The adoption of digital technology in the dental field is changing many clinical protocols, making cumbersome processes easy and the impossible possible. I believe these are positive changes for easier and more convenient clinical workflows. Digital dentistry begins with the digitization of information needed for treatment, and it is important to convert such data into digital form as accurately as possible. An intraoral scanner can be deemed the most suitable input device for the digital workflow, as it directly and immediately digitizes a patient’s intraoral information including teeth, soft tissue, and occlusal relationship.
Many intraoral scanners are being used clinically as of 2022, and their reliability has increased significantly compared to just a few years ago with the overall rapid advancement in performance. There are reports of digital scanning showing better marginal adaptation compared to convention impressions in the case of single restoration, as well as reports of significant improvement in the error range for complete arch scan data, which tended to fall short in accuracy compared to partial arches. My actual clinical experience is consistent with these findings. I’ve been using Medit’s i500 and i700, and have been getting satisfactory results through digital scanning when restoring natural teeth and implants. (Figures 01-04)
Figure 1. Ceramic inlay by digital impression
Figure 2. Monolithic zirconia crown by digital impression
Figure 3. Implant restoration by digital impression
Figure 4. Monolithic zirconia bridge by digital impression
I had the opportunity to use the recently developed i700 wireless and found it easier to apply intraorally and change scan positions. By sharing the screen of the scanner PC with the chair monitor, I was also able to conveniently move the scanner and scan without having to drag a scanner cart. I had no issue applying the i700 wireless to my clinical practice because there was no difference in scan data quality or FPS compared to the wired device (Figure 05). I think will use the i700 wireless more often in the future.
Figure 5. Monolithic zirconia bridge by digital impression
An intraoral scanner is a device attractive enough as an alternative to conventional impressions, but its greater advantage is the possibility of clinical expansion through scan data. My preferred clinical protocol is to digitally create temporary restorations. Intraoral scanning immediately creates a digital model, enabling chairside digital workflow for provisional restorations. After preparations for zirconia crowns and intraoral scanning, I design crowns using a CAD program and create 3D-printed or PMMA milled temporary restorations. (Figures 06, 07)
Figure 6. Single temporary crown by 3D printing
Figure 7. Temporary bridge by 3D printing
A CAD program is required to design the desired shape of restorations. In cases in which the shape of the original tooth before preparation can be used to create a temporary restoration, the Medit Temporaries App can be used to very simply design an eggshell temporary in the shape of the tooth before prep or design a temporary restoration to fit the margin in the shape of a pre-prepared tooth after scanning. (Figures 08,09)
Figure 8. Eggshell temporary design with Medit Temporaries
Figure 9. Temporary restoration with Medit Temporaries
Digital production of temporary restorations is not only better than the analog method for efficient clinic management. Temporary restorations can also be reprinted any time. When a temporary tooth breaks during use, as in Figure 09, it would have to be remade from scratch and require a lot of time and effort. However, the digital workflow easily solves this matter by reprinting temporaries when necessary. (Figure 10)
Copying dentures using intraoral scanners can also be a good protocol. Transferring the patient’s existing denture information to the copy denture significantly simplifies a new denture production process. In the case of Figure 11, we created a copy denture by scanning with an intraoral scanner the temporary denture used by relining the inner surface. It was 3D printed during the soft tissue healing phase after partial denture removal. Because this copy denture contains information of a suitable vertical dimension for the patient and has been border molded through several relining, it can serve as both an individual tray and bite block. By acquiring both impressions and bites using a copy denture, you can gather and deliver the required information to create a final denture at once. This makes denture creation much simpler than the usual production process of a complete denture.
I’ve introduced some clinical applications using the Medit i700, but there are many more advantages of an intraoral scanner, such as preservation of data and better comparison view of oral changes. And intraoral scanner utilization will be significantly expanded through software updates in the future. I believe digital dentistry beginning with intraoral scanners is a flow that one cannot and does not need to go against. I hope you can also experience the convenient and comfortable clinical changes that I have experienced and am experiencing every day through digital dentistry.