Influence of orthodontic bracket block-out materials on superimposition errors when substituting scanned dental imaging data onto computed tomography images.

Purpose: The study was performed to examine the error associated with image superimposition when computed tomography (CT) images of the dental region are substituted with dental scan data, according to the block-out material used in dental impressions. Materials and Methods: A typodont model was created by bonding orthodontic brackets to teeth on plaster dental stones using melted dental base-plate wax. In the experiment, 2 groups were compared: one using wax and the other using putty as the block-out material to prevent tearing of the impression material during the acquisition of dental impressions. In the wax group, dental cast digital data were superimposed onto the CT data of the typodont model using a tooth occlusal surface-based registration method. In the putty group, a surface-based registration method was used that incorporated not only the occlusal surfaces of the teeth, but also the area where the radiopaque putty covered the orthodontic brackets. The absolute value of the error on the dental surfaces was measured for comparisons. Results: Analysis of the scanned areas used for replacement in dental CT images revealed fewer superimposition errors when considering only the tooth occlusal surface area, excluding the area containing putty impression material. Conclusion: The clinical recommendation is to block out the orthodontic bracket with radiolucent wax when obtaining dental impressions. Furthermore, only dental occlusal surface-based registration should be used for the superimposition and replacement of the CT image of the dental area with scanned data from a dental cast model.