A Lasting Impression
Major developments occurring in scanning technology
By Jason Mazda
Although the Fourth Industrial Revolution may be imminent, CAD/CAM dental laboratories have faced some difficult foes in their struggle to persuade dentists to join them in the world of digital dentistry. Whether it is the comfort zone of traditional impression materials, the fact that digital intraoral scanners ranged from approximately $15 000-$40 000 in 2015,1 or other factors, dentists have been slow to embrace this technology. While it has been estimated that 10-15% of dentists own a chairside milling system,2 the rate of digital conversion for dentists who partner with laboratories appears to be slower, as a survey of 45 dental laboratories near the beginning of 2015 indicated that approximately 5% of dentists were providing digital impressions on a routine basis.3
“Financial and clinical factors have limited the penetration of digital optical impression in dentistry,” says François Duret, DDS, DSO, PhD, MS, MD-PhD, known as the “Father of CAD/CAM Technology.” “The hardware technique that most intraoral scanners have used until now is cumbersome and complex. They are very expensive to implement. Furthermore, they often require powder and exhibit 3D views in black and white, prohibiting some diagnostic uses or telemedicine.”
Research indicates, however, that the market for digital impression scanners is expected to grow 17.1% from 2014 to 2020.4 Several companies believe they can be catalysts for that growth by offering groundbreaking technologies aimed at helping to mitigate the factors that are causing reservations for so many dentists.
For dentists who are skeptical of scanning with a wand versus using tried-and-true impression trays, S-Ray (s-rayinc.com) and Medentic (medentic.de) are developing scanners that fit the full arch as traditional impression trays do.
“A handheld wand must be moved in very specific positions throughout the patient’s mouth to scan the full arch,” says Steve Baird, CEO of S-Ray. “This can take anywhere from 2 to 20 minutes. It could be a very pleasant experience or a very difficult experience for the patient.”
S-Ray is working to have the ClearView SCAN available by the end of the year. The device utilizes ultrasound technology built into a mouthpiece that is used just once before being recycled by the manufacturer. In addition to being familiar to the dentist and patient because of its similarities to a traditional impression tray, the ClearView SCAN is designed to be extremely fast and accurate. Operating at the speed of sound, the device completes scans in a matter of seconds, and Baird says it is designed to be the most accurate full-arch scanner. Because it uses ultrasound, it also can scan subgingivally.
“A wand needs to stitch together separate data files,” Baird says. “The problem is that the wand is not in an absolute position to every tooth. It moves, which leads to a disparity in the data files. When you stitch them together, it is like a patchwork quilt. Conversely, our scanner produces one data file that we convert to a digital format. Because it is analog, it is pure data.”
Medentic uses different technology with a similar goal for the iTray. The company had a nonfunctioning model at the International Dental Show (IDS) in 2015 and plans to have a fully functioning model at IDS 2017, with the device hitting the market later in the year.
The iTray utilizes true triangulation due to cameras arranged in three different positions (X, Y, and Z axes), rather than only two, according to Medentic Executive Assistant Martin Machura. The iTray can take an impression of the full arch as well as the bite registration, all in less than 2 minutes, Machura says. The plan is for it to be an open system, and the accuracy is estimated to be within approximately 10 μm.
“The iTray saves you time and, of course, money, because you will need only one device,” Machura says.
While S-Ray and Medentic are changing the physical look of the impression-taking device, Condor (condorscan.com) is aiming to take the well-established wand to a new level.
The CondorScan, expected to be available in the first quarter of 2017, weighs only approximately 3.5 oz.—lighter than anything else on the US market as of late last year.1 It is derived from satellite technology, and its operation is completely based on software rather than hardware. It generates images in color, requires no powder, is fully scalable, and offers tele-diagnostic and 2D imaging functionalities.
“The CondorScan does not need to project light as other scanners do,” says Duret, who is helping to develop the device. “It works in 3D passive stereo-video on micro-asperities present on the surfaces."
Similar to the S-Ray ClearView SCAN, the CondorScan transforms analog data into a virtual object on the screen.
“This allows the dentist to enjoy all the progress of modern physics and mathematics,” Duret says.
Thinking Outside the Mouth
Advances in impression scanning extend beyond intraoral devices. In addition to its ClearView SCAN, S-Ray offers the ClearView LAB, a desktop scanner approximately the size of a tissue box. The ClearView LAB scans models and, with an optional upgrade, impressions.
Because it uses ultrasound technology, the ClearView LAB is not affected by vibrations, Baird says, and it can even be hung on the wall. The technology is the same as the ClearView SCAN; both devices utilize S-Ray’s Latitude software to convert the data into one of several file formats, including STL, depending on the user’s preference.
While the size and capabilities of the ClearView LAB are notable, Baird says the key factor is its cost: The device’s suggested retail price is $5000, with a $2500 software upgrade available to add impression scanning. By contrast, the lowest price submitted among the 24 CAD model scanners featured in IDT’s 2015 Product iNavigator chart was $10 000.5
S-Ray estimates a suggested retail price of $9850 for the ClearView SCAN system, plus a $3 use fee for the mouthpiece—to cover the cost of remanufacturing the mouthpiece after each use. S-Ray is developing software packages for $2000 and a-la-carte options for caries detection, periodontal probing, and more.
Condor and Medentic declined to provide exact prices for their devices, but Duret says the CondorScan will sell for less than $20 000, and Machura says the iTray “will be cheaper than the current systems you can buy.”
‘Only the Beginning’
The digital impression systems that are currently popular are not likely to go away; rather, they will continue to improve and adapt as new technologies are accepted by the industry. As the digital impression market matures and prices continue to drop, adoption of this technology will only continue to grow.
The result, many say, is that laboratories will continue to find it easier and easier to convince their dentists to utilize digital impression scanning, which should help the laboratories save time and money while providing better-quality restorations and helping dentists offer better patient care. “This is only the beginning of a great adventure,” Duret says.
1. Shop and Compare: Digital Intraoral Scanners. Inside Dental Technology. 2015;6(11):40-41.
2. Mazda J. Battling the In-Office Crown. Inside Dental Technology. 2016;7(2):24-32.
3. Meyer E. Digital Trailblazers. Inside Dentistry. 2016;12(1):74-82.
4. Digital Impression Standalone Scanners Market to Expand at a CAGR of 17.1% between 2014 and 2020, Led by Advanced Powder-Free Intraoral Scanners. Transparency Market Research. https://www.transparencymarketresearch.com/pressrelease/digital-impression-stand-alone-scanners-market.htm. Published May 26, 2015. Accessed June 6, 2016.
5. Shop and Compare: CAD Model Scanners. Inside Dental Technology. 2015;6(11):40445.