Intra-oral Scanners: A New Eye in Dentistry

Review Article

Austin J Orthopade & Rheumatol. 2015; 2(3): 1021.

Intra-oral Scanners: A New Eye in Dentistry

Baheti MJ1*, Soni UN1, Gharat NV1, Mahagaonkar P2, Khokhani R2 and Dash S1

1Institute of Pravara Medical Sciences, Department of Orthodontics & Dentofacial Orthopedics, India

2Institute of Pravara Medical Sciences, Department of Prosthodontics, India

*Corresponding author: Baheti MJ, Institute of Pravara Medical Sciences, Department of Orthodontics & Dentofacial Orthopedics, oni – 413736, Maharashtra, India

Received: August 18, 2015; Accepted: November 01, 2015; Published: November 17, 2015


Today, intra-oral mapping technology is one of the most exciting new areas in dentistry since three-dimensional scanning of the mouth is required in a large number of procedures in dentistry such as orthodontics and restorative dentistry. Since the introduction of the first dental impressioning digital scanner in the 1980’s, development engineers at a number of companies have enhanced the technologies and created in-office scanners that are increasingly user-friendly. It offers the clinician the ability to offer patients different appliances and fixed restorations of all types. The new technology has become easier to use for the clinician as well as more precise, and offers technological advances over earlier versions. These systems are capable of capturing 3D virtual images of tooth which can be used to create accurate master models on which the restorations can be made in a dental laboratory (dedicated impression scanning systems). The use of these products is rapidly increasing around the world and presents a paradigm shift in the way in which dental impressions are made. Several of the leading 3D dental digital scanning systems are presented and discussed in this article.

Keywords: Intra-oral scanner; Software; Record keeping


The fast and continuous advances in computer sciences have resulted in increased usage of new technologies in all levels of modern society and orthodontics is not an exception to it. Paperless office is now a reality and although the transition has been slow, it has been steady [1]. Many orthodontists are joining other health professionals in using paperless patient information systems [2]. The digital Era in the orthodontics is moving at lightning speed. Digital radiographs and digital photography are becoming the norm in orthodontic records. Recent advances have now included E-study models and now the intra orally scanned study models. Orthodontists use computers for record keeping, practice management, patient education, and communication with colleagues, restorations fabrication, and many other tasks. Computers have become a necessity rather than an option.

“Impression” has different meaning in life but in dentistry, impression is negative form of teeth or other tissues of the oral cavity [3]. Impression has its importance in various aspects of dentistry like in orthodontics especially; to perform various procedures like diagnosis, model analysis, appliance fabrication, impression has to be made using different materials and techniques. Both in orthodontics and restorative area (Prosthodontics and restorative dentistry in particular), the use of plaster models are not only essential but routine practice in these clinical specialties. It has long been every dentist’s desire to be able to scan plaster models, or even patients’ teeth directly in the mouth [4]. Avoiding discomfort, speeding up work, improving communication between colleagues and prosthetic labs, and reducing the physical space needed for storing these models, are some of the alleged benefits of this technology.

The replacement of alginate and Polyvinyl Siloxane (PVS) impressions with intraoral digital scanners represents a paradigm shift in orthodontics. First introduced as an outsourced technology for storage of three-dimensional electronic study models, the digital scanner has evolved into an in-office tool with a variety of applications [5]. Using this technology, orthodontists can more accurately and efficiently fabricate clear aligners, custom braces, indirect-bonding trays, and laboratory appliances without the unpleasant experience of conventional impressions. The aim of this article is to provide an extensive review of the existing intraoral scanners for orthodontics with particular attention to the technical aspects and applications of digital impressions in dentistry, with emphasis on orthodontics.

Evolution of digital impression systems

The concept of taking impressions to make models, from which appliances could be constructed, goes back to the early 18th century [6,7]. It was not until 1856, when Dr. Charles Stent [6] perfected an impression material for use in the fabrication of the device that bears his name for the correction of oral deformities, that documentation exists of the use of an impression material other than beeswax or plaster of Paris, which had inherent problems, respectively, of distortion or difficulty of use, for creating an oral prosthesis [8].

The widely used techniques currently employed for obtaining elastomeric impressions and for creating gypsum models from those impressions have only been in use since 1937, when Sears [9] introduced agar as an impression material for crown preparations. The first elastomeric material specifically produced for the purpose of dental impression-making was Impregum™, a polyether material introduced by ESPE, GmbH in 1965. In the mere 77 years that elastic impression materials have been in use, numerous formulations have been developed, all of which have exhibited particular shortcomings in the goal of obtaining precise reproduction of the oral structures. Condensation cure silicone impression materials subsequently were developed, but these also suffered from problems with dimensional accuracy. The creation of addition silicone vinyl poly siloxane impression materials solved the issues of dimensional inaccuracy, poor taste and odor, and high modulus of elasticity, and offered excellent tear strength, superior flow ability, and lack of distortion even if models were not poured quickly.

Many dentists are reluctant to embrace the new technologies because they simply believe elastomeric impression materials and techniques have been in use for so long and work so well that they are irreplaceable. Or else, those 3D digital scanning technologies are so recent that they are not yet ready for clinical use. Actually, impression taking using elastomers, for all its inherent problems, has been used in dentistry for 77 years. Digital impression and scanning systems were introduced in dentistry in the mid-1980s and have evolved to such an extent that some authors predict that in five years most dentists in the U.S. and Europe will be using digital scanners for impression taking [10].

The advent of intraoral digital scanners coincided with the development of Computer-Aided Design and Manufacturing (CAD/CAM) technology and the 1984 introduction of Chairside Economical Restoration of Esthetic Ceramics (CEREC).The first system for the dental office was CEREC 1 in 1986. The system was developed by Prof. Dr. Werner Moermann in Switzerland and was eventually licensed to what today is Sirona Dental Systems 2. The Cerec 2 and subsequent Cerec 3 as well as the eventual the Cerec 3D system replaced the original technology in 1994, 2000 and 2003 respectively [11,12]. In 2001, Cadent introduced the Ortho CAD* system for the production of 3D digital models, virtual setups, and indirect-bonding trays. The Lava™ Chairside Oral Scanner (C.O.S.) was created at Bronte’s Technologies in Lexington, Massachusetts, and was acquired by 3M ESPE (St. Paul, MN) in October 2006. In 2006, Cadent developed the in-office iTero* digital impression system, which by 2008 was capable of full-arch intraoral scanning (Figure 1 ); in late 2009, Cadent launched the iOC* system for iTero users. The E4D Dentist system, introduced by D4D Technologies LLC (Richardson, TX) in early 2008. Align Technology purchased Cadent in 2011, allowing clinicians with iOC to begin submitting 3D digital scans in place of physical impressions for the fabrication of Invisalign appliances.