November/December 2020
Volume 41, Issue 10

Challenges of Integrating Intraoral Optical Scanners Into High-Volume Dental Facilities

Samantha Lakhia; Ilser Turkyilmaz, DMD, PhD; and Georgios E. Romanos, DDS, PhD, Prof Dr med dent

Digital dentistry has revolutionized restorative and surgical dental procedures, offering tremendous advances in clinical efficiency and accuracy.1-3 Intraoral optical scanners (IOSs) are just one way in which this technology has taken form. Intraoral optical impressions provide information on 3-dimensional spatial arrangements of teeth, interocclusal relationships, surface texture of dentition, and shade.3,4 Optical impressions eliminate the need for irreversible hydrocolloid, plaster, and polyvinyl siloxane impressions, which lack dimensional stability and impression accuracy.5,6 Additionally, IOSs allow for the fabrication of surgical guides, enabling more accurate implant placement and more predictable flapless surgeries than conventional means.7 However, concerns over cross-contamination, calibration requirements, and digital data transfer need to be considered before IOS integration into high-volume dental institutions becomes mainstream.8-12

IOS utilization comes with risk of cross-contamination.8,9 This concern is exponentially heightened when IOS usage is anticipated on a large scale in high-volume dental institutions. Cross-contamination is the process by which harmful microorganisms are unintentionally transferred from one surface to another, increasing the potential for disease transmission. According to the Centers for Disease Control and Prevention (CDC), steam sterilization using an autoclave is the standard for sterilization and microbe eradication.13 To achieve proper sterilization, an autoclave must reach and maintain a temperature of 121°C (249.8°F) for a minimum of 30 minutes under saturated steam and at least 15 psi of pressure. Until recently, IOSs were mostly not available with a detachable and autoclavable tip, so disinfection was predominantly used.3,4 Some are now offered with autoclavable tips, which aids in the prevention of cross-contamination and disease transmission.

In one autoclavable tip system, the IOS tip can be detached and cleaned with warm soapy water to remove foreign material such as saliva and blood from the mirror.3,4 The tip is then wrapped in paper towel to prevent staining of the mirror and autoclaved according to the CDC guidelines. After sterilization, the tip is inspected to ensure the mirror is undamaged and then reattached to the IOS before the next use.

IOSs require a high degree of trueness and precision in their digital scans to fabricate accurate surgical guides and prosthetic restorations.3 Trueness indicates minimum deviation from the actual dimension of the object being measured; precision refers to consistency in scan measurements.3 Proper calibration of the IOS is vital to ensure accuracy in these measures. If calibration is neglected, scans can become compromised, which will ultimately jeopardize final surgical and restorative outcomes.10

While calibration is manageable in private practices with relatively low patient volumes and definitive staff responsibilities, challenges may arise in large dental institutions as the amount of IOS scans increases among what may be a limited number of trained operators and calibration responsibilities are delegated. Additionally, the frequency of calibration may increase due to vibration of the IOS during transportation and shock that may occur during relocation or dropping.10

Recently developed technology allows for autocalibration through the scanner manufacturer's server. However, most IOSs still require manual calibration through the use of a calibration tool, whereby the tip is removed from the IOS and inserted into the calibration tool, and a number of manual calibration cycles are completed stepwise. Upon successful completion of the manual calibration process, a "pass" window appears on the IOS monitor indicating the process is complete. The IOS tip is then removed from the calibration tool and reattached to the IOS.

The rapid technological evolution in dentistry is prompting infrastructure remodeling at large dental facilities. State-of-the-art hardware and software is necessary that is capable of processing a high volume of digital patient information that can be securely accessed by several clinicians and laboratory personnel. If intraoral scanning and fabrication of final surgical or restorative products are not completed in the same location, then transfer of data digitally via cloud servers is crucial. Transfer of digital data poses risks in the maintenance of patient privacy and protection in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) in the United States.11,12 Therefore, information obtained from IOSs must be properly stored, encrypted, and transmitted to avoid data breaches in patient information.

Incorporation of digital dentistry into large dental institutions, such as dental schools, is a complex process involving many components. Creating a comprehensive strategy prior to its implementation may help to avoid frustrating and costly outcomes.

About the Authors

Samantha Lakhia
Fourth-Year Dental Student, New York University College of Dentistry,
New York, New York

Ilser Turkyilmaz, DMD, PhD
Clinical Professor, New York University College of Dentistry, Department  of Prosthodontics, New York, New York

Georgios E. Romanos, DDS, PhD, Prof Dr med dent
Professor, Daepartment of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York


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