10.59987/ads/2022.1-4.3-8
The purpose of this article is to compare the alginate impression with digital impression using the introral scanner Carestream 3600 and understand which is preferred by patients. 50 young orthodontic patients (25 boys and 25 girls) who had no previous experience of impressions were enrolled in the study. After the impressions the patients were subjected to a questionnaire for both types of impressions. They were asked about feelings of nausea and breathing issues related to whether a digital or alginate impression was taken. As for the feeling of nausea, 24 girls and 22 boys did not have this feeling with digital impressions; as regards breathing, 19 girls and 23 boys did not find respiratory problems with the intraoral scanner. At the end, patients were asked which method they preferred. About 75% both for girls and boys preferred the intraoral scanner. Therefore, the digital method was found to be the most comfortable for the patients.
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Traditional versus digital impression: compliance and preference in pediatric patients- review
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Traditional versus digital impression: compliance and preference in pediatric patients- review
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                                                                                                               Article


Traditional versus digital impression:
compliance and preference in pediatric
patients- review


Valeria Luzzi1                                              tients and children, for whom it represents a moment of
Gabriele Di Carlo1                                          discomfort. It can also be complex for the clinician. The
Elvira Crupi1                                               possibility of effectively replacing the traditional physi-
Ester Quarta1                                               cal detection of the impression represents the main ad-
Francesca De Angelis1                                       vantage of the optical impression. In orthodontics this
Stefano Di Carlo1                                           has a fundamental importance both from a clinical and
Antonella Polimeni1                                         diagnostic point of view. Traditional orthodontic study
Gaetano Ierardo1                                            models have also been replaced by digital study mod-
                                                            els, through which the orthodontist can perform all the
1
    Department of oral and Maxillo-Facial Sciences, Sapi-   measurements he or she made on the plaster model
    enza University of Rome, Via Caserta 6, 00161 Rome,     [2]. In orthodontics, a first attention was paid to the first
    Italy;                                                  scanners capable of transforming plaster models into
                                                            3D images, but with the appearance on the market of
                                                            intraoral scanners, there was a real revolution [3]. In the
                                                            most recent literature there are many studies that focus
*Corresponding author:                                      on the main features of intraoral scanners, such as the
Francesca De Angelis - University of Sapienza Italy         accuracy and precision of measurements, but very few
francesca.deangelis@uniroma1.it                             or almost non-existent studies evaluate the patient’s
                                                            compliance. For this reason, through this research we
                                                            want to understand which method is most appreciated
Abstract
                                                            for taking impressions in the field in the pediatric ortho-
The purpose of this article is to compare the alginate      dontic field.
impression with digital impression using the introral
scanner Carestream 3600 and understand which is
preferred by patients. 50 young orthodontic patients        Materials and methods
(25 boys and 25 girls) who had no previous experi-
                                                            50 pediatric patients, 25 females and 25 males with an
ence of impressions were enrolled in the study. Af-
                                                            age between 6 and 9 years (Table 1), who made the first
ter the impressions the patients were subjected to a
                                                            dental visit at the Department of Pediatric Dentistry of
questionnaire for both types of impressions. They
                                                            the La Sapienza University. The parents of the young pa-
were asked about feelings of nausea and breathing
                                                            tients were informed about the purposes of the research
issues related to whether a digital or alginate im-
                                                            and signed informed consent. In order to be included in
pression was taken. As for the feeling of nausea, 24
                                                            the study, patients had to meet two requirements to par-
girls and 22 boys did not have this feeling with digital
                                                            ticipate in the study:
impressions; as regards breathing, 19 girls and 23
                                                            - They never had impressions procedures before the
boys did not find respiratory problems with the intra-
                                                                 study;
oral scanner. At the end, patients were asked which
                                                            - Make an impression to have study models for orth-
method they preferred. About 75% both for girls and
boys preferred the intraoral scanner. Therefore, the             odontic purposes.
digital method was found to be the most comfortable         Each of them was first subjected to impression taking
for the patients.                                           with alginate and occlusion wax, sent to the technician
                                                            to be able to develop the plaster models and later with
Key words: children, digital impression, alginate           the CareStream 3600 intraoral scanner, thus obtaining
impressions, patient comfort, patients’ preferences,        50 plaster models and 50 corresponding digital models.
orthodontics patient, feeling of nausea, problems in        Each patient was administered an illustrated question-
breathing.                                                  naire, before and after taking the impression. It con-
                                                            tained three questions, made more pleasant in the eyes
                                                            of the children by the replacement of the boxes where
Introduction
                                                            to place the X with three smiley, happy, sad or indiffer-
Nowadays with the advancement of progress and tech-         ent faces (Table 2). The outcomes that have been cho-
nology, dentistry is increasingly facing, embracing all     sen were studied through an assessment of the sense
its branches to the third dimension [1]. The traditional    of nausea, ease of breathing and any other problems
impression is an unwelcome phase both for adult pa-         related to the two techniques. Only in the final analysis



Annali di Stomatologia 2022; XIII (1-4): 3-8                                                                                3
    Traditional versus digital impression: compliance and preference in pediatric patients- review

                          Table 1. Breakdown of patients by age.


                                                                 50 children



                                25 girls                                                    25 boys


                           5                             6 YEARS OLD                   3

                           6                             7 YAERS OLD                   7

                           7                             8 YEARS OLD                   8

                           7                             9 YEARS OLD                   7



 Table 2. Satisfaction questionaire submitted to each
                                           Table       patient. of patients by age
                                                 1: breakdown

                            SATISFACTION QUESTIONNAIRE IMPRESSION
                               SATISFACTION QUESTIONNAIRE
                               DURING THE IMPRESSION       IMPRESSION
                                                     WITH CAMERA

                                 DURING
                                   - DIDTHE
                                         YOUIMPRESSION WITH CAMERA
                                             COME TO THROW  UP?

                                             -       DID YOU COME TO THROW UP?

                                     -       COULD YOU BREATHE QUIETLY?

                                         -       COULD YOU BREATHE QUIETLY?
                                             -       I HAVEN’T ANY PROBLEMS

                                                 -       I HAVEN’T ANY PROBLEMS
                                DURING THE IMPRESSION WITH PONGO

                                     - DID YOU COME TO THROW UP?
                                   DURING THE IMPRESSION WITH PONGO

                                             - DID YOU COME TO THROW UP?
                                     -        COULD YOU BREATHE QUIETLY?


                                         -       COULD YOU BREATHE QUIETLY?
                                             -   I HAVEN’T ANY PROBLEMS


                                                 -       I HAVEN’T ANY PROBLEMS
                                    WHICH METHOD DO YOU PREFER?

                                                             -       CAMERA
                                         WHICH METHOD DO YOU PREFER?
                                                 - GEL
                                                                 -       CAMERA
                                                     -    NO PREFERENCE
                                                                     -    GEL

4                                                                                          Annali di Stomatologia 2022; XIII (1-4): 3-8
V. Luzzi et al.

was the participant asked to express a preference for                         swered that they had no breathing problems, while 6 in
one or the other method. The language that was used in                        an uncertain manner. The data vary by analyzing the
the questionnaires is a simple jargon easily understood                       response with the conventional method. Only 10 girls
by the young patients. The word “pongo” was used in-                          replied that they could breathe quietly, 8 were uncertain
stead of alginate and the word “camera” instead of scan-                      and 7 had problems with breathing (Figure 2).
ner. All procedures were carried out by an operator and                       In graph number 3, the answers of the female patients to
over a period of a month.                                                     the third question regarding the possibility of having had
                                                                              other problems were analyzed. Regarding fingerprints
Results                                                                       for 18 girls there was no problem. Two answered had
                                                                              problems and the remaining 5 answers are uncertain.
As graph one shows, through which the responses con-                          Regarding the conventional method, it can be observed
cerning the feeling of nausea were analyzed, 24 girls re-                     that an equal number of girls responded in the affirma-
plied that they had no sensation, while only one girl gave                    tive and neutral way, while 3 of them have definitely en-
a “short” answer regarding the taking of impressions with                     countered problems (Figure 3).
the scanner. While, for conventional impressions, 6 girls                     The responses of the children were assessed and in
had to vomit, for 10 the experience was uncertain and at                      chart 4. The feeling of nausea was analyzed from the
last 9 girls had no vomiting reflex (Figure 1)                                scanner - 22 children had no problems, 3 remained neu-
In the second graph, the answers from female patients to                      tral and no child gave an affirmative answer.
the second question         ofNO
                               thePREFERENCE
                                    questionnaire were analyzed               On the contrary, during taking the alginate impressions,
                        -- NO      PREFERENCE
regarding the possibility of having difficulties in breathing.                only 5 children did not have the vomiting reflex, 9 per-
Regarding
      Table 2:the
      Table 2:      impression
               satisfaction
               satisfaction        with submitted
                            questionaire
                            questionaire the scanner,
                                         submitted    each19
                                                   to each
                                                   to         girls an-
                                                           patient
                                                           patient            ceived it and finally 11 remained neutral (Figure 4).



             QUESTION 1:
             QUESTION 1: DID
                         DID YOU
                             YOU COME
                                  COME TO
                                       TO THROW
                                          THROW
                                                                                        QUESTION 3: I HAVEN'T ANY PROBLEMS
                              UP?
                              UP?
              30
              30
                                                                                       20
              25                                                                       18
                                                                                        QUESTION 3: I HAVEN'T ANY PROBLEMS
              25
                                                                                       16
              20        24
                        24                                                             14
              20                                                                        20
                                                                                       12
              15                                                                        18
              15                                                                       10
                                                                                        16     18
                                                                                        8
                                                                                        14
              10
              10                                                                        6
                                                                                        12          11                 11
                                                10
                               99               10                                      4
               55                                                                       10
                                         11                         66                  28     18                 5
                                                          00                                                                   2 3
           00                                                                           06
                                                                                                    11                 11
     SCANNER              24                                                      SCANNER        18                  5           2
     SCANNER              24                  11               00                        4
     ALGINATE                                                                     ALGINATE       11              5  11           3
     ALGINATE             99                  10
                                              10               66                        2
                                                                                                                              2 3
                                                                                         0
                                                                                   SCANNER        18                 5          2
Figure 1. Feeling  of nausea
                Figure
               Figure      feelinginof
                       1: feeling
                       1:           ofgirls.
                                       nausea in
                                       nausea  in girls
                                                  girls                       Figure 3. Others problems
                                                                                            Figure         inproblems
                                                                                                   3: others  girls. in girls
                                                                                   ALGINATE       11                11          3


                                                                                                QUESTION      1: DID
                                                                                                 Figure 3: others      YOU
                                                                                                                  problems    COME TO
                                                                                                                           in girls
            QUESTION 2:
            QUESTION 2: COULD
                        COULD YOU
                               YOU BREATHE
                                   BREATHE                                                                  THROW UP?
                        QUIETLY?
                        QUIETLY?
                                                                                                QUESTION 1: DID YOU COME TO
              20                                                                          25            THROW UP?
              20
              18
              18                                                                          20
              16
              16                                                                           25        22
              14
              14                                                                          15
                                                                                           20
              12
              12                                                                                      22
                                                                                          10
              10
              10                                                                           15
                        19
                        19
               88                                                                         5                                      11
                                                                                          10                                                        9
               66                                                                                               5                      0
                             10
                             10                                                                                         3
                                                                                       0                                         11
               44                                    88                                 5
                                           66                            77      SCANNER                  22                3                  09
               22                                                                                               5                      0
                                                               00                ALGINATE
                                                                                        0                  5            3 11                   9
          00                                                                      SCANNER                  22             3                0
    SCANNER
    SCANNER               19
                          19                    66                  00
                                                                                  ALGINATE                 5                11             9
    ALGINATE
    ALGINATE              10
                          10                    88                  77
                                                                                                 Figure 4: feeling of nausea in boys

Figure 2. Breathing
             Figure pproblems
             Figure 2:
                    2:            in girls. in
                       breathing pproblems
                       breathing pproblems   in girls
                                                girls                         Figure 4. Feeling of nausea
                                                                                             Figure 4: feeling in  boys. in boys
                                                                                                                of nausea



Annali di Stomatologia 2022; XIII (1-4): 3-8                                                                                                            5
    Traditional versus digital impression: compliance and preference in pediatric patients- review

    In graph 5 the answers to question number 2 were an-
    alyzed, which concerned the possibility of breathing
    peacefully. While using the digital method, 23 children                          QUESTION 2: DID YOU BREATHE QUIETLY?
    were able to breathe quietly, 2 responded uncertainly                             25
    while no negative response was obtained. While using                                   23
                                                                                    QUESTION  2: DID YOU BREATHE QUIETLY?
    the alginate, on the other hand, 9 children responded in                         20
                                                                                     25
    an affirmative way, 4 in a negative way and most, that is,                                   23
    12 children, responded in an uncertain / hesitant manne
                                                                                     15
                                                                                     20
    (Figure 5).
    Finally, in chart number 6, the answers to the question
                                                                                     10
                                                                                     15
    on the possibility of having had other problems were
    analyzed. During the impression with the scanner, there
                                                                                                                               12
    were no problems for 20 children and five answered                               105                   9
    hesitantly. With the alginate impression, 5 children re-                                                                                      4
                                                                                                                   2           12     0
    plied that they had problems, 12 replied hesitantly while                      50                      9
    for 8 of them experienced no problem (Figure 6).                         SCANNER                  23                   2               0
                                                                                                                                               4
    The last questionnaire that was completed asked the                      ALGINATE
                                                                                   0                  9            2 12               0 4
    children to express a preference for one or the other                    SCANNER                  23                 2                0
    method. From chart ° 7 for boys and ° 8 for girls it can                 ALGINATE                 9                12                 4
    be highlighted how in equal percentage (75%), in both               Figure 5. Breathing problems in boys.
                                                                                            figure 5: breathing problems in boys
    sexes, the scanner is preferred. Alginate is the pre-
    ferred method to a greater extent by boys (20%) than
    girls who choose this option (12%). At last, 5% of boys                                 figure 5: breathing problems in boys
    and 12% of girls do not prefer any of the two methods                         QUESTION 3: I HAVEN'T ANY PROBLEMS
    (Figure 7).
                                                                                   25
                                                                                 QUESTION 3: I HAVEN'T ANY PROBLEMS
    Discussion
    Study models, therefore, represent an essential form of                           20
                                                                                      25
    orthodontic documentation for documentation and anal-
    ysis of the case. With the advent of digital impression,                          15
                                                                                      20
    many of the limits that were had with conventional im-
    pression were overcome. They are not subject to phys-                             10
                                                                                      15          20
    ical damage, do not create dust or other disorders and
                                                                                                                                 12
    require negligible storage space. The digital information                         105        20        8
    can be stored on the computer’s hard drive, on storage                                                             5                  0           5
                                                                                                                                 12
    devices such as CDs or on a central server. Recovery is                         50
    fast and efficient because the models are stored by the                   SCANNER                  20 8                  5                 0
                                                                                                                     5                 0              5
    patient’s name and number. They also make it possible                    ALGINATE
                                                                                   0                   8                   12                 5
    to reduce time and expense of duplicating the models                     SCANNER                  20                   5                  0
    to be transferred to colleagues or laboratories and, at                  ALGINATE Figure 86: other problems12
                                                                                                                in boys                       5
    last, they are an excellent case presentation tool [5]. But
    digital models also have disadvantages. The high initial                                 Figure 6: other problems in boys
    cost to which is added the cost of constant technologi-              Figure 6. Other problems in boys.




                        WHICH METHOD DO YOU                                       WHICH METHOD DO YOU
                              PREFER?                                                   PREFER?

                                                                                               NONE
                             NONE                                                               4%
                              12%                                     ALGINATE
                 ALGINATE                                               20%
                    12%
                                                                                                           SCANNER
                                       SCANNER                                                               76%
                                         76%




                        SCANNER      ALGINATE      NONE                       SCANNER           ALGINATE          NONE


    Figure 7. Preference of boys and girls.       Figure 7: preference of boys and girls




6                                                                                                  Annali di Stomatologia 2022; XIII (1-4): 3-8
V. Luzzi et al.

cal updating. There learning time that the clinician needs    and the time required to obtain the impressions was re-
to effectively master the system and familiarize with the     corded. Data indicated that subjects receiving intraoral
hardware and software. Some patients are more difficult       scans preferred digital impression and that subjects
to manage, for example the inability to hold their tongue     receiving alginate impressions were neutral, while effi-
still or to remain motionless with mouth open. Finally it     ciency varied based on the impression method. The au-
is difficult to scan very pronounced emergence profiles,      thors eventually concluded that intraoral scanners are
interproximal areas with severe misalignment, upper ret-      accepted by orthodontic patients and have an efficiency
romolar areas in proximity to the coronoid process and        comparable with conventional impression methods de-
data overlap of the antero-superior palate-occluded-ves-      pending on the type of scanner [9].
tibular sector [6].                                           In 2018 a study conducted by Mangano A. et al exam-
According to the numerous advantages of digital im-           ined 30 young orthodontic patients (15 male and 15 fe-
pressions, there are some studies in the literature which     male) who had never had experience with the impres-
show, like our study, that young patients prefer these.       sions. Conventional impressions for orthodontic study
In a 2014 study conducted by Yuzbasioglu E. et al the         models were taken using an in alginate and fifteen days
traditional impression was compared with the digital im-      later, the impressions were taken, using an intraoral
pression to understand what was preferred by the pa-          scanner (CS3600®, Carestream Dental, Rochester, NY,
tients. 24 young patients, 12 male and 12 female, who         USA). Immediately after taking the impression, the ac-
had never taken the impression neither in alginate nor        ceptability, comfort and stress of the patients were mea-
digitally, were examined. After taking the impressions        sured using two questionnaires and the State-Trait Anxi-
the patients’ preferences, their perceptions and working      ety Inventory. The data showed no difference in terms of
times were assessed through a questionnaire. Statisti-        anxiety and stress; however, patients preferred the use
cal analyzes were performed using the Wilcoxon Rank           of digital systems rather than conventional impression
test and P <0.05 was considered positive. The results         techniques [10].
showed significant differences between the groups in          In a 2019 study conducted by Ylmaz H. et al the fin-
terms of total working time and processing phases, but        gerprints were compared with alginate and digital ones,
patients still preferred the digital technique over the       assessing the comfort, preference and time required to
conventional one in terms of comfort [7].                     make the impression. 28 children were assessed and
In a 2015 study by Lukasz B. et al, the alginate impres-      comfort was examined by both patients and the clini-
sion technique was compared with two digital techniques       cian during the impression taking; the necessary chair
and the preference was assessed in young orthodontic          times were also assessed. For statistical analysis, the
patients. Thirty-eight subjects aged 10 to 17 years requir-   t test and Mann-Whitney U test were used and P <.05
ing impressions for orthodontic treatment were randomly       was considered significant. In terms of comfort, digital
allocated to 3 groups that differed in the order that an      impression were the ones most preferred by children,
alginate impressions and 2 different intraoral scanning       while in terms of time, no significant differences were
procedures were administered. After each procedure,           found between digital and alginate impressions [11].
patients were asked to evaluate their perceptions on a        Despite this literature supporting the purpose of this re-
5-point Likert scale for reflex of vomiting, nausea, diffi-   view, the study has some limitations. In fact, only one
culty breathing, feeling of discomfort, perception of scan    type of intraoral scanner was used, so other intraoral
time, anxiety and the use of a powder , and select the        scanners with their workflows could lead to different
preferred impression system. The presidential time and        results. In addition, the two types of impressions were
maximum mouth opening were also recorded. During              taken by a single operator, to avoid errors between dif-
the alginate impression taking in the upper arch, greater     ferent operators.
nausea (P = 0.00) and discomfort (P = 0.02) were per-
ceived compared to scans with CEREC Omnicam (Siro-
na Dental Systems, Bensheim, Germany); while there            Conclusions
were no significant differences in perceptions between
the impression taking in alginate and the Lava C.O.S.         The following study showed that young orthodontic pa-
(3M ESPE, St Paul, Minn) and between the 2 scanners.          tients prefer digital impressions, although alginate
51% of subjects preferred digital impressions, while 29%      impressions required the shortest chairside time. These
preferred alginate ones and 20% expressed no prefer-          results is also confirmed by the literature review not only
ence. Therefore, it was possible to conclude that young       in terms of patient comfort, but also for all the advantag-
orthodontic patients prefer digital techniques over algi-     es of intraoral scanners. More well-designed research
nate impressions, although these require less time in the     is needed in the future to increase our knowledge of pa-
chair [8].                                                    tients’ experiences with digital impressions.
Burzynskia J. A. et al in 2017 conducted an initial pilot
study through which a valid and reliable survey tool was
created that can measure 3 areas of patient satisfaction      References
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