DENTAL TECHNIQUE
Imp o ing he accu acy o comple e a ch implan digi al scans
by using auxilia y clips o in ao al scan bodies:
A den al echnique
Ola z E xaniz, BEng, MSc,
a
Xabie Amezua, BEng, MSc, PhD,
b
Mikel Jau egi, BEng, MSc, PhD,
c
and
Eneko Solabe ie a, BEng, MSc, PhD
d
In di ec digi al wo k lows o
p o iding implan -suppo ed
p os heses, implan posi ions
a e ans e ed om he pa-
ien ’s mou h o a i ual cas
by using an implan in ao al
digi al scan.
1
The digi al scan
should be accu a e o ensu e a
passi e i o he p os hesis.
2–4
Howe e , acqui ing an
accu a e implan in ao al digi al scan wi h an in ao al
scanne (IOS) emains challenging.
4–7
IOSs gene a e digi al scans by s i ching oge he
se e al images using bes - i alignmen algo i hms.
8–15
These algo i hms p o ide he bes esul s when s i ching
oge he images o immobile a eas wi h abundan geo-
me ic e e ences. Howe e , di icul ies end o occu in
accu a ely s i ching oge he images o he smoo h and
mo able so issues in eden ulous a eas.
4,10–16
These
image-s i ching e o s accumula e as he scanning span
inc eases, hus making i challenging o ob ain accu a e
comple e a ch implan in ao al digi al scans.
17–19
Adding geome ic e e ences be ween o a ound in-
ao al scan bodies (ISBs) has been epo ed o dec ease
image-s i ching e o s and hus imp o e he accu acy o
he esul ing comple e a ch implan in ao al digi al
scan.
4,20–31
Nume ous me hods ha e been de eloped o
add geome ic e e ences be ween o a ound
ISBs,
4,26–30,32
wi h he splin ing o he ISBs being
common o mos .
26–29,31,33–35
Some me hods use aux-
ilia y de ices ha equi e cus omiza ion wi h he aid o a
p elimina y in ao al digi al scan and, he e o e, equi e
an addi ional pa ien isi .
29,30,35
Pho og amme y-based
de ices ha e also been de eloped o ans e implan
posi ions mo e accu a ely om he pa ien ’s mou h o a
i ual cas , bu hei acquisi ion can en ail conside able
cos o a den al clinic.
36–38
This a icle desc ibes a echnique o imp o e he
accu acy o comple e a ch implan in ao al digi al scans
by using auxilia y clips o ISBs o co e in e implan
eden ulous spans wi h immobile geome ic e e ences
ha a e mo e a o able o IOSs. Once a den al clinic
ob ains a se o auxilia y clips o di e en dimensions o
he ISBs used, hose ha bes co e he indi idual pa-
ien ’s in e implan spans can be selec ed.
Suppo ed by he Uni e si y o he Basque Coun y UPV/EHU [g an no. GIU21/051], Spain; and by he Gipuzkoa P o incial Council [g an no. 2023-CIEN-
000029–01], Spain.
The au ho s decla e ha hey ha e no known compe ing inancial in e es s o pe sonal ela ionships ha could ha e appea ed o in luence he wo k epo ed in his pape .
]]]]
]]]]]]
a
Assis an P o esso , Depa men o G aphic Design and Enginee ing P ojec s, Facul y o Enginee ing Bilbao, Uni e si y o he Basque Coun y (UPV/EHU), Bilbao, Spain.
b
Assis an P o esso , Depa men o G aphic Design and Enginee ing P ojec s, Facul y o Enginee ing Bilbao, Uni e si y o he Basque Coun y (UPV/EHU), Bilbao, Spain.
c
Associa e P o esso , Depa men o Mechanical Enginee ing, Facul y o Enginee ing Gipuzkoa, Uni e si y o he Basque Coun y (UPV/EHU), San Sebas ian, Spain.
d
Associa e P o esso , Depa men o G aphic Design and Enginee ing P ojec s, Facul y o Enginee ing Gipuzkoa, Uni e si y o he Basque Coun y (UPV/EHU),
San Sebas ian, Spain.
ABSTRACT
A echnique o imp o e he accu acy o comple e a ch implan in ao al digi al scans and he
accu acy o hei i ual cas s is desc ibed. Ob aining accu a e comple e a ch implan in ao al
digi al scans wi h an in ao al scanne is challenging because o he smoo h and mo able issues
o eden ulous a eas. The desc ibed echnique uses auxilia y clips a ached o in ao al scan bodies
o co e in e implan eden ulous spans wi h immobile oo h-like geome ic e e ences ha a e
mo e a o able o in ao al scanning. The echnique is designed o be use iendly and
compa ible wi h any in ao al scanne . (J P os he Den 2025;133:43-47)
THE JOURNAL OF PROSTHETIC DENTISTRY 43
TECHNIQUE
1. C ea e he i ual designs o he auxilia y clips in a
e e se enginee ing so wa e p og am (Geomagic
Design X; 3D Sys ems Inc) based on he e e ence
i ual design o he s uc u e o he auxilia y clips
(Fig. 1; Supplemen al Files 1-3, a ailable online).
Fi s , modi y he e e ence i ual design o ensu e
a i m union be ween he c ea ed auxilia y clips and
he ISBs used in he clinic (Tiny Uni e sal Pla o m
Mul i-IM ISB; BTI Bio echnology Ins i u e) by using
he co esponding i ual design o he ISB a ail-
able in implan lib a ies (no e ha auxilia y clips
will be a ached o ISBs apical o he scan egion)
(Fig. 1A). Then, by modi ying he dimensions o he
esul ing i ual design, c ea e a se o i ual de-
signs o s uc u es o di e en dimensions (Fig. 1B).
Finally, ill he c ea ed i ual designs wi h pos e io
ee h by using he i ual designs o he pos e io
ee h a ailable in oo h lib a ies (use each o hem
only once) (Fig. 1C). No e ha he heigh o he
ee h should be simila o he heigh o he scan
egion o he ISB and ha he ee h should no
hinde he scanning o ha egion o he ISB.
2. Manu ac u e he auxilia y clips in a biocompa ible
opaque ma e ial (HP 3D HR PA12; HP Inc).
39,40
3. A ach an auxilia y clip o each ISB and sc ew hem
o he mul iuni abu men s acco ding o he man-
u ac u e ’s ecommenda ions (Fig. 2). Selec he
auxilia y clips ha bes co e he pa ien ’s in e -
implan spans and posi ion hem in such a way ha
he gaps be ween hem and he ISBs a e minimal
(Fig. 2). Ensu e ha he auxilia y clips a e i mly
a ached o he ISBs.
4. Ob ain a comple e a ch implan digi al scan wi h an
IOS (TRIOS 3; 3Shape A/S) by ollowing he
manu ac u e ’s ecommenda ions (Fig. 3).
5. De ach he auxilia y clips om he ISBs and ob ain
a con en ional comple e a ch implan digi al scan
wi h he IOS by ollowing he manu ac u e ’s e-
commenda ions (Fig. 4).
6. In a den al compu e -aided design (CAD) so wa e
p og am (exocad; exocad GmbH), supe impose a
i ual design o he ISB wi h each ISB in he
comple e a ch implan digi al scan ob ained in s ep
4 o ob ain he posi ion o he implan s (Fig. 5). Fo
ha , common a eas o he ISBs should be supe -
imposed by using a bes - i algo i hm.
7. In he den al CAD so wa e p og am, spli he con-
en ional comple e a ch implan digi al scan ob ained
in s ep 5 in o as many pa s as implan s (Fig. 6A) and
supe impose each o hem wi h he co esponding
a ea in he comple e a ch implan digi al scan ob ained
in s ep 4 (Fig. 6B). Fo ha , i he ISBs used p o ide
o ien a ion in o ma ion, common a eas o he ISBs
should only be supe imposed by using a bes - i al-
go i hm. I no , common a eas co esponding o he
so issues should also be supe imposed.
8. Remo e o hide he comple e a ch implan digi al scan
ob ained in s ep 4 and e ain he i ual cas composed
o he spli comple e a ch implan digi al scan ob ained
in s ep 5 and he i ual designs o he con en ional
ISBs (Fig. 7A). I necessa y, emo e he ISBs in he spli
comple e a ch implan digi al scan (Fig. 7B).
DISCUSSION
The desc ibed echnique aims o imp o e he accu acy o
comple e a ch implan in ao al digi al scans and p o ide
A B C
Figu e 1. C ea ion o i ual designs o auxilia y clips o ISBs. A, Adap a ion o e e ence i ual design o s uc u e o used ISBs. B, C ea ion o i ual
designs o s uc u es o di e en sizes. C, C ea ion o i ual designs o auxilia y clips o di e en sizes. ISB, in ao al scan body.
Figu e 2. Auxilia y clips posi ioned in mou h.
44 Volume 133 Issue 1
THE JOURNAL OF PROSTHETIC DENTISTRY E xaniz e al
mo e accu a e i ual cas s. Auxilia y clips o ISBs a e used
o co e smoo h and mo able issues in eden ulous a eas
wi h immobile geome ic e e ences ha a e mo e a o able
o IOSs.
Ob aining accu a e comple e a ch implan in ao al
digi al scans wi h IOSs has been epo ed o be chal-
lenging,
17–19
undamen ally because o he di icul ies in
accu a ely s i ching oge he images o smoo h and
mo able issues in eden ulous a eas. Thus, accu acy has
been epo ed o be imp o ed by adding geome ic e-
e ences be ween o a ound he ISBs,
4,20–31
wi h di -
e en al e na i es being p oposed.
4,26–30,32
A dis inc i e
cha ac e is ic o mos al e na i es is he splin ing o he
A B
Figu e 3. Acquisi ion o comple e a ch implan in ao al digi al scan. A, In ao al scan. B, Comple e a ch implan digi al scan.
A B
Figu e 4. Acquisi ion o con en ional comple e a ch implan in ao al digi al scan. A, In ao al scan. B, Con en ional comple e a ch implan in ao al
digi al scan.
Figu e 5. Supe imposi ion o i ual designs o ISBs wi h ISBs o comple e
a ch implan digi al scan ob ained in s ep 4. ISB, in ao al scan body.
A B
Figu e 6. Spli ing o con en ional comple e a ch implan digi al scan ob ained in s ep 5 and supe imposi ion o each pa wi h comple e a ch
implan digi al scan ob ained in s ep 4. A, Spli ing o con en ional comple e a ch implan digi al scan ob ained in s ep 5. B, Supe imposi ion o each
spli pa wi h comple e a ch implan digi al scan ob ained in s ep 4.
Janua y 2025 45
E xaniz e al THE JOURNAL OF PROSTHETIC DENTISTRY
ISBs, ypically by using auxilia y de ices.
26–30,33–35
Se e al o
hese auxilia y de ices, howe e , need o be cus o-
mized,
29,30,35
equi ing a p e ious digi al scan and, he e o e,
an addi ional pa ien isi . The p esen echnique, in con-
as , only equi es he clinic o acqui e a se o auxilia y clips
o di e en dimensions o he ISBs i uses. Once acqui ed, a
combina ion o auxilia y clips ha minimizes he gaps in he
scanning pa h can be used wi h each pa ien wi hou he
need o any addi ional cus omiza ion.
Recognizing he impo ance o seamless in eg a ion in
exis ing clinical wo k lows, he echnique is enginee ed o
be use iendly and compa ible wi h any IOS, allowing o
s aigh o wa d adop ion and implemen a ion. The auxilia y
clips a e easily placed in he mou h, and ob aining a com-
ple e a ch in ao al digi al scan wi h hem in place is com-
pa able wi h ob aining a comple e a ch in ao al digi al scan
o a den a e pa ien . Auxilia y clips, in addi ion, a e used
only o add s a ic geome ic e e ences be ween ISBs, so
hey do no need o be accu a ely ab ica ed, making hem
sui able o all den al clinics. The auxilia y clips could be
manu ac u ed wi h any addi i e manu ac u ing machine, as
long as he ma e ial used is opaque and mee s o exceeds
he es ablished biocompa ibili y condi ions.
39,40
When de-
signing he clips and selec ing he manu ac u ing p ocess, i
should also be ensu ed ha a i m a achmen exis s be-
ween he auxilia y clips and he ISBs o a oid mo emen o
he auxilia y clips du ing he scanning p ocess. Howe e ,
excessi e o ce should no be equi ed o de ach he aux-
ilia y clip, o a oid pa ien discom o o e en displacemen
o he ISBs. Fu he mo e, i he auxilia y clips a e in ended
o be eusable, he i m a achmen should be main ained
a e mul iple applica ions. The e o e, in ha case he e ec s
o use and s e iliza ion cycles on he p ope ies o he ma-
e ial should be conside ed.
The possibili y o c ea ing a lib a y o auxilia y clips
compa ible wi h di e en ISBs on he ma ke could be
conside ed. Howe e , s udies a e needed o assess he
accu acy o comple e a ch in ao al implan digi al scans
ob ained wi h his echnique and o s udy he clip design
ha o e s he igh es g ip o di e en ma e ials and
ab ica ion me hods.
SUMMARY
A echnique o enhancing he accu acy o comple e a ch
implan in ao al digi al scans and mo e accu a e i ual
cas s is p esen ed. In his no el echnique, auxilia y clips
a e a ached o ISBs in o de o co e eden ulous spans
wi h immobile geome ic e e ences ha a e a o able
o in ao al scanning. To implemen his echnique, a
clinic needs only o acqui e a se o auxilia y clips o
di e en dimensions o he ISBs i uses. Once acqui ed,
he combina ion o auxilia y clips ha bes co e s he
pa ien ’s in e implan spans can be used wi hou he
need o u he cus omiza ion.
PATIENT CONSENT
The illus a ed pa ien signed an in o med consen o m.
The p ocedu e was app o ed by he uni e si y e hics
commi ee (M10_2019_254) acco ding o local and in-
e na ional e hical ules.
APPENDIX A. SUPPORTING INFORMATION
Supplemen al da a associa ed wi h his a icle can be
ound in he online e sion a doi:10.1016/j.p osden .
2024.01.031.
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Indus y and Food and D ug Adminis a ion S a . Sil e Sp ing: FDA; 2020.
40. In e na ional O ganiza ion o S anda diza ion. ISO-10993-1. Biological
e alua ion o medical de ices - Pa 1: E alua ion and es ing wi hin a isk
managemen p ocess. Gene a: ISO; 2018.
Co esponding au ho :
D Eneko Solabe ie a
Depa men o G aphic Design and Enginee ing P ojec s
Facul y o Enginee ing Gipuzkoa
Uni e si y o he Basque Coun y (UPV/EHU)
Plaza Eu opa 1
San Sebas ian 20018
SPAIN
Email: [email p o ec ed]
Acknowledgmen s
The au ho s hank he Uni e si y o he Basque Coun y (UPV/EHU) o p o-
iding hei DEHI esea ch labo a o y (www.ehu.eus/dehi). The au ho s also
hank Ayes a den al p ac ice and Co us Den al Ins i u e SL o hei suppo and
assis ance.
Copy igh © 2024 The Au ho s. Published by Else ie Inc. on behal o he
Edi o ial Council o The Jou nal o P os he ic Den is y. This is an open access
a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/
by-nc-nd/4.0/).
h ps://doi.o g/10.1016/j.p osden .2024.01.031
Janua y 2025 47
E xaniz e al THE JOURNAL OF PROSTHETIC DENTISTRY
