Assessment of the Accuracy of Surgical Guide Designed From Digital Impression, Dental Model Scanning Using CBCT and Desktop Scanner in Computer Guided Implantology: Randomized Clinical Trial
Phase: NA
Conditions: Computer Guided Implant
Sponsor: Cairo University

 
1
Assessment of the Accuracy of Surgical Guide Designed from Digital 
Impression, Dental Model Scanning using CBCT and Desktop 
Scanner in Computer Guided Implantology:Randomized Clinical 
Trial. 
 تقييم دقة الدليل الجراحي
المصمم من االنطباع الرقمي, مسح نمو
ذ ج االسنان عن طريق االشعة
المقطعية بالحاسوب مخروطية الشعاع و الماسح المكتبي في زراعة االسنان الموجهة عن طريق
الحاسوب: تجربة سريرية عشوائية 
 
Submitted for partial fulfillment of the PHD degree requirements in  
Oral & Maxillofacial Radiology department 
Faculty of Dentistry 
Cairo University 
By 
Amr Taha Abu El-wafa 
Teaching Assistant of Oral and Maxillofacial Radiology 
Faculty of Dentistry 
October 2018 
Cairo University 
2018 
Code  
Rad 2:7:1 
 
 
Head of department’s signature 

 
2
Supervisors’ signature 
1- 
 
 
2- 
 
 
3- 
 
 
 
 
Date 
 
 
 
 
 
 
 
Protocol checklist 
Section and topic 
Item no. 
Checked item 
Reported on 
page No. 
Reviewer’s 
check 
I. Administrative information 
1 
Title 
  
 
2 
Protocol registration 
 
 
3 
Protocol version 
 
 
4 
Funding 
 
 
5 
Roles and responsibilities 
 
 
 
II. Introduction 
 
 
 
A) Background and Rationale 
6 a 
Research question  
 
 
Statement of the problem 
 
 
Rationale for carrying out the trial 
 
 
Review of literature 
 
 
6 b 
Choice of comparators 
 
 

 
3
B) Objectives 
7 
Aim of the study 
 
 
Hypothesis 
 
 
Primary and secondary objectives 
 
 
C) Trial design 
8 
Trial design 
 
 
 
III. Methods 
 
 
 
A) Participants, interventions & 
outcomes 
9 
Study setting 
 
 
10 
Eligibility criteria 
 
 
11 
Interventions 
 
 
12 
Outcomes 
 
 
13 
Participant timeline 
 
 
14 
Sample size 
 
 
15 
Recruitment 
 
 
B) Assignment of interventions 
16 
Allocation 
 
 
16 a 
Random sequence generation 
(Randomization) 
 
 
16 b 
Allocation concealment mechanism 
 
 
16 c 
Implementation 
 
 
17 
Blinding (masking) 
 
 
C) Data collection, management, 
and analysis 
18 
Data collection methods 
 
 
19 
Data management 
 
 
20 
Statistical methods 
 
 
D) Monitoring 
21 
Data monitoring 
 
 
22 
Harms 
 
 
23 
Auditing 
 
 
 
IV. Ethics and dissemination 
24 
Research ethics approval 
 
 
25 
Protocol amendments 
 
 
26 
Informed Consent  
 
 
27 
Confidentiality 
 
 

 
4
 
 
 
28 
Declaration of interests 
 
 
29 
Access to data 
 
 
30 
Ancillary and post-trial care 
 
 
31 
Dissemination policy 
 
 
 
V. Appendices 
 
32 
Informed consent materials 
 
 
 
33 
Biological specimens 
 
 
 
VI. References 
 
 
 
 
 
 
Evidence based committee (Reviewers) 
 
Name 
Signature 
Date 
1. 
 
 
 
2. 
 
 
 
 
Research plan committee 
 
Name 
Signature 
Date 
1.  
 
 
 
2.  
 
 
 

 
5
 
 
 
 
 
 

 
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I. Administrative information: 
1. Title:  
Assessment of the Accuracy of Surgical Guide Designed from Digital Impression, Dental Model 
Scanning using CBCT and Desktop Scanner in Computer Guided Implantology: Randomized Clinical 
Trial. 
2. Protocol Registration:  
Site and registration number of the protocol should be reported before final approval of the protocol 
(e.g. Clinicaltrials.gov: NCT01066572). 
 
3. Protocol version:  
Date and version identifier. (e.g. 25 Jul 2018 Protocol number: 5) 
 
4. Funding:  
Self funding 
 
5. Roles and responsibilities: 
1. 
The researcher (AT) will be responsible of case preparation and coding of cases. 
2. 
Expert implantologist will be responsible for the surgical procedure.  
3. 
The main supervisor (MD) will be responsible of the randomization, allocation concealment and 
assessing of final CBCT images. 
4. 
The co-supervisor (AMA) will be responsible for data entry and data monitoring. 
II. Introduction: 
6. Background and rationale: 
Implant nowadays is the most important treatment option suggested for patients to restore  missing 
teeth in  partially or completely edentulous arches ,and achieves a long term successful results and 
prognosis (Hultin, Svensson, and Trulsson 2012). 
To obtain these successful results, implant planning is mandatory .Proper implant planning is achieved 
by gathering a clinical and radiographic information and their correlation. Implant planning must be a 
crown-to-bone approach, starting from crown or suprastrcture design and end with determination a 
proper position of implant in bone.This planning concept will guarantee  a proper biomechanics, 
esthetics and maintenance. All of these aspects lead to a long term successful tooth restoration using 
implants(Worthington, Rubenstein, and Hatcher 2010). 
CBCT is the best imaging modalities for bone scan. From CBCT  bone height and thickness and 
location of surrounding vital structure can be evaluated (Vercruyssen et al. 2015)(Jamjoom et al. 2018). 

 
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Evolution of digital dentistry, 3rd party software and CBCT machine make implant planning more 
accurate by enabling virtual implant planning on a laptop to rapidly review treatment. options and saves 
the surgeon’s time in planning the surgery while improving accuracy. (Hultin, Svensson, and Trulsson 
2012). 
Computer guided implantology aims to transfer the virtual implant planning into the clinical situation 
and helps the clinician to insert the implant in safe and predictable manner and with less time and fast 
healing for patient. Computer guided implantology can be either dynamic system or static 
system.Dynamic system depends on surgical navigation and computer-aided navigation technologies, 
which allows the surgeon to alter the implant position in real time but it is not commonly used due to 
it’s a high cost. Static system (template base system ) is commonly used nowadays as templates are 
easily integrated into the intraoperative workflow by  using a surgical template designed and produced 
using compute aided- design/computer-aided-manufacturing (CAD/CAM) technology (Jamjoom et al. 
2018). 
Proper surgical guide planning depends on collection of 3D data of both, bone using CBCT and dent-
gingival tissue of the patient. Many softwares were introduced in dentistry to utilize both data by 
superimposition of soft tissue data over the 3D CBCT images, virtual patient can be obtained and 
virtual implant placement can be performed in situation resembling the clinical situation.The surgical 
template transfer the virtual implant to the real surgical field (Dolcini, Colombo, and Mangano 2016). 
3D dent-gingival data can be obtained by creating of digital model of patient by scanning of 
conventional cast by desktop scanner,scanning of conventional cast by CBCT machines or by intraoral 
digital impression (IOS) (Becker et al. 2018). 
 
Research question:  
In computer guided Implantology, are surgical stents designed from scan of dental model by CBCT 
and from digital impression as accurate as surgical stents designed from desktop scanner?  
Statement of the problem:  
 
The role digital dentistry is improved in computer guided implantology especially with development 
of computer guided implant software, desktop scanner and intra oral scanner development and CBCT 
machines(van der Meer et al. 2012). 
Intra-oral scanner, desktop scanner and CBCT scanner can be used in creation of 3D digital model that 
can be used with computer guided implant in fabrication of the surgical stent(Rossini et al. 2016). 
And the question, is the accuracy of surgical guide will be affected when designed by one of these 
different modalities? 
Rationale for conducting the research: 
Digital 3D dentoginival details are very important in computer guided implantology and designing of 
surgical stent.nowadays there are many methods to obtain this soft tissue replica as CBCT,desktop 
scanner and intra oral scanner.this study is conducted to asses the effect of different method of soft 
tissue digitization on the accuracy of surgical template used in computer guided implantology. 
Review of literature:  

 
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Many studies were conducted to evaluate the accuracy of desktop scanne, CBCT and intraoral 
scanner to obtain 3D dentogingival details that used in many dental application as orthodontic 
treatment and computer guided implantology. 
In Akyalcin et al. 2013 after scanning 60 dry skulls by intraoral scanner and CBCT ( CS 9300 unit 
Carestream Health, Atlanta, Ga) to evaluate the accuracy of 3-dimensional digital models acquired 
from  intraoral scanner compared with both manual and cone-beam computed tomography 
measurements of the same dental anatomy. Measurements from the intraoral scanner demonstrated 
near-perfect agreement (ICC, 0.91-0.99) with the caliper measurements. Cone-beam computed 
tomography measurements had moderate to high levels of agreement (ICC, 0.65-0.99) compared with 
the caliper measurements.Study conclusion was that intraoral scanner provide almost 1-to-1 
diagnostic information of the investigated anatomy and was superior to the cone-beam computed 
tomography measurements (Akyalcin et al. 2013) 
Kim & Lagravére, 2016 revealed that of desktop laser scanned digital models are highly accurate 
compared to physical models and CBCT scans for assessing the spatial relationships of dental arches 
for orthodontic diagnosis after scanning 50 plaster models using the Ortho Insight 3D laser scanner 
and Bolton ratios were calculated with its software. CBCT scans were imported and analyzed using 
AVIZO software. Plaster models measurements with a digital caliper were considered as a gold 
standard (Kim and Lagravére 2016) . 
Systematic review of Ferreira et al 2017 concluded that digital models obtained from CBCT were not 
accurate for all measures assessed. The differences were clinically acceptable for all dental linear 
measurements, except for maxillary arch perimeter. Digital models are reproducible for all 
measurements when intraexaminer assessment is considered and need improvement in interexaminer 
evaluation (Ferreira et al. 2017). 
In José et al. 2017 one hundred patients were scanned by intraoral scanner and CBCT (Planmeca 
Promax 3D ,Planmeca, Helsinki, Finland). Patients initial plaster models were scanned by desktop 
scanner scanner to be used as a control group.measurment that performed on these digital models 
revealed that intraobserver and interobserver error for the intraoral scanner model was less than 0.44 
mm while for segmented CBCT models, the error was less than 0.97 mm. intraoral scanner models 
provided statistically and clinically acceptable accuracy for all dental measurements, while CBCT 
models showed a tendency to underestimate measurements in the lower arch, although within the 
limits of clinical acceptability (José et al. 2017). 
In Robben et al. 2017 ,patients cast was  scanned by five different  CBCT devices to evaluate the 
accuracy of CBCT cast digitization by different machines. The accuracy measurements showed 
significant differences among the CBCT devices in comparison to direct measurements in plaster cast 
but study conclusion was CBCT devices are suitable for the digitization of plaster casts and show 
very good clinical accuracy. Dental offices equipped with CBCT devices could digitize plaster casts 
without the need for additional devices (Robben et al. 2017). 
  
Explanation for choice of comparators:  
Desktop scanner is selected as a control group depending on the following studies: 
Flügge et al. 2013 revealed that of scanning with the intraoral scanner is less accurate than scanning 
with the extraoral scanner . Intraoral scanning with the iTero (IOS)is less accurate than model scanning 

 
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with the iTero(IOS), suggesting that the intraoral conditions (saliva, limited spacing) contribute to the 
inaccuracy of a scan (Flügge et al. 2013). 
Wesemann et al. 2017 revealed that the most accurate results were obtained by the extraoral scanner. 
The R700 and the TRIOS intraoral scanner showed comparable results. CBCT-3D-rendering with the 
Promax 3D Mid CBCT unit revealed significantly higher accuracy with regard to dental casts than 
dental impression after sixty-four scans were taken with each of the desktop scanners R900 and R700 
(3Shape), the intraoral scanner TRIOS Color Pod (3Shape), and the Promax 3D Mid cone beam 
computed tomography (CBCT) unit (Planmeca). All scans were measured with measuring software 
(Wesemann et al. 2017). 
Another study considered desktop scanner as a gold standard to asses the accuracy of 7 intraoral 
scanner (Patzelt et al. 2014) (Renne et al. 2017). 
7. Objectives: 
This study is conducted to assess the effect of different method of digitization of dento-gingival details 
(intraoral scanner,CBCT or desktop scanner ) on the accuracy of surgical guide used for computer 
guided implantolgy. 
 
 
Hypothesis:  
Null 
 
Primary objective: 
P: Partially edentulous patient seeking implant restoration using computer guided implantology 
I1: Surgical guided manufactured using intra oral digital impression 
I2: Surgical guide manufactured using model cast scanning by CBCT  
C: Surgical guide manufactured using model cast scanning by extra-oral laser scanner 
O: Assessment of accuracy of surgical guided manufactured using digital impression, model cast 
scanning by CBCT and Desktop scanner by Evaluation of angular deviation of virtual implants and 
actual implant position by 3rd party software in degrees. 
Secondary objectives 
Evaluation of linear deviation of virtual implants and actual implant position by 3rd party software in 
mm. 
8. Trial design: 
Randomized clinical trial will be conducted on nine patients in outpatient clinic of oral and 
maxillofacial radiology department in Faculty of Dentistry, Cairo university. 
Patients will be divided into 3 group : 

 
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Intervention Group one : Surgical guide manufactured using intra oral digital impression 
Intervention Group two: Surgical guide manufactured using model cast scanning by CBCT  
Control group: Surgical guide manufactured using model cast scanning by desktop scanner 
III. Methods 
A) Participants, interventions & outcomes 
9. Study settings: 
Randomized clinical trial will be conducted  in outpatient clinic  of oral and maxillofacial radiology 
department in Faculty of Dentistry, Cairo university. 
 
 
 
10. Eligibility criteria: 
Inclusion criteria  
• partially edentulous patient. 
• Patients with bucco-lingual bone thickness more than 6 mm allowing flapless implant 
placement. 
Exclusion criteria: 
• Completely edentulous patient or free end saddle edentulous area. 
• Patients needing graft or sinus lifting with implant placement. 
• Patients with thin ridges. 
• Patients with systemic disease that may affect bone quality. 
• Patients with poor oral hygiene and active periodontal diseases. 
• Patient with limited mouth opening  
11. Interventions 
 Patients fulfilling inclusion criteria will be divided randomly into 3 groups, 
• Group 1: Full arch digital impression will be taken by IOS carestream CS3600 to 
produce the digital cast for patient in form of STL file. 
• Group 2: Conventional impression will be taken for patient then poured to obtain a 
plaster cast. This plaster cast will be scanned by CBCT to produce a digital cast in 
form of STL file. 
• Group 3: Conventional impression will be taken then poured to obtain a plaster cast 
that will be digitized by desktop scanner to obtain a digital cast in form of STL file. 

 
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All Patients will be scanned by CBCT machine (Planmeca Promax 3D Mid - 
Asentajankatu, Helsinki, Finland) ) to obtain the bony data in the edentulous area in 
which implant will be placed. 
Digital model from each group & CBCT scanning will be imported by 3rd party 
software (blue sky), and digital cast will be superimposed over CBCT images for each 
patient. Then virtual implant planning will be performed. 
Surgical guide will be designed and exported as STL file to be 3D printed. 
Implant placement will be performed by 10 years’ experience implantologist using 
the surgical guide. 
After implant placement, post-operative CBCT scan for each patient will be performed 
by the same parameters of pre operative CBCT scans. 
Postoperative CBCT scanning will be imported by 3rd party software and 
superimposes over the preoperative CBCT images that used in implant planning and 
surgical guide designing to assess the accuracy of implant placement by surgical guide 
in comparison to the virtual implant planning to determine the effect of method of 
digitization of dento-gingival data of patient on the accuracy of surgical guide 
 
 
 
12. Outcomes: 
Outcome 
Measuring device 
Measuring unit 
Evaluation of angular deviation of virtual 
implants and actual implant position 
Special computer software (Blue 
sky bio ) 
(Degrees) 
Evaluation of linear deviation of virtual 
implants and actual implant position 
Special computer software (Blue 
sky bio ) 
(mm) 
 
13. Participant timeline 
Group one 
Group two 
Group three 
Pre operative CBCT scan  
Pre operative CBCT scan 
Pre operative CBCT scan 
Digital impression by IOS. 
Patient cast will be scanned by 
CBCT. 
Patient cast will be scanned by 
desktop scanner 
Digital 
model 
& 
CBCT 
scanning will be imported by 
3rd party software (blue sky), 
and 
digital 
cast 
will 
be 
superimposed 
over 
CBCT 
images for each patient. Then 
Digital 
model 
& 
CBCT 
scanning will be imported by 
3rd party software (blue sky), 
and 
digital 
cast 
will 
be 
superimposed 
over 
CBCT 
images for each patient. Then 
Digital 
model 
& 
CBCT 
scanning will be imported by 
3rd party software (blue sky), 
and 
digital 
cast 
will 
be 
superimposed 
over 
CBCT 
images for each patient. Then 

 
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virtual implant planning will be 
performed. 
virtual implant planning will be 
performed. 
virtual implant planning will be 
performed. 
After implant placement, post-operative CBCT scan for each patient will be performed by the same 
parameters of pre operative CBCT scans. 
Postoperative CBCT scanning will be imported by 3rd party software and superimposes over the 
preoperative CBCT images that used in implant planning and surgical guide designing to assess the 
accuracy of implant placement by surgical guide in comparison to the virtual implant planning to 
determine the effect of method of digitization of dento-gingival data of patient on the accuracy of 
surgical guide 
14. Sample size: 
Sample size calculation was done using R statistical package, version 3.3.1 (21-06-2016).  Copyright 
(C) 2016.  The R Foundation for Statistical Computing. (1) 
 
One-way analysis of variance power calculation for more than two groups was used to detect the proper 
sample size.  Means and standard deviations were determined according to Arisan et al. (2010) based 
on the degree of angular deviation. 
The results showed that, at a power of 80% and a two-sided significance level of 5%; a total sample 
size of 9 implants will be adequate to reject the null hypothesis that the group means are equal.  This 
means with equal allocation to three arms, there will be 3 implants in each group.   
 
 
15. Recruitment: 
Patients will be selected from the outpatient clinic of the Oral and Maxillofacial Surgery Department 
– Cairo University. 
Screening of patients will continue until the target population is achieved. 
Identifying and recruiting potential subjects is achieved through patient database. 
B) Assignment of interventions 
16. Allocation: 
16a. Randomization: 
• 
Patients will be randomly divided to three groups according to three different method of 
digitization of dento-gingival details(IOS,CBCT and desktop scanner) 
The patients will be randomly divided into 3 groups using www.random.org 
The whole sample size will be divided into equal 3 groups 
 16b. Allocation concealment mechanism:  
• 
All patients who give consent for participation and who fulfill the inclusion criteria will be 
randomized. 
• 
Funded patient files in a dark sealed envelope will be the method for allocation concealment. 

 
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• 
The supervisors (M.D. and A.M.) are responsible of division the sealed envelopes into three 
groups and implementation for patients allocation. 
16c. Implementation 
• 
Main supervisor (MD) will generate the allocation sequence. 
• 
(AM) and implantologist will enroll participants.  
• 
Co-supervisor  will assign participants to interventions. 
 
17. Masking/blinding: 
• 
Each patient will be given a code by the researcher (AT) and the observers will be blind to 
which group this case belong. 
• Evaluators and statistician will be blinded 
C) Data collection, management, and analysis: 
18. Data collection methods 
Accuracy of surgical guide     
a- The angular and linear deviation between the virtual planning and the post-operative result using 
CBCT. 
b- Plans to promote participant retention  
Telephone numbers of all patients included the study will be recorded as a part of the written consent. 
-All patients will be given a phone call at the time of the pre-determined follow up dates . 
 
 
 
19. Data management: 
• 
All data will be entered electronically. 
• 
Patient files funded in a dark sealed envelope, stored in numerical order and stored with the 
co-supervisor. 
• 
All data will be maintained in storage for 1 year after completion of the study. 
 
20. Statistical methods: 
Statistical analyses will be  carried out using SAS Version 9.1.3. USA). A power 
analysis with n = 10 and a standard deviation of 1 revealed a power of 90% (power analysis of a 
noninferiority test of one mean). 

 
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D) Data monitoring: 
21. Monitoring 
The trial and its data will be monitored by MD and A.A to ensure that there are no problems with trial’s 
procedure and ways of collecting data. 
22. Harms 
• 
The possible adverse effect of the intervention is inaccuracy of the process of surgical guide 
fabrication and this require remake of surgical guide. 
23. Audit 
• 
Auditing of the study design will be done by the evidence based committee-oral and 
maxillofacial radiology department - Faculty of Dentistry, Cairo University, at the end of the trial. 
IV. Ethics and dissemination 
24. Research ethics approval 
• 
This protocol and the template informed consent form will be reviewed by the ethics committee 
of scientific research, Faculty of Dentistry, Cairo University. 
25. Protocol amendments 
• 
Any modification to the protocol which may impact on the conduct of the study, potential 
benefit of the patient or may affect patient safety, including changes of study objectives, study design, 
sample sizes, study procedures, or significant administrative aspects will require a formal amendment 
to the protocol. 
 
• 
Such amendment will be agreed upon by the council of oral radiology department. 
26. Informed consent 
• 
The researcher will introduce the trial to patients and will discuss the trial with patients. The 
purpose, the nature of this study and detailed surgical procedure with possible complications will be 
also discussed. 
• 
Patients will then be able to have an informed discussion with the participating consultant. The 
researcher will obtain written consent from patients willing to participate in the trial. All consent forms 
will be translated into Arabic. 
27. Confidentiality 
All study related information will be stored securely at the study site. All participant 
information will be stored in locked file cabinets in areas with limited access. All CT 
images, reports, data collection, process and administrative forms will be identified by a 
coded ID (identification number) only to maintain participant confidentiality. All records 
that contain names or other personal identifiers, such as informed consent forms, will be 
stored separately from study records identified by code number. 

 
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28. Declaration of interest 
The study is self-funded and there is no conflict of interest to declare. 
29. Access to data 
• 
The co-supervisor will be given access to the data. 
• 
To ensure confidentiality, data dispersed to project team members will be blinded of any 
identifying participant information  
30. Post-trial care 
All patients will be followed up until complete healing and satisfactory reconstruction results occur. 
31. Dissemination policy 
• 
Study will be registered online on the clinical trial.gov. 
• 
Study results will be published in a thesis as partial fulfillment of the requirements for PHD degree 
of oral and maxillofacial radiolgy. 
• 
Paper will be extracted from the study for publication.. 
V. Appendices 
32. Informed consent 
• 
The researcher will introduce the trial to patients and will discuss the trial with patients. The 
purpose, the nature of this study and detailed surgical procedure with possible complications will be 
also discussed. 
• 
Patients will then be able to have an informed discussion with the participating consultant. The 
researcher will obtain written consent from patients willing to participate in the trial. All consent forms 
will be translated into Arabic. 
33. Biological specimens 
Plans for collection, laboratory evaluation, and storage of biological specimens for genetic or molecular 
analysis in the current trial and for future use in ancillary studies, if applicable. 
 
VI. References 
1. Akyalcin, Sercan et al. 2013. “Diagnostic Accuracy of Impression-Free Digital Models.” 
American Journal of Orthodontics and Dentofacial Orthopedics 144(6): 916–22. 
http://dx.doi.org/10.1016/j.ajodo.2013.04.024. 
2. Becker, Kathrin, Ulf Schmücker, Frank Schwarz, and Dieter Drescher. 2018. “Accuracy and 
Eligibility of CBCT to Digitize Dental Plaster Casts.” Clinical Oral Investigations 22(4): 
1817–23. 
3. Dolcini, Giorgio Andrea, Marco Colombo, and Carlo Mangano. 2016. “From Guided 

 
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Surgery to Final Prosthesis with a Fully Digital Procedure: A Prospective Clinical Study on 
15 Partially Edentulous Patients.” International Journal of Dentistry 2016. 
4. Ferreira , Christovam , Alencar, Andréa F J da Motta. 2017. “© 201 7 The Authors. 
Published by the British Institute of Radiology.” British Institute of Radiology 46(7). 
5. Flügge, Tabea V. et al. 2013. “Precision of Intraoral Digital Dental Impressions with ITero 
and Extraoral Digitization with the ITero and a Model Scanner.” American Journal of 
Orthodontics and Dentofacial Orthopedics 144(3): 471–78. 
6. Frisardi, Gianni et al. 2011. “Integration of 3D Anatomical Data Obtained by CT Imaging 
and 3D Optical Scanning for Computer Aided Implant Surgery.” BMC Medical Imaging 11. 
7. Hultin, Margareta, Krister G. Svensson, and Mats Trulsson. 2012. “Clinical Advantages of 
Computer-Guided Implant Placement: A Systematic Review.” Clinical Oral Implants 
Research 23(SUPPL.6): 124–35. 
8. Jamjoom, Faris Z. et al. 2018. “Effect of Length and Location of Edentulous Area on the 
Accuracy of Prosthetic Treatment Plan Incorporation into Cone-Beam Computed 
Tomography Scans.” Clinical Implant Dentistry and Related Research 20(3): 300–307. 
9. José, Verónica San et al. 2017. “Dental Measurements and Bolton Index Reliability and 
Accuracy Obtained from 2D Digital, 3D Segmented CBCT, and 3d Intraoral Laser Scanner.” 
Journal of Clinical and Experimental Dentistry 9(12): e1466–73. 
10. Kim, Jooseong, and Manuel O. Lagravére. 2016. “Accuracy of Bolton Analysis Measured in 
Laser Scanned Digital Models Compared with Plaster Models (Gold Standard) and Cone-
Beam Computer Tomography Images.” Korean Journal of Orthodontics 46(1): 13–19. 
11. van der Meer, Wicher J., Frank S. Andriessen, Daniel Wismeijer, and Yijin Ren. 2012. 
“Application of Intra-Oral Dental Scanners in the Digital Workflow of Implantology.” PLoS 
ONE 7(8): 1–8. 
12. Patzelt, Sebastian B.M. et al. 2014. “Accuracy of Full-Arch Scans Using Intraoral Scanners.” 
Clinical Oral Investigations 18(6): 1687–94. 
13. Renne, Walter et al. 2017. “Evaluation of the Accuracy of 7 Digital Scanners: An in Vitro 
Analysis Based on 3-Dimensional Comparisons.” Journal of Prosthetic Dentistry 118(1): 
36–42. http://dx.doi.org/10.1016/j.prosdent.2016.09.024. 
14. Robben, Jan et al. 2017. “Suitability and Accuracy of CBCT Model Scan: An in Vitro 
Study.” International journal of computerized dentistry 20(4): 363–75. 
http://www.ncbi.nlm.nih.gov/pubmed/29292411. 
15. Rossini, Gabriele et al. 2016. “Diagnostic Accuracy and Measurement Sensitivity of Digital 
Models for Orthodontic Purposes: A Systematic Review.” American Journal of Orthodontics 
and Dentofacial Orthopedics 149(2): 161–70. 
16. Vercruyssen, Marjolein, Isabelle Laleman, Reinhilde Jacobs, and Marc Quirynen. 2015. 
“Computer-Supported Implant Planning and Guided Surgery: A Narrative Review.” Clinical 
Oral Implants Research 26: 69–76. 
17. Wesemann, Christian, Jonas Muallah, James Mah, and Axel Bumann. 2017. “Accuracy and 
Efficiency of Full-Arch Digitalization and 3D Printing: A Comparison between Desktop 
Model Scanners, an Intraoral Scanner, a CBCT Model Scan, and Stereolithographic 3D 
Printing.” Quintessence Int 48(1): 41–50. http://www.ncbi.nlm.nih.gov/pubmed/27834416 
(September 21, 2018). 
18. Worthington, Philip, Jeffrey Rubenstein, and David C. Hatcher. 2010. “The Role of Cone-
Beam Computed Tomography in the Planning and Placement of Implants.” The Journal of 
the American Dental Association 141(October): 19S–24S. 
http://linkinghub.elsevier.com/retrieve/pii/S0002817714637417. 
 

 
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