CAD/CAM versus traditional complete dentures: A systematic review and meta-analysis of patient- and clinician-reported outcomes and costs.

Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 0433604 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2842 (Electronic) Linking ISSN: 0305182X NLM ISO Abbreviation: J Oral Rehabil Subsets: MEDLINE

Original Publication: Oxford, Blackwell Scientific Publications.

Computer-Aided Design* ; Denture, Complete*/economics ; Patient Satisfaction* ; Patient Reported Outcome Measures* ; Quality of Life* ; Denture Design*/economics ; Denture Design*/methods; Humans

Statement of Problem: Computer-aided design and manufacturing (CAD/CAM) have been increasingly used to enhance the patient and clinician experiences with removable complete dentures (CDs). Yet, evidence from systematic reviews is lacking to validate the clinical significance of these digital prostheses.
Purpose: The purpose of this systematic review was to compare CAD/CAM CDs with the traditional ones in terms of patient and clinician-reported outcomes, post-insertion adjustment visits and costs.
Materials and Methods: An electronic search of four databases [Medline (Ovid), Embase, Scopus and Cochrane CENTRAL; last update: May 2022] was performed to retrieve clinical studies comparing CAD/CAM and traditional CDs. Two independent reviewers screened the articles, extracted data (methods and outcomes) and assessed risk of bias of the included studies. The following outcomes underwent meta-analysis (random-effects model): overall patient and clinician satisfaction, oral health-related quality of life (OHRQoL), number of post-insertion adjustment visits, as well as laboratory and total costs.
Results: This review included 11 studies. Meta-analysis revealed that CAD/CAM CDs are comparable to the traditional CDs in terms of overall patient satisfaction and OHRQoL. Clinician-reported data depended on the manufacturing technique: whereas milled CDs performed better than traditional CDs in terms of clinician satisfaction and number of adjustments, 3D printed and traditional CDs were similar. Fabrication of CAD/CAM CDs required significantly less laboratory and overall costs than the traditional CDs.
Conclusions: There is some evidence showing that CAD/CAM CDs are at least comparable to traditional CDs. Further well-designed randomized clinical trials are needed to evaluate the performance of specific CAD/CAM approaches for manufacturing CDs, however.
(© 2024 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Steele J, Treasure E, O'sullivan I, Morris J, Murray J. Adult dental health survey 2009: transformations in British oral health 1968–2009. Br Dent J. 2012;213:523‐527.
World Health Organization. Working Together for Health: the World Health Report 2006: Policy Briefs. World Health Organization; 2006.
Holm‐Pedersen P, Schultz‐Larsen K, Christiansen N, Avlund K. Tooth loss and subsequent disability and mortality in old age. J Am Geriatr Soc. 2008;56:429‐435.
Carlsson G, Omar R. The future of complete dentures in oral rehabilitation. A critical review. J Oral Rehabil. 2010;37:143‐156.
Anadioti E, Musharbash L, Blatz MB, Papavasiliou G, Kamposiora P. 3D printed complete removable dental prostheses: a narrative review. BMC Oral Health. 2020;20:1‐9.
Srinivasan M, Kamnoedboon P, McKenna G, et al. CAD‐CAM removable complete dentures: a systematic review and meta‐analysis of trueness of fit, biocompatibility, mechanical properties, surface characteristics, color stability, time‐cost analysis, clinical and patient‐reported outcomes. J Dent. 2021;113:103777.
de Oliveira Limírio JPJ, de Luna Gomes JM, Rezende MCRA, Lemos CAA, Rosa CDDRD, Pellizzer EP. Mechanical properties of polymethyl methacrylate as a denture base: conventional versus CAD‐CAM resin–a systematic review and meta‐analysis of in vitro studies. J Prosthet Dent. 2021;128:1221‐1229.
Wang C, Shi Y‐F, Xie P‐J, Wu J‐H. Accuracy of digital complete dentures: a systematic review of in vitro studies. J Prosthet Dent. 2021;125:249‐256.
Srinivasan M, Gjengedal H, Cattani‐Lorente M, et al. CAD/CAM milled complete removable dental prostheses: an in vitro evaluation of biocompatibility, mechanical properties, and surface roughness. Dent Mater J. 2018;2017:207‐533.
Kalberer N, Mehl A, Schimmel M, Müller F, Srinivasan M. CAD‐CAM milled versus rapidly prototyped (3D‐printed) complete dentures: an in vitro evaluation of trueness. J Prosthet Dent. 2019;121:637‐643.
Steinmassl P‐A, Klaunzer F, Steinmassl O, Dumfahrt H, Grunert I. Evaluation of currently available CAD/CAM denture systems. Int J Prosthodont. 2017;30:116‐122.
Hassan B, Greven M, Wismeijer D. Integrating 3D facial scanning in a digital workflow to CAD/CAM design and fabricate complete dentures for immediate total mouth rehabilitation. J Adv Prosthodont. 2017;9:381‐386.
Jafarpour D, deSouza R, Morris M. Patient‐reported outcomes and clinical performance of CAD/CAM removable dentures: a scoping review: AADOCR/CADR Annual Meeting: International Association for Dental Research; 2022.
Page M, Moher D, Bossuyt P, Boutron I, Hoffmann T, Mulrow C. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. Br Med J. 2021;372:160.
Stephen H, Halpern M, Joanne D. Jadad Scale for Reporting Randomized Controlled Trials. Blackwell Publishing Ltd; 2005.
Wells GA, Shea B, O'Connell D, et al. The Newcastle‐Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta‐Analyses. Oxford; 2000.
Cochrane Training. Review Manager (RevMan) 5.3. The Nordic Cochrane Centre; 2008:373.
DerSimonian R, Laird N. Meta‐analysis in clinical trials. Control Clin Trials. 1986;7:177‐188.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. Lawrence Earlbaum Associates; 1988.
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:1‐10.
Greco T, Biondi‐Zoccai G, Gemma M, Guérin C, Zangrillo A, Landoni G. How to impute study‐specific standard deviations in meta‐analyses of skewed continuous endpoints? World J Meta‐Anal. 2015;3:215‐224.
Allen F, Locker D. A modified short version of the oral health impact profile for assessing health‐related quality of life in edentulous adults. Int J Prosthodont. 2002;15:5.
Higgins JP, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019.
Higgins JP, Green S, Scholten R. Maintaining reviews: updates, amendments and feedback. Cochrane Handbook for Systematic Reviews of Interventions. Vol 31. John Wiley & Sons; 2008.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Stat Med. 2002;21:1539‐1558.
Thompson SG. Systematic review: why sources of heterogeneity in meta‐analysis should be investigated. Br Med J. 1994;309:1351‐1355.
Hardy RJ, Thompson SG. Detecting and describing heterogeneity in meta‐analysis. Stat Med. 1998;17:841‐856.
Orwin RG. A fail‐safe N for effect size in meta‐analysis. J Educ Stat. 1983;8:157‐159.
Bidra AS, Farrell K, Burnham D, Dhingra A, Taylor TD, Kuo C‐L. Prospective cohort pilot study of 2‐visit CAD/CAM monolithic complete dentures and implant‐retained overdentures: clinical and patient‐centered outcomes. J Prosthet Dent. 2016;115:578‐586.
Schlenz MA, Schmidt A, Wostmann B, Rehmann P. Clinical performance of computer‐engineered complete dentures: a retrospective pilot study. Quintessence Int. 2019;50:706‐711.
Saponaro PC, Yilmaz B, Johnston W, Heshmati RH, McGlumphy EA. Evaluation of patient experience and satisfaction with CAD‐CAM‐fabricated complete dentures: a retrospective survey study. J Prosthet Dent. 2016;116:524‐528.
Elawady DM, Ibrahim WI, Osman RB. Clinical evaluation of implant overdentures fabricated using 3D‐printing technology versus conventional fabrication techniques: a randomized clinical trial. Int J Comput Dent. 2021;24:375‐384.
Deng K, Chen H, Wang Y, Zhou Y, Sun Y. Evaluation of functional suitable digital complete denture system based on 3D printing technology. J Adv Prosthodont. 2021;13:361‐372.
Smith PB, Perry J, Elza W. Economic and clinical impact of digitally produced dentures. J Prosthodont. 2021;30:108‐112.
Chaturvedi S, Addas MK, Alqahtani NM, Al Ahmari NM, Alfarsi MA. Clinical analysis of CAD‐CAM milled and printed complete dentures using computerized occlusal force analyser. Technol Health Care. 2021;29:797‐811.
Srinivasan M, Kalberer N, Fankhauser N, Naharro M, Maniewicz S, Muller F. CAD‐CAM complete removable dental prostheses: a double‐blind, randomized, crossover clinical trial evaluating milled and 3D‐printed dentures. J Dent. 2021;115:103842.
Ohara K, Isshiki Y, Hoshi N, et al. Patient satisfaction with conventional dentures vs. digital dentures fabricated using 3D‐printing: a randomized crossover trial. J Prosthodont Res. 2022;66:623‐629.
Peroz S, Peroz I, Beuer F, Sterzenbach G, von Stein‐Lausnitz M. Digital versus conventional complete dentures: a randomized, controlled, blinded study. J Prosthet Dent. 2021;8:956‐963.
Otake R, Kanazawa M, Iwaki M, et al. Patient‐reported outcome and cost‐effectiveness analysis of milled and conventionally fabricated complete dentures in a university clinic: a retrospective study. J Prosthet Dent. 2024;131:227‐232.
Arakawa I, Al‐Haj Husain N, Srinivasan M, Maniewicz S, Abou‐Ayash S, Schimmel M. Clinical outcomes and costs of conventional and digital complete dentures in a university clinic: a retrospective study. J Prosthet Dent. 2021;128:390‐395.
Kim TH, JungHuh B, Lee J, Bae EB, Park CJ. Retrospective comparison of postinsertion maintenances between conventional and 3D printed complete dentures fabricated in a predoctoral clinic. J Prosthodont. 2021;30:158‐162.
Kattadiyil MT, Jekki R, Goodacre CJ, Baba NZ. Comparison of treatment outcomes in digital and conventional complete removable dental prosthesis fabrications in a predoctoral setting. J Prosthet Dent. 2015;114:818‐825.
Srinivasan M, Schimmel M, Naharro M, O' Neill C, McKenna G, Müller F. CAD/CAM milled removable complete dentures: time and cost estimation study. J Dent. 2019;80:75‐79.
Clark WA, Brazile B, Matthews D, Solares J, De Kok IJ. A comparison of conventionally versus digitally fabricated denture outcomes in a university dental clinic. J Prosthodont. 2021;30:47‐50.
Drago C, Borgert AJ. Comparison of nonscheduled, postinsertion adjustment visits for complete dentures fabricated with conventional and CAD‐CAM protocols: a clinical study. J Prosthet Dent. 2019;122:459‐466.
Inokoshi M, Kanazawa M, Minakuchi S. Evaluation of a complete denture trial method applying rapid prototyping. Dent Mater J. 2012;31(1):40‐46.
John MT, Omara M, Su N, et al. Recommendations for use and scoring of oral health impact profile versions. J Evid‐Based Dent Pract. 2022;22:101619.
Ellis JS, Burawi G, Walls A, Thomason JM. Patient satisfaction with two designs of implant supported removable overdentures; ball attachment and magnets. Clin Oral Implants Res. 2009;20:1293‐1298.
de Souza RF, Bedos C, Esfandiari S, et al. Single‐implant overdentures retained by the Novaloc attachment system: study protocol for a mixed‐methods randomized cross‐over trial. Trials. 2018;19:1‐11.
Schwindling FS, Stober T. A comparison of two digital techniques for the fabrication of complete removable dental prostheses: a pilot clinical study. J Prosthet Dent. 2016;116:756‐763.
Gruber S, Kamnoedboon P, Özcan M, Srinivasan M. CAD/CAM complete denture resins: an in vitro evaluation of color stability. J Prosthodont. 2021;30:430‐439.

Keywords: CAD/CAM; clinical performance; complete denture; digital technology; patient reported outcome measures

Date Created: 20240527 Date Completed: 20240813 Latest Revision: 20240813

20240813

10.1111/joor.13738

38797954