Think Your Patients Like Intraoral Scanning Better? New Data on Patient Comfort.

BY TATE H. JACKSON
 
STUDY SYNOPSIS
A new study from a group in Copenhagen addresses a topic that many practicing orthodontists consider on a daily basis: how might intraoral scanning affect patient experience?
 
59 children (28 female) age 9-15 years were recruited to participate in the study, which took place during 2016 -2017. Of particular note, none of the participants had any prior experience with either intraoral scanning or alginate impressions.
 
Each of the children had an alginate impression made at their first visit, followed by an intra-oral scan (Trios, 3Shape) at the second visit. The same operator, who was a novice in terms of intraoral scanning (calibrated with 10 hours of instruction and 5 practice scans), obtained both the impressions and the scan.

All participants (n=59) experienced an intraoral scan after having experienced an alginate impression.

Patients rated comfort in terms of several parameters, including time perception, gag reflex, breathing, and smell and taste. Patients also answered questions that assessed anxiety during each procedure. Additionally, chairside time for each procedure was recorded, a cost estimate for both procedures was made, and dental arch measurements were made to test accuracy.
 
The results:

• Intraoral scans were significantly more comfortable across all parameters measured, except time perception and temperature.
• There was no significant difference in chairside time for either procedure.
• There were no significant differences in accuracy between digital models and casts.
  
• The initial cost of scanning was much greater than alginate impressions, although the two procedures reached a cost equivalency point after 3.6 years of use.
  

 
WHAT THE PROFESSOR THINKS
 A randomized study design would have been better, because it would have limited the priming or biasing effects that could be created by consistently exposing patients to alginate impressions first. Nonetheless, the longitudinal design in which each patient had both a scan and an impression administered by the same clinician is a strength of the study. Similarly, using a clinician relatively naïve in the use of an intraoral scanner, but presumably more experienced with alginate impressions, lends credibility to the result that scanning truly was more comfortable.
 
The study found that intraoral scanning is just as accurate as using alginate. These results are not surprising. Certainly, the ‘old way’ (alginate) is accurate enough, but now ample evidence confirms that 3D scanning and printing is capable of the accuracy and reliability needed for high-quality patient care.
 
When it comes to patient comfort, these data are more useful:

• For patients age 9-15 years, intraoral scanning is significantly more comfortable and less likely to be associated with anxiety than alginate impressions.
• Of note, patients are significantly less likely to experience a feeling of gagging or difficulty in breathing with an intraoral scan.

It is not a foreign concept to clinicians in practice that we might purchase costly new technology and then need to ‘justify’ its use in our clinic. To that end, we might be tempted to echo an industry claim that a new procedure or material is faster or more accurate. Now, orthodontists have peer-reviewed evidence that supports the use of intraoral scanners in order to improve the patient experience.

Does that mean alginate is no longer ‘standard of care’? Or, that intraoral scanners should be required to meet the standard of care? Certainly not.
 
It does mean that orthodontists can confidently suggest to patients that using an intraoral scanner is an evidence-based effort to provide them with the most comfortable experience possible.
 
Article Reviewed: Olja Glisica, Louise Hoejbjerrea, Liselotte Sonnesenb. A comparison of patient experience, chair-side time, accuracy of dental arch measurements and costs of acquisition of dental models. Angle Orthodontist. Online July 2019.

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