Clinical Effectiveness and Accuracy of Fully Digital Workflows Versus Conventional Methods in Implant-Supported Restorations: A Systematic Review and Meta-Analysis

TL;DR

Digital workflows for dental implants save time and are preferred by patients, with similar accuracy and success rates compared to traditional methods.

Contribution

A systematic review and meta-analysis comparing digital and conventional implant restoration workflows, focusing on clinical effectiveness and patient outcomes.

Findings

Digital workflows significantly reduced mean procedure time compared to conventional methods.

Digital workflows showed a trend toward higher patient comfort and satisfaction.

Both workflows had comparable accuracy, fit, and implant survival rates.

Abstract

The transition from conventional analogue techniques to digital workflows is transforming implant dentistry. However, a comprehensive synthesis of comparative clinical evidence is lacking. This systematic review and meta-analysis aimed to evaluate the clinical effectiveness, accuracy, and patient-centred outcomes of fully digital versus conventional workflows for fabricating implant-supported restorations. This review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered with PROSPERO (International Prospective Register of Systematic Reviews). A comprehensive search of PubMed/MEDLINE, Embase, and Cochrane Library was performed to identify randomized controlled trials (RCTs) and non-randomized clinical studies comparing digital (intraoral scanning) and conventional (elastomeric impression) restorative workflows for single-unit or full-arch implant prostheses. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 and ROBINS-I tools. The primary outcomes were time efficiency, accuracy/fit, and patient-reported outcome measures (PROMs). Secondary outcomes included biological and prosthetic complication rates. Random-effects meta-analyses were conducted using the Hartung-Knapp method, with heterogeneity assessed using the statistic. The certainty of the evidence was evaluated using the GRADE approach. Ten clinical studies (six RCTs, four non-randomized) met the inclusion criteria. Most RCTs demonstrated a low risk of bias, while non-randomized studies showed a moderate risk of bias. Meta-analysis revealed that digital workflows significantly reduced mean procedure time compared to conventional methods (mean difference (MD): -4.28 minutes; 95% CI: -8.40 to -0.16; p < 0.05). No statistically significant difference was found in restorative accuracy or fit between the two workflows (standardized mean difference (SMD): 0.20; 95% CI: -3.72 to 4.12). Patient-reported outcomes showed a trend toward favoring the digital workflow for comfort and satisfaction (MD: 13.98; 95% CI: -7.74 to 35.70). Implant survival rates were high (>98%) and comparable for both groups, with no significant difference in complication rates. The certainty of the evidence ranged from Low for accuracy to Moderate for time efficiency and PROMs. Fully digital workflows for implant-supported restorations are significantly more time-efficient and are preferred by patients, while demonstrating comparable clinical accuracy and survival rates to conventional methods. These findings support the adoption of digital technologies as a robust and effective alternative in modern implant prosthodontics.

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