DIGITAL DENTAL

TECHNOLOGIES
Comparison of Digital and Conventional
Impressions Based on the 3D Fit of Crowns
Lara Berger, Dr Med Dent
Department of Prosthodontics, Erlangen University Hospital, Erlangen, Germany.

Werner Adler, PD Dr rer biol hum

Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universiät
Erlangen-Nürnberg, Erlangen, Germany.

Meike Maria Katharina Kreuzer, Dr Med Dent

Manfred Wichmann, Prof Dr Med Dent
Ragai-Edward Matta, PD Dr Med Dent
Department of Prosthdontics, Erlangen University Hospital, Erlangen, Germany.

Purpose: To evaluate intraoral scanners, scannable impression materials, and conventional methods for
impression-taking with regard to precision and accuracy. Materials and Methods: Ten impressions per
technique were initially taken from a cobalt-chromium (Co-Cr) master model (chamfer preparation for the
maxillary right first molar) for fabricating Co-Cr crown copings. The test specimens, their respective metal
master model, and the plaster casts from the conventional impressions were then digitized with the light-
optical Atos Triple Scanner. The fit of the dental crown copings was measured in two and three dimensions
using computer-aided design software. Global differences between the methods were determined using
Kruskal-Wallis test, and pairwise comparisons were performed with Mann-Whitney U test. The significance
level was set at .05. Results: The 2D analysis showed that the average absolute marginal distance of the
crown copings was 0.026 mm when fabricated with the digital impression method and 0.038 mm when
fabricated with the conventional method (P = .028). However, the 3D analysis revealed that the conventional
group had a smaller marginal gap (0.028 mm) compared to the digital group (0.06 mm; P = .015). Conclusion:
This study showed that, in the field of single-crown prosthetics, digital impressions and the use of scannable
impression material could serve as alternatives to conventional methods in the future. Int J Prosthodont
2022;35:801–808. doi: 10.11607/ijp.7652

A
crucial prerequisite for the fabrication of prosthetic dentures by a dental techni-
cian is the replication of a patient’s intraoral structure for transfer to the dental
laboratory. It is of the utmost importance that all anatomical conditions are
reproduced as accurately and in as much detail as possible because this is the only
way to ensure the production of high-quality, accurately fitting prosthetic restorations.
Historically, conventional impressions were the only option for reproducing the neces- Correspondence to:
Dr Ragai Matta, Department of
sary structures in order to fabricate correctly fitting dentures. However, this technique, Prosthodontics, Erlangen University
as well as the subsequent fabrication of the restoration, are limited by methodologic Hospital , Glueckstrasse 11,
and material errors.1,2 Deficiencies such as expansion, shrinkage, or deformation of 91054, Erlangen Province, Bavaria,
Germany. Fax: 09131 85-36781.
the impression or plaster material cannot be avoided with the available impression Email: ragai.matta@uk-erlangen.de
materials or trays.3 Consequently, in recent years, intensive research has been con-
ducted with the aim of discovering an alternative approach that could reproduce all Submitted March 5, 2021;
accepted February 11, 2022.
relevant anatomical features of the patient’s oral cavity in at least equivalent detail ©2022 by Quintessence
to that achieved with conventional impressions. Publishing Co Inc.

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 Digital Dental Technologies
Fig 1   Metal master model (patient model) with an individual tray
placed on the construction guide for standardization of the impres-
sion procedure.
Recent advances and innovative technologies have
made it possible to make digital impressions with scan-
nable impression materials and a light-optical 3D scan-
ner.4 This approach eliminates the need to fabricate a
plaster master model, thus avoiding a number of poten-
tial sources of error, including the pouring of the plaster
into the impression, the drilling and fixing of pins in the
plaster model, and the sawing of the model.5
To overcome further potential inaccuracies inherent to
conventional technology, the workflow is becoming in-
creasingly digitized.3,6 Various intraoral scanning systems
have become available on the market; in the course of
the present study, the TRIOS system (3Shape), based on
the principles of confocal microscopy, became available
for image acquisition.7 The primary feature of this intra-
oral scanner is that the object to be scanned, the optical
system, and the camera are in defined relationships to
each other. The light source generates an illumination
pattern to produce light oscillation on the object, and it
should be noted that the spatial relationship between the
object and the scanning head always remains constant.
As a result, 2D images are generated at several points on
the focal plane, ultimately producing a large number of
images within a short time.8 Another advantage of this
scanner is the true-color reproduction of the scanned
structures, which makes it easy to distinguish between
the soft tissue and the tooth structure when planning
dental prostheses. In addition, this system offers the
possibility of powder-free scanning, unlike other brands,
which require powdering the object.9
Furthermore, in contrast to the conventional impres-
sion method, the principle of direct intraoral digitization
provides a real-time display of the relevant structures,
which allows for examinations and analyses of the
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preparations directly on the 3D digital model. Finally,
both the fabrication and the insertion of the prosthetic
restoration can be performed in a single session. This
system has numerous other advantages, including the
easy and selective reproducibility of scans, the material
savings, and the ease of use.10 However, its decisive
advantages are twofold: (1) the workflow can be signifi-
cantly shortened; and (2) it is no longer necessary to digi-
tize the impression separately. Consequently, additional
sources of error can be avoided, which ultimately has
a positive effect on the fit of the resulting restoration.9
Only a few studies have compared these three meth-
ods: making impressions from a scannable material; mak-
ing direct intraoral digital impressions with an intraoral
scanner; and making impressions with the conventional
technique, which has been used to date.11 The present
in vitro study aimed to verify and compare the precision
of these three impression approaches. For this purpose,
impressions were taken using the different techniques,
and corresponding crown copings were fabricated with
an identical CAD/CAM process. Subsequently, the inter-
nal fit and accuracy of the margins of the restorations
were assessed with a 3D scanning procedure. The null
hypothesis was that all test specimens manufactured
based on the three impression methods would show
identical accuracies of fit.
MATERIALS AND METHODS
In the first step, a cobalt-chromium (Co-Cr) master model
of a chamfer preparation of the maxillary right first molar
was prepared to fit a single crown. A two-step impres-
sion was initially taken using silicone (AFFINIS Heavy
Body and Light Body, Coltène/Whaledent). The model
body was then laterally fitted with two guide elements
made of Co-Cr for attachment in order to ensure the
same position for all impressions taken. Furthermore,
special individual impression trays designed to maintain
a distance of 5 mm on all sides between the model die
and the tray wall were manufactured. The trays were
also provided with a construction guide so that the im-
pressions could be taken guided and without changing
position (Fig 1).
From the metal master model, 10 digital impressions
were taken with a TRIOS scanner (3Shape), and 20 physi-
cal impressions were taken: 10 with a conventional im-
pression material (AFFINIS Precious Heavy and Light
Body) with the double-mix technique, and 10 with a
scannable material (Identium Medium, Identium Light,
Kettenbach).
The impressions in the conventional group (group A;
AFFINIS Precious) were poured with class IV gypsum
(Fujirock EP Classic super hard plaster, GC). Then, the
resulting plaster master casts were given to the CAD/
CAM milling/manufacturing center (CADfirst, Brautlach,

a b
Fig 2   Correct virtual positioning of the crown copings on the reference models. (a) Reference model alone. (b) Crown coping alone,
scanned from the inside and outside. (c) Virtual superimposition of the crown coping and reference model.
Germany). There, the plaster casts were digitized with a
3D laser scanner (7Series, Dental Wings).
In the scannable material group (group B), a special
elastomeric impression material (Identium Scan) designed
for optical acquisition with the CAD/CAM process was
used with the double-mix technique. Subsequently, the
10 impressions obtained were digitized with an iSeries
3D scanner (Dental Wings). The 3D standard tessellation
language (STL) data were also sent to the milling center
(CADfirst).
In the intraoral digital group (group C), digital impres-
sions were taken with the cara TRIOS intraoral scanner
(3Shape). The optical impression data were converted
into STL data with the software integrated in TRIOS-
Converter (3Shape). The STL data were then also trans-
mitted to the milling center (CADfirst).
Subsequently, for each impression method, 10 Co-Cr
test specimens corresponding to anatomically reduced
crown copings were milled with the CAD/CAM proce-
dure at the milling center (CADfirst) based on the re-
spective STL data. DWOS 4.0.1.29805 software provided
with the Dental Wings 3Series scanner was used during
the design process. The fabricated test specimens were
subsequently subjected to a digitization process with a
noncontact optical scanner (ATOS Triple Scan, GOM).
Since a matte surface is required to avoid reflections
with the optical detection of objects, the metal master
model and the crown copings were previously sand-
blasted with aluminum oxide (Al2O3). To evaluate the
marginal gap, three scans were taken of each specimen
according to Holst et al and Matta et al12,13 to ensure that
the crown copings on the metal master model made of
Co-Cr (groups A to C) and the plaster master casts from
the conventional impressions (control group, group D)
could be correctly positioned on a virtual level (Fig 2).
The manufactured crown copings in group A were ad-
ditionally scanned and measured on the corresponding
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Berger et al
c
plaster casts to investigate the accuracy of the laboratory
scans (group D).
In summary, the groups were defined as follows:
• Group A: Analysis of fit of the crown copings
on the metal master model (ie, patient model)
fabricated on the basis of conventional impressions
and laboratory scans of the plaster casts.
• Group B: Analysis of fit of the crown copings on
the patient model manufactured on the basis of
laboratory scans of the scannable impressions.
• Group C: Analysis of fit of the crown copings
on the patient model produced on the basis of
digital impressions of the model using the intraoral
scanner.
• Group D: Analysis of fit of the crown copings on the
plaster casts (control group) fabricated on the basis
of the laboratory scans of the plaster casts.
The Co-Cr master model and the plaster casts were
equipped with high-contrast reference points at the base
(ATOS, GOM) to facilitate precision during the following
scanning process. The crown copings for the different
impression methods were first scanned individually in a
specially calibrated measuring frame (reference frame,
GOM). Subsequently, the test specimens placed on the
metal master model were scanned. Finally, the crown
copings obtained from the conventional impressions
were positioned on the corresponding plaster casts and
scanned. During this process, each test specimen was
checked by an experienced dentist (R-E.M.) to ensure
that it was correctly positioned on the metal master
model or plaster master cast. Subsequently, the crown
copings were fixed with adhesive wax in order to prevent
position changes during the scanning process.
After digitizing the restorations, ATOS software (ATOS
Professional, GOM) was used to generate STL data.
Volume 35, Number 6, 2022 803
 Digital Dental Technologies
(mm)
0.15
0.12
0.09
0.06
0.03
0.00
–0.03
–0.06
–0.09
–0.12
–0.15
a b
Fig 3    False color illustration of the (a) marginal fit and (b) internal fit of the crown copings. The color scale codes the size (mm) of the gaps
between the test specimens and the reference models.
These data were then aligned with each other three-
dimensionally according to the protocol introduced by
Holst et al.12 This process of superimposition was per-
formed with the local best-fit function, which ensured
that the deviations never exceeded 3 µm. Finally, all STL
data sets were aligned with each other, resulting in the
matched files.
Next, a 3D analysis of the internal and marginal fit
was performed by selecting the inner surface of the
crown copings (actual value) and calculating the devia-
tions from the reference object, which was the metal
master model or one of the plaster casts (target value
or CAD mesh). In addition, the actual mesh was cut on
a curve at a distance of 1 mm in the direction of the
lumen to the inner crown margin, which was located at
the preparation margin. Thus, the marginal and internal
areas were created to determine the marginal and inter-
nal fit. Finally, a surface comparison of these two actual
meshes on the target meshes was carried out to ensure
that all distance measurements, starting from the inner
surface of the crown copings to the die of the metal
master model or plaster casts, could be reproduced at all
points in the corresponding area. Thus, the deviations of
the fabricated test specimens from the reference model
could be calculated. The deviations were displayed in the
program in numeric (tabular) form and also represented
with a false color scale (Fig 3).
In addition to the 3D analysis, a 2D analysis was car-
ried out to assess the edge closure. For this purpose, the
804 The International Journal of Prosthodontics
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(mm)
0.15
0.12
0.09
0.06
0.03
0.00
–0.03
–0.06
–0.09
–0.12
–0.15
virtual complex, consisting of the die of the reference
model and the crown coping, was digitally cut into 20
radial sections, 18 degrees per section (Fig 4).
According to the definition of Matta et al and Holmes
et al,13,14 each of the individual measuring points was
subsequently subjected to three different measurements:
the absolute marginal discrepancy (xyz), the vertical dis-
crepancy (z), and the horizontal (xy) marginal gap (Fig 5).
Figure 6 illustrates an overview of the workflow in
this study.
The R Program (R Core Team) was used for statistical
analysis. First, a global group comparison of the crown
copings was performed with Kruskal-Wallis test. If a
significant result was found, pairwise comparisons with
Mann-Whitney U test were performed. The significance
level was set at .05.
RESULTS
The accuracy of fit of the crowns on their respective
master model and plaster casts was determined in two
dimensions as well as in three dimensions. The accuracy
of fit of the crown copings on their corresponding metal
master models and plaster casts is illustrated in Figs 7
and 8.
Statistical analysis of the 2D results showed that there
were no significant differences between groups A, B, and
C with regard to the vertical marginal discrepancies (z)
between the test specimens and the reference models. In
 Berger et al

z+
xyz

xy + xy –

Fig 4    Illustration of the 20 slices virtually
cut through the die for 2D analysis.
z–
a b
Fig 5    (a) Measurements performed to describe the closure between the edge of the crown
copings and the preparation margin of the reference models. (b) A virtual section cut through
the die. The reference model is shown in blue and the crown coping in green. The boxed area
represents the edge closure, magnified in (a). z = the vertical marginal discrepancy from the
lowest structure of the crown margin to the lowest margin of the preparation; xy = horizontal
marginal discrepancy between the outermost corner of the crown and the outermost part of
the preparation margin; xyz = the absolute marginal discrepancy, expressed as a vector sum
of the horizontal and vertical deviations.

Master model

Physical impressions Digital impressions

Group A

Group C
STL data
Conventional Scannable
Group B

impression material impression material

10 crown copings

Plaster casts Lab scanning

Group D

Lab scanning 10 crown copings

10 crown copings

Fig 6   Overview of the study procedure. Groups A to C represent accuracy of fit based on the different impression modalities, while group
D examines fit based on conventional impressions made from plaster casts.

contrast, group D showed a significantly smaller marginal
gap in the vertical plane (0.007 ± 0.017 mm) compared
to group A (0.024 ± 0.005 mm; P = .009).
Furthermore, the horizontal marginal discrepancy (xy)
of the crown copings in group C (0.014 ± 0.003 mm)
was significantly lower than groups A, B, and D
(0.024 ± 0.008, 0.022 ± 0.004, and 0.025 ± 0.005 mm,
respectively; P < .005).
Finally, the 2D evaluation also included determination
of the absolute marginal discrepancy (xyz). The low-
est values were found in the crown copings of group
C (0.026 ± 0.007 mm). In comparison, significantly

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 Digital Dental Technologies

Fig 7    The vertical, horizontal, and absolute

P = .035 marginal discrepancies of the crown copings
compared to their corresponding reference
0.06 P = .043 model (metal master model or plaster cast)
P = .009 P = .001 based on 2D analysis for all groups.

0.04 P < .005

Deviation (mm)

0.02

P < .001
0.00 P < .001 P = .028

A B C D A B C D A B C D
Vertical gap Horizontal gap Absolute marginal gap

DISCUSSION
0.12
The long-term clinical success of a fixed dental restora-
0.10 tion is based on its accuracy of fit. Fit can be influenced
by many different factors, including the impression-
Deviation (mm)

0.08
P = .001
0.06
P = .001
0.04
P = .001
0.02
A B C D
Internal gap
Fig 8    3D evaluation of the internal and marginal fit between each
group and their corresponding reference model (metal master model
or plaster cast).
larger marginal gaps were found in groups A (0.038 ±
0.011 mm; P = .028), B (0.034 ± 0.008 mm; P = .043),
and D (0.045 ± 0.01 mm; P < .001).
The 3D investigation included measurements of the
internal and marginal fit. The crown copings in group
D showed the best internal fit on the plaster master
casts, with the lowest gaps (0.087 ± 0.006 mm) com-
pared to groups A (0.103 ± 0.005 mm), B (0.105 ±
0.01 mm), and C (0.109 ± 0.007 mm; P = .001). In ad-
dition, group D had a significantly smaller marginal gap
(0.028 ± 0.008 mm) than groups A (0.046 ± 0.009 mm;
P = .015), B (0.09 ± 0.0049 mm; P = .005), and C (0.06 ±
0.013 mm; P = .015). Furthermore, the marginal devia-
tions were significantly smaller in group A compared to
group B (P = .025).
P = .015
taking step and other steps performed during the working
P = .005
procedure after the preparation has been completed.15
P = .025 P = .005 The present study examined the accuracy and precision of
three different impression techniques that are well known
(conventional, digital, and conventional with a scannable
material). The influence of these different methods on
the restoration fit was examined.
The results showed that the null hypothesis, which
A B C D
stated that all crown copings would fit equally accurately
Marginal gap
regardless of the impression technique used, could be re-
jected. Indeed, significant differences were found among
the three methods in certain parameters related to fit.
For example, the average absolute marginal discrepancy
in the 2D analysis was 26 μm in group C, indicating that
the digital impression resulted in the lowest deviations
of the fabricated crown copings. In this regard, a better
fit of the same crown copings in groups A (38 µm) and
D (45 µm) on the master model was also observed. Due
to the sections defined by the software, which cannot
be changed during 2D evaluation, possible errors at the
preparation margin of the plaster cast are also mea-
sured.5 However, the results of the absolute marginal
discrepancy (xyz) of these four groups showed that all
restorations provided adequate fit, with gaps far smaller
than the maximum 120-μm marginal gap required by
McLean and von Fraunhofer.16
These results were comparable to the in vitro study by
Cetik et al,10 who compared the precision of zirconium
oxide crowns based on conventional and digital (TRIOS)
impressions. They did not find any significant differences
in most measurement points between the restorations

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obtained from the different impression modalities. Over-
all, all crowns were clinically acceptable and exhibited
similar fit.
Measurements of the vertical marginal discrepan-
cies showed that the smallest deviations of the crown
copings were observed in group D (restoration fitted
on the plaster cast), which is why this group ultimately
performed best. The other three groups showed no
significant differences. Overall, the restorations in group
A (restoration fitted on the metal master model) showed
the largest vertical discrepancies, which might have been
due to the general inaccuracies in the conventional im-
pression method or even due to impression errors.
Measurements of the horizontal marginal discrepan-
cies showed that the crown copings in group C achieved
the best values. In contrast, the other groups showed
oversizing in the horizontal plane, which could be ex-
plained by an error in the impression-taking process.
The 3D measurements of the accuracy of fit showed
that group D had the smallest marginal gap. The differ-
ences among the groups could be attributed to general
impression errors.
When the present in vitro study results were com-
pared to clinical examinations, the measured dimen-
sions of the marginal fit increased significantly. It
should be noted, however, that most previous stud-
ies evaluated the fit of ceramic copings; in contrast,
the present study examined single crowns based on
Co-Cr copings. The reasoning was that Co-Cr could
avoid the sintering process used in ceramics. Thus, this
study could focus purely on the accuracy of fit of the
restorations resulting from the different impression
processes. For example, a recent study by Berrendero
et al17 compared the accuracy of fit of all-ceramic
crowns that were based on either a conventional
silicone impression or an intraoral digital impression
taken with the TRIOS scanner. They found a marginal
gap of 106.6 μm with the digital method and a de-
viation of 119.9 μm with the conventional method.
Comparable results were found in an in vivo study by
Rödiger et al,18 who also investigated deviations of
zirconium oxide crowns fabricated with CAD/CAM
and the impression techniques mentioned above. They
found marginal discrepancies of 151.68 μm in restora-
tions made of impressions taken with the TRIOS scan-
ner and 138.17 μm in restorations based on silicone
impressions taken with the conventional method using
the double-mix technique. The present results were
better, potentially due to the fact that the sintering
process used in making ceramics was avoided.
In addition, the in vivo study by Boeddinghaus et al19
examined the marginal fit of zirconium oxide copings cre-
ated with three different intraoral impression modalities
and one conventional impression modality. Several intra-
oral scanners were used for the digital method, including
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Berger et al
the TRIOS scanner, which produced restorations with a
marginal gap of 112 μm; the True Definition Scanner
(3M), which produced restorations with a marginal gap
of 88 μm from the zirconium oxide copings; and the
CEREC Omnicam (Dentsply Sirona), which produced
restorations with deviations of 149 μm. In contrast, the
crowns created with the conventional method showed
a gap of 113 μm, comparable to the result achieved with
the TRIOS scanner.
The present study additionally performed 3D evalu-
ations to examine the internal accuracy of the fit of
the crown copings. The best internal fit, and thus the
smallest internal gap, was achieved with the restora-
tions in group D (87 µm), which employed the con-
ventional impression on the metal master model. In
comparison, groups A, B, and C showed deviations of
103, 105, and 109 μm, respectively. In contrast, Pradíes
et al20 performed a clinical study to compare the fit
of ceramic crowns fabricated from conventional sili-
cone impressions vs digital intraoral impressions. They
found that restorations based on the digital method
(149.86 μm) achieved better results than those based
on the conventional method (165.77 μm). Similarly, an
in vivo study by Zarauz et al21 also found that the in-
ternal fit of all-ceramic crowns from the digital group
(111.40 μm) performed significantly better than the
crowns from the conventional group (173 μm).
In summary, the results presented in those stud-
ies were comparable to the results from in vivo
studies,10,17–21 although study-related influencing pa-
rameters should also be considered. For example, the
necessary sandblasting of the surfaces before the digi-
tization process or the adhesive wax application to fix
the crown copings could lead to minor measurement
errors.12,13 Overall, the internal fit, like the marginal
discrepancy, is an important criterion for the longev-
ity of a dental restoration because it influences the fit
of a dental restoration on the tooth die and thus the
marginal fit.22,23
Eames et al24 showed that the application of a spacer
on a tooth die provided additional space for material
used in a subsequent cementation. That technique im-
proved the fit of a crown and in addition increased the
retention by 25%. That finding suggested that fixed
dental restorations should generally have some space
between the tooth and the restoration during the inser-
tion process. The space should be a certain size, but not
too generous, because this could lead to a disturbance
in the bond and accelerate the wash-out of the cement.
Furthermore, for restorations based on a certain mate-
rial, such as ceramic, an oversized marginal gap could
reduce the fracture resistance and the layer thickness
of the restoration.25 In the literature, recommendations
of a clinically acceptable marginal gap vary from 50 to
a maximum of 120 μm.16,26–29
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 Digital Dental Technologies
With regard to future research, it would be interesting
to investigate the precision of the different impression
modalities on the basis of multi-unit restorations.29
CONCLUSIONS
From a clinical point of view, the results obtained in
this study illustrated that all three impression modalities
tested could be used as a basis for clinically satisfactory
restorations. Based on the maximum marginal gap size
of 120 μm, all restorations fabricated in this study were
clinically acceptable. Therefore, digital impressions taken
with an intraoral scanner could be regarded as an equiva-
lent alternative to a conventional impression.
ACKNOWLEDGMENTS
This study was based, in part, on the results from the doctoral thesis
of Meike Kreuzer. Furthermore, the authors would also like to thank
the GOM company for the metrological support and CAD first mill-
ing center (Karlskron, Germany) for support during the production
of the crown copings. This investigation was funded by the ELAN
Foundation of the University Hospital Erlangen. The funding source
had no influence on the study design, the results obtained, or the
data analysis. The authors report no conflicts of interest.
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