In Vitro Comparison of Trueness and Precision of Real Time Library Matching with Medit SmartX on Full Arch Implant Scanning Accuracy with Scan Ladder

Background: Accurate transfer of implant positions is essential for the long-term success of full-arch prosthetic rehabilitation. Photogrammetry is widely regarded as the gold standard for accuracy, but its high cost and complexity limit widespread use. Recent developments in artificial intelligence (AI)-assisted intraoral scanning, such as Medit’s SmartX protocol combined with the Scan Ladder system, may offer a simplified and cost-effective alternative. Methods: This in vitro study evaluated the trueness and precision of full-arch implant scans obtained with the Medit i900 intraoral scanner using SmartX real-time library matching and Scan Ladder scan bodies. A 3Shape E2 desktop scanner served as the reference standard. Six implant positions (35, 33, 31, 41, 43, 45) were scanned across 20 SmartX datasets (n = 120 observations). Average surface deviations were calculated against the master STL using CloudCompare software, and descriptive statistics and two-way ANOVA were performed in SPSS. Results: The SmartX + Scan Ladder workflow achieved a mean deviation of 11.41 μm with a standard deviation of 12.16 μm across all implant positions. Anterior sites (31: 4.7 μm; 45: 6.1 μm) showed the lowest deviations, while posterior sites exhibited slightly higher values (43: 22.5 μm). No mean deviation exceeded 25 μm, and no individual measurement surpassed 45 μm. Implant position was a significant factor influencing accuracy (P < .001), whereas scan iteration had no effect (P > .05). Conclusions: SmartX combined with Scan Ladder achieved trueness and precision within the sub-20 μm range, comparable to reported values for photogrammetry. These findings suggest that high-fidelity, full-arch digital implant impressions can be achieved using this simplified workflow. Further in vivo studies are required to validate clinical applicability under real-world conditions.