DENTAL TECHNIQUE

Additively manufactured scan body for transferring a virtual

3-dimensional representation to a digital articulator for
completely edentulous patients
Marcelo Gabriel Pérez-Giugovaz, DDS,a Delaram Mostafavi, DDS,b and Marta Revilla-León, DDS, MSDc

Fabricating a 3-dimensional ABSTRACT

(3D) virtual patient involves a A technique is described for obtaining a virtual 3-dimensional representation of completely
digital visualization of the pa- edentulous patients with the virtual definitive casts mounted on the virtual articulator. An
tient. Typically, this requires additively manufactured intraoral scan body was developed to record the definitive maxillary
the integration of digital and mandibular casts and gothic arch interocclusal registration. The intraoral scan body guided
maxillary and mandibular casts the integration of the digital definitive casts and facial scans to obtain the virtual 3-dimensional
and facial scans with or patient’s representation and facilitated the transfer of the definitive casts to the virtual
articulator. (J Prosthet Dent 2022;128:1171-8)
without aligning cone beam
computed tomography (CBCT)
data, as not all the prosthodontic treatments necessitate a authors are unaware of a report describing the integra-
CBCT scan.1-3 However, a complete virtual patient rep- tion of digital maxillary and mandibular definitive casts
resentation also comprises dynamic mandibular move- with facial scans to obtain a 3D virtual representation of a
ments simulated in a virtual articulator.1 completely edentulous patient and transfer them to a
Various techniques have been described to obtain the virtual articulator.
digital casts mounted on a virtual articulator by The intraoral digital scanning accuracy of completely
combining conventional and digital procedures or by edentulous arches has been evaluated in different
performing different digitizing procedures to mount the in vitro34-36 and clinical studies.37-40 However, there is a
4-8
digital casts directly onto the virtual articulator. Simi- lack of agreement regarding the clinically acceptable ac-
larly, digital approaches have been described to record curacy of intraoral digital scans in completely edentulous
the patient’s mandibular movement into computer-aided arches.41 Diverse techniques have been described to
design (CAD) software programs for the fabrication of digitize conventional impressions of edentulous arches
dental prostheses.9-25 indirectly.42-45
Different methods for obtaining a virtual patient have The present article describes a technique to acquire a
been reported by aligning intraoral digital scans or digi- virtual 3D representation of a completely edentulous
tized conventional stone casts, facial scans, and CBCT patient with the virtual definitive casts mounted on the
scans.26-30 When a CBCT scan is not required, scan virtual articulator. An additively manufactured intraoral
bodies have been used to guide the superimposition scan body was used to record the definitive maxillary and
methods of the patient’s digital data.31-33 However, the mandibular casts and gothic arch interocclusal

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
a
Director Graduate in Digital Dentistry, Catholic University of Córdoba, Córdoba, Argentina; and Director Centro de Capacitación CAD3D, City Bell-La Plata, Buenos Aires,
Argentina; and Private practice, Buenos Aires, Argentina.
b
Private practice, Dallas, Texas.
c
Assistant Professor and Assistant Program Director AEGD Residency, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, Texas; and
Affiliate Faculty Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; and Researcher at Revilla
Research Center, Madrid, Spain.

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Kerr Corp) followed by a polyvinyl siloxane

impression (President Regular Body; Coltène).
Subsequently, verify the maxillary occlusion rim
display at rest, occlusal plane, lip support, and
facial midline location. If changes are needed,
modify the maxillary occlusion rim as needed by
using adding autopolymerization acrylic resin
(Triad TranSheet VLC; Dentsply Sirona) or by
trimming the occlusion rim with a trimmer (Model
Trimmer Wet; Whip Mix Corp). Then, without
removing the maxillary impression, obtain a face-
bow record (Bioart 7 Plus Elite Facebow; Bio-Art)
(Fig. 6) and a facial scan with the patient in rest
and smile position by using a facial scanner (Bellus
Figure 1. Intraoral digital scan. Face Camera Pro; Bellus) according to the manu-
facturer’s recommendation.
registration. In addition, the intraoral scan body guided
Similarly, clinically evaluate the mandibular custom
the alignment of the digital definitive casts and facial
tray and occlusion rim. Obtain a mandibular impression
scans to obtain the virtual patient and facilitate the
of the edentulous arch by using the same technique as
transfer of the definitive casts to the virtual articulator.
described for the maxillary arch. Verify the position and
vertical dimension of the mandibular occlusion rim and
TECHNIQUE
modify as needed by using the same methods as
described for the maxillary custom tray and occlusion rim.
1. During the first clinical appointment, obtain an
Finally, with the gothic arch tracer, obtain an inter-
intraoral digital scan by using an intraoral scanner
occlusal registration.
(3600 CS; Carestream) as perthe scanning protocol
Position the additively manufactured intraoral scan
endorsed by the manufacturer under the optimal
body into the maxillary occlusion rim and splint them
ambient light illuminance conditions (Fig. 1).46,47
by using an autopolymerization acrylic resin material
Export the standard tessellation language (STL1)
(PERM Resin; Coltène) (Fig. 7A). Without removing the
file.
intraoral scan body, record another facial scan with the
2. Import the STL1 files into a CAD software program
same facial scanner according to the manufacturer’s
(MeshMixer; Autodesk). Use the software tools to
recommendations. Then, remove the devices from the
design maxillary and mandibular custom trays and
mouth.
occlusion rims (Fig. 2).48 Provide the conventional
dimensions of the maxillary and mandibular occlu- 5. Digitize the additively manufactured maxillary and
sion rims.48 Subsequently, add a gothic arch tracer mandibular impressions and occlusion rims with the
on the virtual design of the maxillary and mandib- attached intraoral scan body and a laboratory
ular occlusion rims (Fig. 3). Export the STL2 files of scanner (Open Technologies Small; Faro) as per the
the virtual designs. protocol recommended by the manufacturer
3. Import the virtual design of the maxillary and (Fig. 7B). Export the STL3 files.
mandibular occlusion rims (STL2 files) and the vir- 6. Import the STL3 files into a CAD software program
tual design intraoral scan body49 into the printer (Dental CAD Plovdiv; exocad GmbH). Obtain the
software program (ChiTuBox V1.7.0; ChiTuBox). maxillary and mandibular definitive casts by using
Select the printing parameters recommended by the the intaglio of the digitized impressions and create
manufacturer, based on the vat-polymerization the base for each definitive cast (Fig. 8).
printer (Sonic 4K 3D Printer; Phrozen) and poly- 7. Mount the maxillary occlusion rim on the semi-
mer material (Optiprint Mock-up B1; Dentona) adjustable articulator by using the facebow record
selected. Manufacture the devices and follow the (Bioart 7 Plus; Bio-Art) and autopolymerization
postprocessing procedures endorsed by the manu- acrylic resin material (Fig. 9A). Digitize the maxillary
facturer (Figs. 4, 5).50 mounted occlusion rim with the same laboratory
4. During the second clinical appointment, clinically scanner (Fig. 9B,C). Export the STL4 files.
evaluate the maxillary custom tray and occlusion 8. Import the STL4 files into the same CAD software
rim. Obtain a maxillary impression of the edentu- program. Align the digitized maxillary mounting
lous arch using green modeling plastic impression plate with the virtual mounting plate of the
compound material (Impression Compound Sticks; articulator by using the tools of the program.

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Figure 2. Virtual design of maxillary custom tray and occlusion rim. A, Selection of surface area of custom tray. B, Digital design of custom tray. C,
Selection of surface area of maxillary occlusion rim. D, Finalized virtual design of maxillary custom tray and occlusion rim.

Figure 3. A, Virtual design of gothic arch tracer. B, Virtual design on maxillary and mandibular occlusion rims with gothic arch tracer.

Align the mounted maxillary occlusion rim with
the digitized maxillary occlusion rim. Then, align
the mandibular occlusion rim with the intraoral
scan body (Fig. 10).
9. Import the facial scans into the treatment of the
software program and align with the intraoral scan
body by using the technique described
previously.31,33 Then, obtain the virtual 3D patient’s
representation with the definitive casts mounted on
the virtual articulator (Fig. 11).
The virtual patient was used to design denture trials
arrangement which was additively manufactured and
evaluated in the patient’s mouth. After confirming the

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1174 Volume 128 Issue 6

Figure 4. A, Digital design of intraoral scan body. B, Additively manufactured intraoral scan body.

Figure 5. A, Printer software program with digital design of maxillary and mandibular tray and occlusion rim with gothic tracer positioned on build
platform. B, Additively manufactured mandibular tray and occlusion rim with gothic tracer before removal of supportive structures. C, Additively
manufactured mandibular trays and occlusion rims with gothic tracer after postprocessing procedures.

tooth position, the trial dentures were processed by using

a compression-molding technique with gypsum molds
(Fig. 12).

DISCUSSION
The described technique involves 2 main procedures,
the data acquisition and patient data alignment using a
CAD software program. The clinical data collection
methods included the indirect digitalization of the
maxillary and mandibular edentulous arches by using
additively manufactured custom trays and occlusion
rims and the maxillary and mandibular interocclusal
registration with an additively manufactured gothic arch
tracer, facebow record, and facial scanning processes. Figure 6. Facebow record using additively manufactured custom tray
The data processing obtained the virtual definitive casts and occlusion rim.
mounted on the virtual articulator and the integration of
the patient’s facial scans into the virtual patient.
The virtual patient visualization facilitated the tooth cloud for future needs, such as fabricating a new com-
arrangement procedures, which were additively manu- plete denture. In addition, the virtual tooth arrangement
factured and clinically evaluated. The virtual planning can be used for different procedures such as static
facilitated the tooth library selection, tooth shape and implant surgical planning.
size modification, and straightforward custom charac- In the present technique, a conventional impression
terization of the denture waxing and festooning. In of both maxillary and mandibular edentulous arches was
addition, the virtual data and design can be stored in the acquired. The indirect digitalization of both impressions

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December 2022 1175

Figure 7. A, Additively manufactured intraoral scan body with maxillary and mandibular impressions, occlusion rims, and gothic tracer registration. B,
Digitized intraoral scan body with maxillary and mandibular impressions, occlusion rims, and gothic tracer registration. C, Digitized maxillary occlusion
rim. D, Digitized mandibular occlusion rim.

Figure 8. A, Intaglio of digitized maxillary impression. B, Virtual maxillary definitive cast. C. Base of virtual maxillary definitive cast.

Figure 9. A, Maxillary occlusion rim mounted on conventional semiadjustable articulator by using facebow record. B, Maxillary occlusion rim mounted
on conventional articulator C, Digitized mounted maxillary occlusion rim.

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Figure 10. A, Aligned digitized maxillary mounting plate with virtual mounted base of articulator using computer-aided design tools of software
program. B, Alignment between maxillary occlusion rim and intraoral scan body. C, Mandibular occlusion rim aligned to intraoral scan body.

Figure 11. A, Reference facial scan alignment with intraoral scan body. B, Facial scan with additively maxillary occlusion rim alignment with intraoral
scan body. C, Virtual 3D representation of completely edentulous patient mounted on digital articulator.

Figure 12. A, Maxillary and mandibular trial denture designs. B, Maxillary and mandibular complete dentures delivered.

obtained the virtual definitive casts from which the
denture trial was designed. This method has been pre-
viously described42-45; however, additional studies are
recommended to further evaluate the accuracy of the
indirect digitalization methods.
Additive manufacturing technologies assisted the
fabrication of the different devices used, such as custom
trays and occlusion rims, the gothic arch tracer, or the
intraoral scan body. The selection printing parameters
and the execution of the postprocessing procedures
may impact the accuracy of the devices50,51; however, in
the present technique, the accuracy of the custom tray
and occlusion rims and intraoral scan body is not
critical.
The technique described requires not only the un-
derstanding and handling of the digital capturing de-
vices but also knowledge of the CAD software program.
Although the technique might seem complex, the con-
ventional concepts remain. Undoubtedly, the incorpo-
ration of digital technologies requires the adaptation of
patient data collection methods and virtual data inte-
gration, which might need specific training. However,
the accuracy of the described technique should be
evaluated.

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December 2022
SUMMARY
This article describes a technique to obtain a virtual 3D
representation of completely edentulous patients with
the virtual definitive casts mounted on the virtual artic-
ulator. Additively manufactured custom trays and oc-
clusion rims, gothic arch tracer, and intraoral scan bodies
were used to record and integrate patient data.
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