# Influence of scan body design and digital implant analogs on implant replica position in additively manufactured casts

Revilla-León, Marta; Fogarty, Rachel; Barrington, Jennifer J; Zandinejad, Amirali; Özcan, Mutlu (2020). Influence of scan body design and digital implant analogs on implant replica position in additively manufactured casts. Journal of Prosthetic Dentistry, 124(2):202-210.

## Abstract

STATEMENT OF PROBLEM
Additive manufacturing (AM) technologies can be used to fabricate definitive casts for implant-supported restorations. However, information regarding the accuracy of the implant replica position on the polymeric AM cast generated with different scan bodies and digital implant replica systems is lacking.
PURPOSE
The purpose of this in vitro study was to compare with a conventional stone cast the linear and angular discrepancies of the implant analog positions in a polymeric AM cast obtained from 3 different scan body and digital implant replica systems.
MATERIAL AND METHODS
A partially edentulous maxillary typodont with 3 implant replicas (Implant replica RP Branemark system; Nobel Biocare) was prepared. Two duplicating methods were evaluated: conventional (CNV group) and AM (AM group) procedures. For the CNV group, polyvinyl siloxane open-tray implant impressions (CNV) were made at room temperature (23 °C). The AM group was further divided into the subgroups Elos Medtech, Nt-Trading, and Dynamic Abutment. For the Elos Medtech subgroup, the corresponding scan bodies were placed on each implant, and the typodont was digitized by using a laboratory scanner (E3 scanner; 3Shape A/S). The same procedure was repeated with the remaining subgroups. All the AM polymer casts were fabricated at once by using the same 3D printer (Eden 500V; Stratasys). Ten specimens of each group were obtained (n=10). A coordinate-measuring machine (CMM) was used to measure the position of each implant replica, and distortion was calculated for each system at the x-, y-, and z-axes and 3D distortion measurement (3D=x$^{2}$+y$^{2}$+z$^{2}$). The Shapiro-Wilk test revealed that the data were not normally distributed. The Kruskal-Wallis and pairwise Mann-Whitney U tests (α=.05) were used for the analysis.
RESULTS
The CNV group presented significantly higher linear discrepancy than the Dynamic Abutment group on the x- and y-axes. On the z-axis, however, the CNV group showed significantly lower linear discrepancy than the Nt-Trading and Dynamic Abutment groups. The 3D linear discrepancy was 12 ±12 μm for the CNV group, 4 ±100 μm for the Elos Medtech group, 8 ±52 μm for the Nt-Trading group, and 5 ±19 μm for the Dynamic Abutment. The CNV group demonstrated a significantly higher angle than the Nt-Trading group but a significantly smaller angle than the Elos Medtech and Dynamic Abutment groups.
CONCLUSIONS
The AM groups had lower 3D discrepancies than the CNV group. The Dynamic Abutment group had significantly better accuracy for the mesiodistal and buccolingual implant replica positions than the CNV group, but the conventional procedures had significantly better results for the apicocoronal implant replica position. Scan body and digital implant replica design systems only influenced the accuracy of the angular implant replica position on the AM casts.

## Abstract

STATEMENT OF PROBLEM
Additive manufacturing (AM) technologies can be used to fabricate definitive casts for implant-supported restorations. However, information regarding the accuracy of the implant replica position on the polymeric AM cast generated with different scan bodies and digital implant replica systems is lacking.
PURPOSE
The purpose of this in vitro study was to compare with a conventional stone cast the linear and angular discrepancies of the implant analog positions in a polymeric AM cast obtained from 3 different scan body and digital implant replica systems.
MATERIAL AND METHODS
A partially edentulous maxillary typodont with 3 implant replicas (Implant replica RP Branemark system; Nobel Biocare) was prepared. Two duplicating methods were evaluated: conventional (CNV group) and AM (AM group) procedures. For the CNV group, polyvinyl siloxane open-tray implant impressions (CNV) were made at room temperature (23 °C). The AM group was further divided into the subgroups Elos Medtech, Nt-Trading, and Dynamic Abutment. For the Elos Medtech subgroup, the corresponding scan bodies were placed on each implant, and the typodont was digitized by using a laboratory scanner (E3 scanner; 3Shape A/S). The same procedure was repeated with the remaining subgroups. All the AM polymer casts were fabricated at once by using the same 3D printer (Eden 500V; Stratasys). Ten specimens of each group were obtained (n=10). A coordinate-measuring machine (CMM) was used to measure the position of each implant replica, and distortion was calculated for each system at the x-, y-, and z-axes and 3D distortion measurement (3D=x$^{2}$+y$^{2}$+z$^{2}$). The Shapiro-Wilk test revealed that the data were not normally distributed. The Kruskal-Wallis and pairwise Mann-Whitney U tests (α=.05) were used for the analysis.
RESULTS
The CNV group presented significantly higher linear discrepancy than the Dynamic Abutment group on the x- and y-axes. On the z-axis, however, the CNV group showed significantly lower linear discrepancy than the Nt-Trading and Dynamic Abutment groups. The 3D linear discrepancy was 12 ±12 μm for the CNV group, 4 ±100 μm for the Elos Medtech group, 8 ±52 μm for the Nt-Trading group, and 5 ±19 μm for the Dynamic Abutment. The CNV group demonstrated a significantly higher angle than the Nt-Trading group but a significantly smaller angle than the Elos Medtech and Dynamic Abutment groups.
CONCLUSIONS
The AM groups had lower 3D discrepancies than the CNV group. The Dynamic Abutment group had significantly better accuracy for the mesiodistal and buccolingual implant replica positions than the CNV group, but the conventional procedures had significantly better results for the apicocoronal implant replica position. Scan body and digital implant replica design systems only influenced the accuracy of the angular implant replica position on the AM casts.

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