Occlusal adjustment of 3-unit tooth-supported fixed dental prostheses fabricated with complete-digital and -analog workflows: A non-randomized crossover clinical trial

Karasan D., Sailer I., Lee H., DEMİR F., Zarauz C., AKÇA K.

Journal of Dentistry, vol.128, 2023 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 128
  • Publication Date: 2023
  • Doi Number: 10.1016/j.jdent.2022.104365
  • Journal Name: Journal of Dentistry
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Aerospace Database, CAB Abstracts, CINAHL, Communication Abstracts, EMBASE, MEDLINE, Metadex, Veterinary Science Database, Civil Engineering Abstracts
  • Keywords: Clinical research, Tooth -supported, Fixed dental prosthesis (FDP), Effectiveness, Model -free fabrication, Complete digital workflow, Monolithic zirconia
  • Hacettepe University Affiliated: Yes


© 2022Aim: This non-randomized 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 (mm3) (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 mm3 [±7.02] and 25.95 mm3 [±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.