Validité, fiabilité et reproductibilité des modèles digitaux obtenus avec iTero (Align Technology) et Unitek TMP Digital (3M) en comparaison avec les modèles de plâtre

Objective: The primary objective of this study was to evaluate the validity, reliability and reproducibility of dental measurements obtained on digital models produced by iTero (Align Technology, San Jose, California) and by Unitek TMP Digital (3M, Monrovia, California) in comparison with those obtained on plaster models (gold standard). The secondary objective was to compare two different impression materials (alginate and polyvinylsiloxane-PVS) to determine whether the material used affects accuracy of the measurements. Methods: The first part of the study involved Unitek and iTero digital models, which were all obtained from 25 pairs of plaster models randomly selected from one of the co-author's private practice. Alginate and PVS impressions were taken on plaster models and were scanned by the Unitek scanner. The same models were then scanned with the iTero scanner. The second part of the study sought to compare iTero digital models (intraoral scans) with plaster models (alginate and PVS impressions) taken on 25 patients requiring treatment from the Orthodontic clinic of the University of Montreal. In both parts of the study, two authors took the following measurements on the different models: mesio-distal width of each tooth from first molar to the other first molar, intermolar and intercanine distances, overbite and overjet. Bolton 6 and 12 ratios and excesses, maxillary and mandibular space available and required were also calculated in order to determine space differentials. Results: A good to excellent reliability (ICC) was found for all measurements when comparing digital (Unitek and iTero) and plaster models [ICC=0.762–0.998], and excellent reliability when comparing both impression materials [ICC=0.947–0.996]. In the two parts of the study, measurements on iTero models were generally larger than on plaster models. Highest mean differences for iTero-plaster were found for maxillary space available and mandibular space available (systematically larger for that variable): 2.24 mm and 2.02 mm respectively in the first part of the study, 1.17 mm and 1.39 mm respectively in the second part. Differences were considered clinically insignificant for all variables. Intraexaminer reproducibility was good to excellent for plaster and digital models, except for mandibular space differential on Unitek models [ICC=0.690-0.692]. Interexaminer reproducibility was good to excellent for plaster and digital models in both parts of study, but fair to moderate for Unitek models regarding Bolton 6 and 12, and maxillary and mandibular space differentials [ICC=0.362-0.548].  Conclusions: The accuracy and reliability of dental measurements done on Unitek and iTero digital models were clinically acceptable and reproducible when compared with measurements done on traditional plaster models. The choice of impression material between alginate and PVS did not affect accuracy of the measurements. This study tends to indicate that Unitek and iTero digital models examined with their associated software can be reliably used for orthodontic cast analysis and diagnosis.

Keyphrases: Scanners intra-oraux, iTero, Unitek TMP Digital, Digital models, Intraoral scanners, Impression materials, Orthodontics