RESEARCH AND EDUCATION

Accuracy of complete-arch model using an intraoral

video scanner: An in vitro study
Il-Do Jeong, PhD,a Jae-Jun Lee, MSc,b Jin-Hun Jeon, MSc, PhD,c Ji-Hwan Kim, MPH, PhD,d
Hae-Young Kim, DDS, PhD,e and Woong-Chul Kim, MPH, PhDf

During the fabrication of dental ABSTRACT

restorations using a computer-
aided design and computer-
aided manufacturing (CAD/
CAM) system, a definitive cast
is often digitized from a con-
ventional impression.1 Errors
inevitably occur when obtain-
ing the impression, creating
the cast, and digitizing with a
laboratory scanner and are
caused by the impression
materials used, expansion and
shrinkage of the gypsum cast,
and impression distortion. 2,3
Intraoral scanning systems
provide an alternative to the
use of conventional impres-
sions, stone casts, and labora-
tory digitization. Intraoral
scanning systems could reduce
errors more effectively than
scanning casts in the labora-
tory.4 However, errors caused
by a number of variables will still be reflected in the data
from intraoral scanning systems. Thus, to replace con-
ventional impressions with models generated using
Statement of problem. Information on the accuracy of intraoral video scanners for long-span areas
is limited.
Purpose. The purpose of this in vitro study was to evaluate and compare the trueness and precision
of an intraoral video scanner, an intraoral still image scanner, and a blue-light scanner for the
production of digital impressions.
Material and methods. Reference scan data were obtained by scanning a complete-arch model.
An identical model was scanned 8 times using an intraoral video scanner (CEREC Omnicam;
Sirona) and an intraoral still image scanner (CEREC Bluecam; Sirona), and stone casts made from
conventional impressions of the same model were scanned 8 times with a blue-light scanner as
a control (Identica Blue; Medit). Accuracy consists of trueness (the extent to which the scan data
differ from the reference scan) and precision (the similarity of the data from multiple scans). To
evaluate precision, 8 scans were superimposed using 3-dimensional analysis software; the
reference scan data were then superimposed to determine the trueness. Differences were
analyzed using 1-way ANOVA and post hoc Tukey HSD tests (a=.05).
Results. Trueness in the video scanner group was not significantly different from that in the control
group. However, the video scanner group showed significantly lower values than those of the still
image scanner group for all variables (P<.05), except in tolerance range. The root mean square,
standard deviations, and mean negative precision values for the video scanner group were
significantly higher than those for the other groups (P<.05).
Conclusions. Digital impressions obtained by the intraoral video scanner showed better accuracy
for long-span areas than those captured by the still image scanner. However, the video scanner was
less accurate than the laboratory scanner. (J Prosthet Dent 2015;-:---)
intraoral scanning systems, the accuracy of the scanner
should exceed that of the conventional impression.4 In
addition, unlike the conventional method, with which a

Supported by a Korea University grant.

a
Doctoral student, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, Republic of Korea.
b
Master student, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, Republic of Korea.
c
Doctoral student, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, Republic of Korea.
d
Professor, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, Republic of Korea.
e
Associate Professor, Department of Dental Laboratory Science and Engineering, College of Health Science & Department of Public Health Sciences,
Graduate School & BK21PLUS Program in Public Health Sciences, Korea University, Seoul, Republic of Korea.
f
Professor, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, Republic of Korea.

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2 Volume
Clinical Implications
Compared with intraoral still image scanning,
intraoral video scanning allowed the digitization of
a complete dental arch; however, this technique
could not completely replace the method of
scanning a cast derived from a conventional
impression.
wide range of impressions can be obtained, the narrow
range of intraoral scanners needs to be broadened.5,6
Recently, an intraoral video scanner (CEREC Omni-
cam; Sirona) has been introduced. This system is rec-
ommended for wide-range scanning because it creates a
3-dimensional (3D) model through continuous data
acquisition. However, few studies have evaluated the
accuracy of digital impressions of the complete arch
captured using this intraoral video scanner.7
Studies on the accuracy of intraoral scanners have
used 3D comparative analysis.4-6,8-12 In these studies,
systematic errors were quantified to determine the true-
ness, and random errors were quantified to determine
the precision.13,14 Thus, the accuracy of a scanner is
the combination of trueness, that is, the extent to
which the measurements differ from those of the refer-
ence model, and precision, that is, the similarity between
measurements.13,14
The purpose of this in vitro study was to evaluate the
accuracy of the digital impressions of a complete-arch
model obtained with the intraoral video scanner and to
compare them with those obtained with an intraoral still
image scanner (CEREC Bluecam; Sirona) and a labora-
tory scan (Identica Blue; Medit) of a cast from a con-
ventional impression. The null hypothesis was that no
significant difference would be found in the trueness or
precision of the digital impressions obtained using the
intraoral video scanner, intraoral still image scanner, and
blue-light scanner.
MATERIAL AND METHODS
A reference model (ANKA-4 V CER; Frasaco) that did
not require a light powder coating for use with the
intraoral still image scanner (CEREC Bluecam; Sirona)
was chosen for this study. By using 2 cameras set
asymmetrically at 10 degrees, 20 degrees, and 30 degrees,
accurate data could be collected for areas that were
difficult to measure, and a reference scan was obtained
using a high-precision optical scanner with an accuracy
of 7 mm (SmartSCAN R5; Breuckmann GmbH).
Two types of intraoral scanner systems were used
(CEREC Omnicam and CEREC Bluecam; Sirona). In
compliance with ISO-12836, each scanner was main-
tained at an ambient temperature of 23 ±2
C.
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Experienced staff carried out 8 scans on each system in
accordance with the manufacturer’s recommended
scanning protocols. The data obtained were converted to
the stereolithography (STL) file format for 3D analysis
using the manufacturer’s certified software (CEREC
Connect Software 4.3; Sirona).
Heavy-body and light-body impression materials
(Aquasil Ultra XLV and Rigid; Dentsply Caulk) were
placed into a metal stock tray to obtain 8 impressions of
the reference model. These impressions were obtained in
a temperature-controlled room at 35 ±1
C to reproduce
the intraoral temperature when the mouth is open15 and
were allowed to polymerize for the duration recom-
mended by the manufacturer. Wetting agent was spread
and dried on the inside of the obtained impressions to
increase the quality of the stone casts. Subsequently,
Type IV stone (CAM-Stone N; Siladent) was poured into
the impression, which was then hardened in a pressure
pot for 45 minutes under a pressure of 200 kPa. After 48
hours at room temperature, the cast was scanned with a
blue-light scanner (Identica Blue; Medit) and 3D software
(IdenticaBlue V1.2; Medit) to obtain the STL files.
All acquired data were exported to 3D analysis soft-
ware (Geomagic Verify 2015; Geomagic GmbH). Data
approximately 1 mm from the gingival margin to the
gingival groove were defined as the border of each image,
and the remaining scan data, except that of the teeth,
were removed. Trueness was calculated by overlapping
all of the data from each group with the reference data
(n=8), and precision was obtained based on the overlap
of the data within each group (n=28). The spectrum was
set for 20 color segments, with each color depicting the
tolerance values. The max/min nominal values were set
to ±50 mm, and the max/min critical values were set to
±500 mm. The data obtained in the analysis included the
standard deviations (SD), mean positive/negative values
(±AVG), tolerance range values, and root mean square
(RMS) values. The RMS values were calculated using the
following equation:
sffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
1 X n  2
RMS = pffiffiffiffi $ x1;i − x2;i ;
n i=1
where x1;i is the measurement point of i of the reference,
x2;i is the measurement point of i of the data set, and n is
the total number of points to be measured in each
analysis.
A statistical power analysis was performed to deter-
mine the number of specimens required in each group.
With an effect size of 1.0, a=.05, and a power of .80, the
calculations revealed that 8 specimens per group would
be needed to detect the postulated effect size.
All of the obtained values were analyzed using software
(IBM SPSS Statistics v21.0; IBM Corp). The Shapiro-Wilk
test was used to examine the normal distribution of each
Jeong et al
- 2015 3

Table 1. Trueness of 2 different types of intraoral scan and laboratory Table 2. Precision of 2 different types of intraoral scan and laboratory
scan of complete dental arch scan of complete dental arch
Intraoral Video Intraoral Still Laboratory Intraoral Video Intraoral Still Laboratory
Scanner Image Scanner Scanner Scanner Image Scanner Scanner
Variable (mean ±SD) (mean ±SD) (mean ±SD) P Variable (mean ±SD) (Mean ±SD) (mean ±SD) P
RMS (mm) 197 ±4a 378 ±11b 170 ±12a <.05 RMS (mm) 58 ±13a 116 ±28b 78 ±15c <.05
SD (mm) 195 ±4a 375 ±14b 165 ±12a <.05 SD (mm) 57 ±13a 115 ±28b 78 ±14c <.05
+AVG (mm) 114 ±6a 211 ±16b 81 ±15a <.05 +AVG (mm) 37 ±10a 65 ±19b 43 ±10a <.05
−AVG (mm) 83 ±5a 151 ±9b 82 ±8a <.05 −AVG (mm) 42 ±11a 63 ±15b 51 ±13c <.05
Tolerance (%) 52 ±4a 53 ±8a 42 ±14a <.05 Tolerance (%) 73 ±13a 64 ±14a 70 ±13a <.05

Means in row with different superscript letters indicate significant difference (P<.05) by *Means in row with different superscript letters indicate significant difference (P<.05) by
ANOVA and Tukey HSD post hoc test. ANOVA and Tukey HSD post hoc test.

Figure 1. Three-dimensional deviations between scan data and reference data. A, Trueness. B, Within each test group, precision.

value. The Levene test was used to assess the equality of RESULTS
variance, and, according to the result, the differences be-
A comparison of the trueness and precision of each
tween the test groups were analyzed using 1-way ANOVA
scanner is shown in Tables 1, 2. With regard to trueness,
and post hoc Tukey HSD tests (a=.05).
the intraoral video scanner and blue-light scanner groups

Jeong et al THE JOURNAL OF PROSTHETIC DENTISTRY

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were significantly different from the intraoral still image

scanner group for all values except the tolerance range
values; no statistically significant differences were found
between the intraoral video scanner and blue-light
scanner groups (P>.05). With regard to precision, the
intraoral video scanner and blue-light scanner groups
showed significantly different +AVG values from the
intraoral still image scanner group. The RMS, SD,
and −AVG values were significantly different in each of
the 3 groups (P<.05). However, no statistically significant
differences were found in the tolerance range values
among the groups (P>.05).
Fig. 1A indicates that the intraoral video scanner and
blue-light scanner groups showed deviation at the labial
surface of the anterior teeth and the buccal surface of the
posterior teeth; this deviation was particularly pro-
nounced at the occlusal surface of the first and second
molars. The intraoral still image scanner group also
showed deviation at the labial surface of the anterior
teeth and the buccal surface of the posterior teeth. Fig. 1B
indicates that all of the 3 groups showed deviation at the
labial surface of the anterior teeth and the occlusal sur-
face of the second molar; in particular, the intraoral still
image scanner group showed pronounced deviation at
the right maxillary second molar, and the blue-light
scanner group showed a small amount of deviation in
many parts of the model. Lastly, the maximum and
minimum gap distance values were calculated at the
contact part of each tooth (Fig. 1). Figure 2 shows the
differences in the point sets, not only for the reference
scan data but also for the scan data of each group. The
quantities of the point sets of the reference scan data and Figure 2. Visual differences in quantity of point sets of each
3-dimensional data set.
blue-light scan data were higher than those of the 2
different types of intraoral scan data (Fig. 2).
scanner were significantly different from those obtained
DISCUSSION
with the intraoral still image scanner for all values, with
With regard to measuring the accuracy of the definitive the exception of the tolerance range values. This was
cast created by a conventional impression obtained using because the intraoral still image scanner group had a
impression materials, the most frequently used method high deviation out of the tolerance range and a larger SD
to date has been the line distance with limited points.16,17 than the other 2 groups. In addition, the intraoral still
Recently, the accuracy, (the trueness and precision) of the image scanner group had more tolerance range values at
digital impressions and that of conventional ones has the occlusal surface compared with the other groups
been compared in 3D.4-6,8-12 (Fig. 1A). This was because the characteristics of the
In the current study, a scanner with high precision occlusal surface had a greater effect on image stitching
was used to obtain reference data, and the difference in and the ease of obtaining still images. However, the
the data obtained in each scan from the reference data intraoral video scanner and blue-light scanner groups
(trueness) as well as the difference in the data obtained in showed a similar pattern of deviation.
repeated scans (precision) was measured. The results led The results of the present study indicated that the
to the rejection of the null hypothesis because there were intraoral video scanner showed less random error than
significant differences in trueness and precision between the other scanners, but no statistically significant differ-
the 2 different types of intraoral scanners and a blue-light ence was found in the tolerance range values among the
scanner (P<.05). different scanners tested. Similar to the data for trueness,
The analysis of trueness showed that the results ob- the intraoral still image scanner showed a low level of
tained with the intraoral video scanner and blue-light precision and seemed to be greatly affected by outlier

THE JOURNAL OF PROSTHETIC DENTISTRY Jeong et al

- 2015
values. The tolerance patterns of deviation for all 3
groups showed high deviation at the labial surface of the
anterior teeth and the maxillary second molars, whereas
the blue-light scanner showed a small amount of devi-
ation in many parts of the model, without a definitive
pattern. This seemed to result from the overall random
error of the blue-light scanner, which would have
occurred in the workflow from a conventional impression
to a stone cast to a laboratory scan. Therefore, analyses
of the trueness and precision in this study showed that
the Omnicam was not significantly more accurate than
the laboratory scan; hence, our data do not support the
concept that intraoral video scanners can replace labo-
ratory scanning.
Although the quantities of the point sets of the
intraoral scanners were significantly less than those of
the blue-light scanner (Fig. 2), no significant difference in
trueness was found between the intraoral video scanner
and blue-light scanner data. This may have been because
the exact position of the point set affected the accuracy
more than the quantity of the point set.
The main limitation of this in vitro study is that the
effects of intraoral environmental factors were excluded.
Future research evaluating and comparing specimens
containing prepared teeth would be useful to investigate
accuracy in the clinical setting.
CONCLUSIONS
Within the limitations of the current study, the following
conclusions may be drawn. Digital impressions obtained
by the Omnicam intraoral video scanner were more ac-
curate than those obtained by the Bluecam intraoral still
image scanner and had the advantage of covering long-
span areas.
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Corresponding author:
Dr Woong-Chul Kim
Department of Dental Laboratory Science and Engineering
College of Health Science, Korea University
Anam-dong 5-ga, Seongbuk-gu, Seoul 136-072
Republic of Korea
Email: kuc2842@korea.ac.kr
Acknowledgments
The authors thank Seung-Jin Kang, who helped to record the data.
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
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