Digital technologies in prosthetic dentistry: a systematic analysis of the effectiveness of individualized prosthodontics

Background. Traditional dental prosthetic methods are characterized by marginal fit errors of 100–200 μm, fabrication times of 2–6 weeks, and postoperative complication rates of 15–40%. Digital technologies — CAD/CAM systems, intraoral scanning, and additive manufacturing — represent a paradigm shift in prosthetic dentistry; however, systematized data on their clinical effectiveness and economic feasibility remain fragmented.

Aim. To conduct a systematic analysis of the accuracy, clinical effectiveness, and economic indicators of digital technologies in prosthetic dentistry compared to traditional methods.

Materials and methods. A systematic review was performed according to the PRISMA protocol. Searches were conducted in PubMed, Scopus, Web of Science, and Cochrane Library (2013–2023). Forty-seven studies were included: 23 randomized controlled trials, 18 prospective cohort studies, and 6 systematic reviews with meta-analysis. Cumulative sample: 6,284 patients, 8,917 prostheses. Primary endpoints: marginal fit accuracy (μm), fabrication time (days), complication rate (%). Secondary endpoints: patient satisfaction (OHIP-14), prosthesis cost (euros), corrective visits. Study quality was assessed using Cochrane Risk of Bias Tool 2.0 and NewcastleOttawa scales. Statistical analysis: weighted mean differences with 95% confidence intervals, meta-regression (RevMan 5.4, Stata 17.0).

Results. Digital technologies reduced marginal fit errors from 127.5 μm to 34.2 μm (weighted mean difference –93.3 μm; 95% CI: –102.1 to –84.5; p<0.001), representing a 73.2% relative improvement. Best results were achieved with monolithic zirconia crowns fabricated by CAD/CAM milling: 23.1 μm versus 134.2 μm (p><0.001). Median fabrication time for fixed prostheses decreased from 14 to 2 days (p><0.001). Chairside CAD/CAM technology enabled single-visit completion in 78% of cases (mean time 87 ± 23 minutes). The incidence of inflammatory complications at 12 months decreased from 14.8% to 6.2% (relative risk 0.42; 95% CI: 0.31–0.57; p >< 0.001). Temporomandibular joint dysfunction frequency decreased from 8.9% to 3.4% (relative risk 0.38; p = 0.001). Secondary caries developed in 2.8% versus 9.4% with traditional prosthodontics (relative risk 0.30; p<0.001). Cumulative survival of fixed prostheses at 24 months was 96.8% for digital versus 92.3% for traditional constructions (p=0.002). Mean OHIP-14 score: 41.2±6.3 versus 35.7±8.1 points (difference 5.5; 95% CI: 4.2–6.8; p><0.001). Adaptation time to removable prostheses decreased from 16.8 to 4.2 days (p><0.001). Cost per single crown decreased from €280 to €195 (30.4% savings). Economic efficiency is achieved with monthly volumes ≥12 prostheses, reaching break-even at 18–24 months. Implementation barriers: equipment cost €109,500–128,400, learning curve with optimal accuracy achieved after >100 procedures, post-processing of 3D-printed constructions required in 11.3% of cases, scanning artifacts in subgingival preparations in 8.4% of cases. Meta-regression revealed accuracy improvement of 0.142 μm per additional procedure (p=0.003).

Conclusions. Digital technologies demonstrate statistically and clinically significant superiority over traditional methods in marginal fit accuracy (73.2% improvement), fabrication time (7-fold reduction), complication rates (58–70% decrease), patient quality of life, and under certain conditions — economic indicators. Optimal cost-effectiveness is achieved in clinics with volumes ≥12 prostheses/month. Structured educational programs to overcome the learning curve, protocol standardization, and ensuring equitable access to technologies are critically important.

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