM and DMs by examiner one (Fig. 4) and examiner two (Fig. 5) was found to be statistically nonsignificant. Similar results were shown in a study conducted by Çayönü et al.,15 in 2019, where there was no statistical significance between the plaster and digital dental models when intercanine width was assessed.
Fig. 5: Mean comparison of different parameters between SM and digital mode
The mean comparison of intermolar width between SM and DM showed a statistically significant difference for examiner one in Figure 4 and nonsignificant results for examiner two in Figure 5. These results could be attributed to the delicate contact points on the digital images compared to the bulky caliper on the stone casts. In addition, the differences noted between the analog and digital measurements of intermolar distance might be a function of the long distance to be measured. Another reason that can influence the difference in intermolar width can be that in the present study, we took an age group of 5–11 years in which jaw sizes are different, which can be a factor. Furthermore, children tend to be unstable and show abrupt movements while scanning, which can lead to distortion in the images, and the algorithm fixes it with software, which could result in differences in intermolar width. A study conducted by Schieffer et al.,16 compared differences in intermolar width measurements and showed similar results.
The mean comparison of arch length between stone and DMs, as seen in Table 1 for examiner one and Table 2 for examiner two, depicts nonsignificant results for both examiners. Similarly, Leifert et al.,17 found in their study that DMs were clinically acceptable and repeatable when compared to traditional models, despite having minor differences in the measurements of mesiodistal tooth width and arch length on DMs.
The difference between the mean arch perimeter of SM and DM is statistically significant for examiner two, as illustrated in Table 2 and Figure 5 and nonsignificant for examiner one as represented in Table 1 and Figure 4, respectively. This minute difference in readings may be attributed to the variability in identifying landmarks, as proposed by Houston.18 Also, the ability of software to magnify the scanned models on the screen to identify landmarks is better.19 Moreover, the movement of the hands during the procedure of measurements and the weight of the models may have an impact on the precision of the conventional measurements.20
A larger mean value for DM was found in the present study for intermolar width and arch perimeter in Table 1 and Table 2. Possible reasons for the difference between the stone and digital could be due to the absence of a physical barrier to the placement of measurement points with DMs and the difficulty in scanning contact points with the scanner that often results in small amounts of missing data, which is interpolated by a computer algorithm. The above is in congruence with the findings reported by Santoro et al.,21 Taneva et al.,22 who concluded that the digital measurements were larger than the manual measurements and the mean differences were statistically significant but fell within a small range from 0.16 to 0.49 mm.
CONCLUSION
Intraoral scanners constitute a paradigm change in the evolution of digital dentistry as an effective tool for planning and follow-up of cases, reduced chair time, virtual accessibility, and without the gag. They also offer easy and fast electronic transfer of data, immediate access, and reduced storage space requirements. Intraoral scanners provide the pediatric dentist with numerous applications, such as measurements of arch width and length, tooth size, transverse dimensions, Bolton’s discrepancy, overjet, and overbite, which are obtained with remarkable accuracy and efficiency. In conclusion, intraoral scans have clinically acceptable accuracy, reliability, and reproducibility of the tooth measurements, and can be a viable alternative to SMs and calipers for dental arch analysis. Further studies should aim at evaluating patients’ comfort while using intraoral scanners and also the operator time required for intraoral scans and for measurements on digital study models.
ORCID
Naman Pahuja https://orcid.org/0000-0003-3293-9322
Divya Doneria https://orcid.org/0000-0001-8523-9245
Shivani Mathur https://orcid.org/0000-0002-9339-9748
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