Evaluation of Digital Versus Conventional Workflows for Full-Arch Implant-Supported Zirconia Prostheses: A Clinical and In Vitro Study

Abstract

Background: Digital workflows have increasingly transformed implant prosthodontics by integrating digital data acquisition, virtual prosthetic planning, and computer-aided design and computer-aided manufacturing (CAD/CAM). However, comparative evidence regarding their clinical efficiency, prosthetic accuracy, and patient-related outcomes in full-arch implant-supported zirconia rehabilitation remains limited. The present study compared conventional and digital workflows with respect to clinical, time-related, and in vitro prosthetic outcomes.

Materials and Methods: A comparative study involving 60 participants was conducted, with 30 participants managed using a conventional workflow and 30 using a digital workflow for full-arch implant-supported zirconia prostheses. Demographic characteristics, total workflow time, chairside time, occlusal adjustment time, clinical prosthesis fit, patient satisfaction, prosthetic complications, three-dimensional (3D) deviation, implant positional deviation, and marginal and internal gaps were evaluated. Continuous variables were analyzed using the independent-samples Student’s t-test, categorical variables using the chi-square test, and the relationship between 3D deviation and clinical fit was assessed using Pearson’s correlation coefficient. Statistical significance was established at p < 0.05.

Results: The two groups were comparable in terms of age, sex, and arch distribution. The digital workflow significantly reduced total workflow time compared with the conventional approach (133.24 ± 17.97 vs. 189.09 ± 16.30 minutes; p < 0.001), as well as chairside time (96.82 ± 12.31 vs. 132.31 ± 10.90 minutes; p < 0.001) and occlusal adjustment time (10.27 ± 4.01 vs. 18.43 ± 5.95 minutes; p < 0.001). Clinical fit scores were significantly higher with the digital workflow (4.16 ± 0.51 vs. 3.67 ± 0.51; p < 0.001), as were patient satisfaction scores (4.41 ± 0.50 vs. 3.51 ± 0.55; p < 0.001). A significantly greater proportion of digital prostheses required no occlusal adjustment (60.0% vs. 30.0%; p = 0.020), and a higher proportion of patients reported satisfaction scores of ≥4/5 (86.7% vs. 63.3%; p = 0.037). The digital workflow demonstrated significantly lower 3D deviation (49.54 ± 11.87 vs. 84.96 ± 15.39 µm), implant positional deviation (46.32 ± 9.63 vs. 82.96 ± 20.05 µm), marginal gap (58.45 ± 14.92 vs. 89.71 ± 20.10 µm), and internal gap (96.20 ± 24.04 vs. 119.36 ± 27.70 µm) compared with the conventional workflow (all p < 0.001). Implant positional deviation was significantly lower with the digital workflow in the anterior, premolar, and molar regions. A moderate negative correlation was observed between 3D deviation and clinical fit score (r = −0.577, p < 0.001).

Conclusion: The digital workflow demonstrated significant advantages over the conventional approach in terms of procedural efficiency, clinical prosthesis fit, patient satisfaction, and prosthetic accuracy. Reduced 3D and implant positional deviations, along with smaller marginal and internal gaps, indicate improved precision of digitally fabricated full-arch zirconia prostheses. The findings suggest that digital integration may provide a more efficient and predictable approach to full-arch implant-supported rehabilitation, although larger multicenter studies with extended follow-up are required to confirm its long-term clinical benefits.