Crown Accuracy and Time Efficiency of Cement-Retained Implant-Supported Restorations in a Complete Digital Workflow: A Randomized Control Trial.

Abstract

This is a clinical study to compare complete digital workflows generated using intraoral scanning and the split-file technique with a conventional workflow for cement-retained implant-supported restorations. Forty patients requiring posterior single-unit implant restorations were included. Twenty patients were randomly assigned to the complete digital workflow group, involving intraoral scanning and manufacture of cement-retained crowns using the split-file technique (test group). The remaining 20 patients were assigned to the hybrid workflow group (control group), involving conventional impressions and CAD-CAM fabricated crowns based on stone casts. Scanning of the crowns was performed before and after clinical adjustment using an intraoral scanner (TRIOS Color; 3Shape). Two 3D digital models were trimmed and superimposed to evaluate changes in dimensions using Geomagic Control 2014 software. Chair-side and laboratory times for the entire workflow were recorded. Independent-sample t tests were used for the statistical analysis. All crowns were inserted without refabrication. The average maximum occlusal adjustment of the crowns, measured as maximum deviation of occlusal area in superimposed pre and post scans, was -212.7 ± 150.5 and -330.7 ± 192.5 µm in the test and control groups, respectively (p = 0.037). The average area of occlusal adjustment, measured as area of deviation larger than 100 µm, was 8.4 ± 8.1 and 17.1 ± 12.3 mm2 in the test and control groups, respectively (p = 0.012). The mesial and distal contact adjustment amounts, maximum deviations of proximal area, were -33.0 ± 96.2 and -48.6 ± 70.5 µm in the test group, and -3.7 ± 66.7 µm and -11.4± 106.7 µm in the control group, respectively. The mean chair-side time was 20.20 ± 3.00 and 26.65 ± 4.53 minutes in the test and control groups, respectively (p < 0.001). The mean laboratory time was 43.70 ± 5.56 and 84.55 ± 5.81 minutes in the test and control groups, respectively (p < 0.001). Single-unit cement-retained crowns with complete digital workflows required fewer crown adjustments and had shorter clinical and laboratory times compared to conventional impressions and hybrid workflows. Digital impressions and the split-file technique provided customized abutments and cement-retained crowns, thus broadening the indications for digital workflows for implants.