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Purpose: To assess the effect of different scan patterns on the fit of implant‐supported complete‐arch prototype prostheses fabricated via a complete digital extraoral protocol with a reverse scan body. Materials and Methods: A mandibular cast with four multi‐unit abutment (MUA) implant analogs with adequate antero‐posterior spread served as the reference cast, simulating a common clinical patient situation, and a polymethylmethacrylate interim screw‐retained prosthesis was fabricated on it. Novel reverse scan bodies were connected to the interim prosthesis on the intaglio of the MUA abutments and extraoral scanning was performed with a white light intraoral scanner (TRIOS 4; 3 shape) and three different scan patterns: starting from the occlusal surface of the interim prosthesis (O–group), starting from the intaglio (I–group), and helix pattern (H–group). The resulting STL files from the three groups were then imported to computer‐aided design (CAD) software and after the digital design, the STL files were exported to a computer‐aided manufacturing (CAM) milling machine which generated a total of 15 CAD‐CAM milled prototype prostheses per group. Two clinicians assessed the fit of each digitally fabricated prototype prosthesis on the reference cast, utilizing the screw‐resistance test and radiographic evaluation. Fisher's exact test was used to test the difference between the three groups, and Cohen's k‐score was used to assess the inter‐examiner agreement. Results: Out of the three different groups, the O–group scan pattern led to 100% prosthesis fit, while the prototype prostheses generated from I‐ and H‐groups had 80% and 53% fit, respectively. The results were statistically significant (p = 0.008). Conclusions: Occlusal scan pattern leads to fitting milled prototype prostheses after extraoral scanning with reverse scan bodies without intraoral implant data acquisition. [ABSTRACT FROM AUTHOR]

Purpose: To assess the accuracy of fit of complete‐arch printed prosthesis prototypes generated with a digital workflow protocol for completely edentulous jaws. Materials and methods: Forty‐five edentulous jaws (35 patients) underwent intraoral complete‐arch digital scans with the double digital scanning (DDS) technique and the generated standard tessellation language (STL) files were superimposed and imported into computer‐aided design software. After STL merging, each master STL file was used for printing a prosthesis prototype. The primary outcome was the accuracy of fit assessment of the printed prototypes on verified master stone casts. Two experienced clinicians tested the accuracy of fit with radiographs and screw‐resistance tests. Secondary outcomes were the effect of the scan body shape and implant number on the accuracy of fit. Results: Out of the 45 DDS‐generated prosthesis prototypes, 39 presented with accurate fit on verified master stone casts, yielding an 86.70% accuracy of fit. Cylindrical scan bodies led to 100% accuracy of fit (25/25), whereas polygonal scan bodies presented with 70% accuracy of fit (14/20). Four implant‐supported prostheses yielded 100% accuracy of fit (12/12), compared with 25/29 (86.30%) accuracy of fit for the six‐implant‐supported ones. Fisher's exact test was used to assess the effect of different scan body shapes (p = 0.005) and implant number on accuracy of fit. Chi‐squared test was used to assess the association between the number of implants per arch and the accuracy of fit (p = 0.039). Conclusions: Thirty‐nine out of 45 complete‐arch prosthesis prototypes generated with a completely digital workflow presented with clinically acceptable fit. The effect of the scan body design and implant number was statistically significant, favoring cylindrical scan bodies and four‐implant‐supported prostheses. [ABSTRACT FROM AUTHOR]

Digital applications have changed therapy in prosthodontics. In 2017, a systematic review reported on complete digital workflows for treatment with tooth-borne or implant-supported fixed dental prostheses (FDPs). Here, we aim to update this work and summarize the recent scientific literature reporting complete digital workflows and to deduce clinical recommendations. A systematic search of PubMed/Embase using PICO criteria was performed. English-language literature consistent with the original review published between 16 September 2016 and 31 October 2022 was considered. Of the 394 titles retrieved by the search, 42 abstracts were identified, and subsequently, 16 studies were included for data extraction. A total of 440 patients with 658 restorations were analyzed. Almost two-thirds of the studies focused on implant therapy. Time efficiency was the most often defined outcome (n = 12/75%), followed by precision (n = 11/69%) and patient satisfaction (n = 5/31%). Though the amount of clinical research on digital workflows has increased within recent years, the absolute number of published trials remains low, particularly for multi-unit restorations. Current clinical evidence supports the use of complete digital workflows in implant therapy with monolithic crowns in posterior sites. Digitally fabricated implant-supported crowns can be considered at least comparable to conventional and hybrid workflows in terms of time efficiency, production costs, precision, and patient satisfaction. [ABSTRACT FROM AUTHOR]

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The introduction of computer-aided manufacturing technologies and further developments have changed the routine workflow in dentistry, and dentists are now rapidly shifting from conventional to digital. As a result, intra-oral scanners have become a standard device in dental clinics even though they have a considerable cost. One of the important reasons of this digital transition is to ensure standardized-quality manufacturing with a shorter chair time, which is promised by complete digital workflow. So, what does complete digital workflow mean for dentistry? This review elaborately answers to this question and summarizes the stages of complete digital workflow in dental applications. [ABSTRACT FROM AUTHOR]

Abstract Background The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical model situations. The aim was to compare fully digitalized workflows to conventional and/or mixed analog-digital workflows for the treatment with tooth-borne or implant-supported fixed reconstructions. Methods A PICO strategy was executed using an electronic (MEDLINE, EMBASE, Google Scholar) plus manual search up to 2016–09-16 focusing on RCTs investigating complete digital workflows in fixed prosthodontics with regard to economics or esthetics or patient-centered outcomes with or without follow-up or survival/success rate analysis as well as complication assessment of at least 1 year under function. The search strategy was assembled from MeSH-Terms and unspecific free-text words: {((“Dental Prosthesis” [MeSH]) OR (“Crowns” [MeSH]) OR (“Dental Prosthesis, Implant-Supported” [MeSH])) OR ((crown) OR (fixed dental prosthesis) OR (fixed reconstruction) OR (dental bridge) OR (implant crown) OR (implant prosthesis) OR (implant restoration) OR (implant reconstruction))} AND {(“Computer-Aided Design” [MeSH]) OR ((digital workflow) OR (digital technology) OR (computerized dentistry) OR (intraoral scan) OR (digital impression) OR (scanbody) OR (virtual design) OR (digital design) OR (cad/cam) OR (rapid prototyping) OR (monolithic) OR (full-contour))} AND {(“Dental Technology” [MeSH) OR ((conventional workflow) OR (lost-wax-technique) OR (porcelain-fused-to-metal) OR (PFM) OR (implant impression) OR (hand-layering) OR (veneering) OR (framework))} AND {((“Study, Feasibility” [MeSH]) OR (“Survival” [MeSH]) OR (“Success” [MeSH]) OR (“Economics” [MeSH]) OR (“Costs, Cost Analysis” [MeSH]) OR (“Esthetics, Dental” [MeSH]) OR (“Patient Satisfaction” [MeSH])) OR ((feasibility) OR (efficiency) OR (patient-centered outcome))}. Assessment of risk of bias in selected studies was done at a ‘trial level’ including random sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other bias using the Cochrane Collaboration tool. A judgment of risk of bias was assigned if one or more key domains had a high or unclear risk of bias. An official registration of the systematic review was not performed. Results The systematic search identified 67 titles, 32 abstracts thereof were screened, and subsequently, three full-texts included for data extraction. Analysed RCTs were heterogeneous without follow-up. One study demonstrated that fully digitally produced dental crowns revealed the feasibility of the process itself; however, the marginal precision was lower for lithium disilicate (LS2) restorations (113.8 μm) compared to conventional metal-ceramic (92.4 μm) and zirconium dioxide (ZrO2) crowns (68.5 μm) (p

This clinical case report describes the application of net-shape-formed self-glazed zirconia prostheses via a complete digital workflow in oral implant and restoration. It demonstrates that by using a novel self-glazed zirconia, the commonly encountered clinical problem of porcelain chipping can be avoided, while the treatment quality and efficiency can be improved. [ABSTRACT FROM AUTHOR]

Background: The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical model situations. The aim was to compare fully digitalized workflows to conventional and/or mixed analog-digital workflows for the treatment with tooth-borne or implant-supported fixed reconstructions. Methods: A PICO strategy was executed using an electronic (MEDLINE, EMBASE, Google Scholar) plus manual search up to 2016-09-16 focusing on RCTs investigating complete digital workflows in fixed prosthodontics with regard to economics or esthetics or patient-centered outcomes with or without follow-up or survival/success rate analysis as well as complication assessment of at least 1 year under function. The search strategy was assembled from MeSH-Terms and unspecific free-text words: {(("Dental Prosthesis" [MeSH]) OR ("Crowns" [MeSH]) OR ("Dental Prosthesis, Implant-Supported" [MeSH])) OR ((crown) OR (fixed dental prosthesis) OR (fixed reconstruction) OR (dental bridge) OR (implant crown) OR (implant prosthesis) OR (implant restoration) OR (implant reconstruction))} AND {("Computer-Aided Design" [MeSH]) OR ((digital workflow) OR (digital technology) OR (computerized dentistry) OR (intraoral scan) OR (digital impression) OR (scanbody) OR (virtual design) OR (digital design) OR (cad/cam) OR (rapid prototyping) OR (monolithic) OR (full-contour))} AND {("Dental Technology" [MeSH) OR ((conventional workflow) OR (lost-wax-technique) OR (porcelain-fused-to-metal) OR (PFM) OR (implant impression) OR (hand-layering) OR (veneering) OR (framework))} AND {(("Study, Feasibility" [MeSH]) OR ("Survival" [MeSH]) OR ("Success" [MeSH]) OR ("Economics" [MeSH]) OR ("Costs, Cost Analysis" [MeSH]) OR ("Esthetics, Dental" [MeSH]) OR ("Patient Satisfaction" [MeSH])) OR ((feasibility) OR (efficiency) OR (patient-centered outcome))}. Assessment of risk of bias in selected studies was done at a 'trial level' including random sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other bias using the Cochrane Collaboration tool. A judgment of risk of bias was assigned if one or more key domains had a high or unclear risk of bias. An official registration of the systematic review was not performed. Results: The systematic search identified 67 titles, 32 abstracts thereof were screened, and subsequently, three full-texts included for data extraction. Analysed RCTs were heterogeneous without follow-up. One study demonstrated that fully digitally produced dental crowns revealed the feasibility of the process itself; however, the marginal precision was lower for lithium disilicate (LS2) restorations (113.8 µm) compared to conventional metal-ceramic (92. 4 µm) and zirconium dioxide (ZrO2) crowns (68.5 µm) (p < 0.05). Another study showed that leucite-reinforced glass ceramic crowns were esthetically favoured by the patients (8/2 crowns) and clinicians (7/3 crowns) (p < 0.05). The third study investigated implant crowns. The complete digital workflow was more than twofold faster (75. 3 min) in comparison to the mixed analog-digital workflow (156.6 min) (p < 0.05). No RCTs could be found investigating multi-unit fixed dental prostheses (FDP). Conclusions: The number of RCTs testing complete digital workflows in fixed prosthodontics is low. Scientifically proven recommendations for clinical routine cannot be given at this time. Research with high-quality trials seems to be slower than the industrial progress of available digital applications. Future research with well-designed RCTs including follow-up observation is compellingly necessary in the field of complete digital processing. [ABSTRACT FROM AUTHOR]

Aim: This prospective crossover clinical trial aimed to compare the complete-digital and -analog workflows in terms of occlusal adjustment of 3-unit tooth-supported fixed dental prostheses, operator, and patient preferences., Materials and Method: This study included twelve patients receiving fourteen 3-unit posterior FDPs. 2 FDPs were made for each restoration site: one fabricated in complete-digital workflow comprising intraoral scan with static bite registration (Trios 3) and a monolithic zirconia FDP (test); the other fabricated in complete-analog workflow comprising conventional impression/face-bow transfer and a porcelain-fused-to-metal FDP (control). The FDPs (n=28) were intraorally/provisionally fixed, and quadrant-like intraoral scans were taken for every FDP before & after their occlusal adjustments. Pre- and post-adjustment scans of each FDP were then superimposed using best-fit alignment (GOM Inspect) to measure the volumetric occlusal adjustment amount (mm 3 ) (3Matic) (Mann Whitney U, α=0.05). The patient and operator experience for digital and analog workflows were evaluated using visual analog scales (Wilcoxon test, α=0.05)., Results: Mean occlusal adjustments were 7.63 mm 3 [±7.02] and 25.95 mm 3 [±39.61] for test and control groups, respectively. The volumetric adjustment difference was clinically noticeable but not significant (P=0.12). The impression and digital workflow adjustment were perceived more favorably by both operator (P=0.003, P=0.046, respectively) and the patients (P=0.003, P=0.002, respectively)., Conclusions: Within the limitations of this clinical study, the complete digital workflow with digital static bite-registration provided high occlusal accuracy for short-span tooth-supported FDPs. In addition, the patient and operator preferences significantly favored the digital workflow., Clinical Significance: Complete-digital workflow employing intraoral scanning and model-free fabrication of monolithic-Zr short-span tooth-supported FDPs offers an effective treatment modality with sufficient occlusal accuracy. Therefore complete-digital workflow is a valid alternative for complete-analog workflow comprising conventional impression, face-bow transfer, and use of a semi-adjustable articulator., Competing Interests: Dclaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2022. Published by Elsevier Ltd.)