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Background:
Systematic Review

Intraoral Scanning Versus Conventional Methods for Obtaining Full-Arch Implant-Supported Prostheses: A Systematic Review with Meta-Analysis

by
Fernanda L. Vieira
1,
Maísa Carnietto
2,
José R. A. Cerqueira Filho
3,
Ester A. F. Bordini
4,
Hiskell F. F. Oliveira
5,
Thiago A. Pegoraro
6 and
Joel F. Santiago Junior
4,*
1
Postgraduate Program in Oral Rehabilitation, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil
2
Independent Researcher, Avaré 18700-030, SP, Brazil
3
Military Fire Department of the State of Rio de Janeiro, Rio de Janeiro 20211-030, RJ, Brazil
4
Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil
5
Bone Research Lab, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto 14040-904, SP, Brazil
6
Dentistry Course Coordinator in Sacred Heart University Center, Bauru 17011-160, SP, Brazil
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(2), 533; https://doi.org/10.3390/app15020533
Submission received: 21 October 2024 / Revised: 13 December 2024 / Accepted: 21 December 2024 / Published: 8 January 2025
(This article belongs to the Special Issue Recent Advances in Digital Dentistry and Oral Implantology)
Browse Figures
Review Reports Versions Notes

Abstract

:
There is still no consensus on whether intraoral scanning for producing full-arch implant-supported prostheses is effective. Therefore, this systematic review aimed to analyze clinical studies that evaluated intraoral scanning versus conventional impression to obtain rehabilitation of full-arch fixed prostheses and removable. Registration was carried out in the PROSPERO database (CRD: 42020152197). Searches were performed in 11 databases. Review Manager 7.2 (2024) software was used for the quantitative analysis stage (α = 0.05). Bias analysis was conducted using the ROBINS-I and ROB scales, and the certainty of the evidence was evaluated using the GRADE scale. The initial search showed 33,975 abstracts and titles, from which, after applying the inclusion/exclusion criteria, 11 clinical studies were selected. Based on the studies collected, it was observed that there was no difference in the comparison between the digital (DG) and conventional (CG) groups for the following criteria: technical and biological complication rates and marginal bone loss (p > 0.05). The analysis of clinical execution time highlights a notable advantage of the DG over the CG at both scanned patient and implant levels (p < 0.05). Nevertheless, CG achieved fewer retakes than the DG (p < 0.05), demonstrating its reliability in execution. It is concluded that the survival rates of full-arch fixed prostheses produced using intraoral scanning are comparable to those achieved with traditional impression techniques, providing a reliable option for patients. However, further clinical studies are necessary due to the variability in clinical protocols.

1. Introduction

Oral rehabilitation with osseointegrated implants has a high survival rate, which is well supported by the literature [1,2]. However, there are challenges inherent to oral rehabilitation for completely edentulous patients, such as clinical situations of low bone availability, resulting in the need for inclined positioning of the implants, selection of components, adaptation of infrastructure, and greater difficulty impressing the alveolar mucosa. These aspects increase the level of difficulty during the prosthesis fabrication stages; errors at any stage can negatively affect the clinical performance of the prosthesis, potentially leading to a higher complication rate and reduced survival [3,4,5].
A current clinical execution protocol should be based on scientific evidence and consider the professional’s experience and the patient’s expectations for the treatment [5]. The conventional method for fabricating full-arch fixed prostheses involves a carefully organized sequence of steps [3,4,6,7]. Errors at any stage of this process can result in poor prosthesis adaptation, increased stress concentration on both prosthetic components and the surrounding bone, screw loosening, and various failures in oral rehabilitation [3,4,8].
In contrast, the use of a fully digital workflow has intensified based on the significant evolution of intraoral and facial scanners and resources, such as cone beam computed tomography (CBCT). Additionally, new occlusal materials have become available for dental use [3,9]. The literature has highlighted that intraoral scanning has the advantages of digital storage, reduced infrastructure mismatch, more accessible communication between the technician and the dentist, and reduction of chair-side time and laboratory steps, in addition to increasing patient comfort when compared to the conventional technique [6,9,10,11]. However, in addition to the need for a defined protocol for use, there is disagreement in the literature regarding its total effectiveness. Some studies do not identify advantages in comparing the intraoral scanning and conventional techniques [12]. Other studies demonstrate a success rate similar to the conventional technique [6]. There are even studies that conclude there is a disadvantage in using the digital technique for intraoral scanning in partially edentulous patients [10,13].
Given the diversity of results in the literature, a systematic review incorporating the best scientific evidence on this subject is necessary. Therefore, the present study aims to conduct a comprehensive analysis of published clinical studies (study type) involving completely edentulous patients (population) who received implants and oral rehabilitations using the intraoral scanning method (intervention) compared to the conventional impression technique (comparison). This analysis seeks to identify potential differences regarding the survival rates and complications of implant-supported prostheses, marginal bone loss, scanning and impression time, and number of retakes required for scanning and impressions (outcomes).

2. Materials and Methods

This research was designed following the criteria established by the Cochrane Collaboration and PRISMA [14,15,16]. The researchers registered this systematic review in the PROSPERO database (CRD42020158879).
The systematic review was designed considering the PICO index; Population: Individuals requiring oral rehabilitation with implants; Intervention: Prosthetic rehabilitation with complete fixed or removable prostheses (full-arch fixed prostheses supported/overdenture) obtained by the intraoral scanning method; Comparison: Patients who were rehabilitated with prostheses with complete fixed or removable prostheses (full-arch fixed prostheses supported/overdenture) obtained by the conventional method; Outcome: Results of evaluation of survival rates and complications of both prostheses, patient satisfaction after rehabilitation, execution time, biological and technical complications, and marginal bone loss.
The selected studies accomplished the following inclusion criteria: (1) conducted in English and (2) clinical studies with a sample size greater than five participants that compared implant-supported prostheses using digital methods to conventional methods in edentulous patients. Studies that included only the digital group were also considered if they aligned with the proposed outcomes. The participants in each study were adults who received full-arch implant-supported fixed prostheses or overdentures. Studies related to in vitro methodologies, studies with uncontrolled clinical case series, studies with incomplete data that did not allow for the necessary information to be collected, and studies involving patients with complications from extensive surgical resections were excluded.
The databases used were Medline/PubMed, Cochrane Library, EMBASE, and SciELO. An additional search was carried out in grey literature and other databases to complement the survey of studies: Open Grey, Clinical Trials, Rebec, Google Scholar, Bireme, Lilacs, and Portal Periódicos Capes. These searches were carried out for articles published up to 8 August 2024, using the keywords based on MeSH/PubMed: “conventional versus digital impressions”, “dental implants”, “digital workflow”, “impressions”, “digital versus traditional workflow”, “digital impression”, and “edentulous patients”.
The research, article selection, and data collection were carried out by previously calibrated researchers (M.C., F.L.V., and H.F.F.O). In case of disagreement, other reviewers verified the data (J.R.A.C.F. and J.F.S.J.R.). Two other researchers in the area (T.A.P. and E.A.F.B.) were part of the study, contributing to the data evaluation and discussion of the topics.
Data were collected using an Excel spreadsheet (Excel®, Microsoft, Redmond, WA, USA). The qualitative data from each study are organized in Table 1, which includes the following information: author, year of publication, type of study, country, whether the patients were randomized, average age of patients, groups analyzed in the study (digital and conventional), region of implant placement (maxilla and mandible), scanner commercial company, type of prosthesis (full-arch and overdentures), type of infrastructure utilized, number of implants per prosthesis, implants commercial company, dimensions of the implants (width and length), and follow-up duration.
Table 2 organizes quantitative data from each study by author, number of patients, number of implants per group (digital and conventional), total number of prostheses observed, implant and prosthesis survival rate, prosthesis adaptation rate, marginal bone loss rate, clinical execution time (scanning and conventional group), and technical and biological complications observed.
Initially, the included clinical studies were evaluated according to the classification of the type of clinical study, as indicated by the National Health and Medical Research Council (NHMRC, 2000) [17]. Then, the risk and bias analysis was also included using the tool (ROB2) developed for controlled and randomized clinical studies (Cochrane) and a specific tool for non-randomized studies (ROBINS-I) [18,19].
The quantitative data collected from the articles were tabulated, allowing risk ratio (RR) analysis with 95% confidence interval (CI); the contribution weight of each study was performed for meta-analysis calculation purposes (dichotomous data). Continuous data were analyzed using the mean difference (MD) and 95% CI. For all analyses performed, significant values were considered p < 0.05. The Review Manager 7.2 software (The Cochrane Collaboration, 2024; London, UK) was used for the meta-analysis and preparation of graphs.
Table 1. Qualitative data from selected studies.
Table 1. Qualitative data from selected studies.
Author and Year of PublicationDesignBias ScaleCountryRandomizationAverage Age
(Min–Max)		GroupsRegionScannerType of Prosthesis
(N° of Implants)		InfrastructureTrademarkLength × Diameter of ImplantsFollow-Up (M)
Cappare et al., 2019 [6]RCTIIItalyYes64.4
(48–72)		CG and DGMxCarestream CS 3600Full-arch (6)Metallic CSR Implant13; 15–3.8; 4.224
Cattoni et al., 2021 [20]RCTIIItalyYes46–85GC and GDMx and MdMyRay 3Di TS, Cefla, Imola, BO, ItalyFull-arch (6)ZirconiaWinsix TTX13–15; 3.3; 3.848
Chochlidakis et al., 2020 [21]ProspectiveIII-2USANoNRCG and GDMxTrue Definition 3MFull-arch (6)TitaniumNRNRNR
Elawady et al., 2024 [8]RCTIIEgyptYes56CG andGDMxios-i-500 MeditFull-arch (6)CoCrNobelNR6, 12, 24 M
Eldint et al., 2024 [22]RCTIIEgyptYes67.1CG and DGMdOmnicam (Dentsply Sirona, Charlotte, NC, USA)Overdenture (2)TitaniumNeobiotechNRNR
Gherlone et al., 2015 [3]ProspectiveIII-3ItalyYes56.3DGMx and MdLava COS (3M)Full-arch (4)Metallic (NR)Winsix BioSAFin13; 15–3.8; 4.512
Gherlone et al., 2016 [4]ProspectiveIII-1ItalyYes57.2
(43–70)		CG and GDMx and MdTrios (3 shape)Full-arch (4)CoCrNR12; 15.5–3.75; 4.312
Klein et al., 2023 [23]RetrospectiveIII-3USANo70.6DGMx and MdNEXUS IOSFull-archTitanium**NR12 M
Mangano et al., 2019 [9]ProspectiveIII-3RussianNo68.8
(58–76)		DGMxCarestream CS 3600Overdenture (4)ZirconiaBTSafeNR12
Papaspyridakos et al., 2023 [24]RetrospectiveIII-3USANoNRDGMx and MdTrios 3; bench scanner (Dental
Wings 7)		Full-arch
(4, 5, or 6)		PEEKStraumman and Nobel8; 10; 12; 14–3.3; 3.75; 4.1; 4.8NR
Papaspyridakos et al., 2023 [25]RetrospectiveIII-3USANoNRDGMdTrios 3Full-arch
(4, 5, or 6)		ZirconiaStraumman and NobelNRNR
NR: not reported; CG: control group; DG: digital group; Mx: maxilla; Md: mandible; M: months; RCT: randomized controlled trials. Bias Scale: National Health and Medical Research Council (NHMRC) [17]. ** BLX® (Straumann, Basel, Switzerland), Paltop® Prima Plus® (Keystone Dental, Burlington, MA, USA), Biohorizon® (Biohorizon Implants, Birmingham, AL, USA), NobelActive® (Nobel Biocare, Zurich, Switzerland), Southern®, (Southern Implants, Irene, South Africa), and Genesis® implants (Keystone Dental, Burlington, MA, USA).
Table 2. Data for quantitative synthesis of selected articles.
Table 2. Data for quantitative synthesis of selected articles.
Author and Year of PublicationPatientsImpl. (CG)Impl. (DG)ProsthesisSurvival Impl./ProsthesisAdaptationMarginal Bone Loss (mm)Scanning/Impression TimeTechnical/Biological
Complications
Cappare et al., 2019 [6]5015015050100%100%DG (1.11 ± 0.54); CG (1.07 ± 0.66), p > 0.05DG (08.59 ± 2.46) < CG (16.45 ± 4.49) (p < 0.05)CG (0/25); DG (0/25)
Cattoni et al., 2021 [20]5010010050CG (2/100 implantes: 98%)100%DG (0.83 ± 0.11); CG (1.12 ± 0.26), p < 0.0001NRBiol.: CG: 3, DG = 0; Techn.: CG = 8, DG = 4
Chochlidakis et al., 2020 [21]168383NRNR100%NRNRNR
Elawady et al., 2024 [8]28848428100% (implant);
Prosth: CG—8/14; DG—4/14.		NRCG (1.28 ± 0.016);
DG (1.14 ± 0.02)
−24 M		NRCG (19); DG (12)
Eldin et al., 2024 [22]36363636NRCG = DG **NRNRNR
Gherlone et al., 2015 [3]14NR5614100%100%Mx (1.07 ± 0.99 A);
Md (1.02 ± 0.72 A);
Mx (1.07 ± 0.81 T);
Md (1.1 ± 0.89 T) 		NR0
Gherlone et al., 2016 [4]25606030100%100%DG (1.13 ± 0.66 A);
(1.06 ± 0.91 T);
CG: (1.08 ± 0.77 Axial);
(1.09 ± 0.32 Tilted)		DG (07.57 ± 3.08) < CG (18.23 ± 5.38) (p < 0.05)CG (1/15); DG(0/15)
Klein et al., 2023 [23]29NR20337100%100<3.00 mmNRPeri-implant mucositis (n = 1) after six months; zirconia decementation (n = 1), zirconia fracture (n = 1)
Mangano et al., 2019 [9]15NR6015100%80%NRNRAdaptation (3/15);
periimpl: (1/15);
fractured tooth (2/15)
Papaspyridakos et al., 2023 [24]27121 Max.83 Max.36NRMx = Md ***NRNRNR
Papaspyridakos et al., 2023 [25]35NR24545NR86.70%NRNRAdap. scan body poligonal 70% (14/20)
Adap. scan body cylindrical 100% (25/25)
NR: not reported; DG: digital group; CG: control group; Impl.: implant; Mx: maxilla; Md: mandible; M: Months. ** Analysis of the difference of rotation angles in the passive and non-passive situations (screw). *** Papaspyridakos et al., 2023 [24]: 3D implant deviations (micrometer).
The primary outcome was to quantify the survival and complication rates of implant-supported prostheses manufactured using the intraoral scanning method and compare them with the conventional technique (impression with dental implant transfer). The secondary outcomes were an analysis of marginal bone loss, time taken to obtain the scan/impression, and need for retakes. The success criteria for implant survival were the absence of a radiolucent area around the implant, implant stability, no mucosal suppuration, and no pain. Prosthetic survival was defined as the absence of fractures in the occlusal material/infrastructure and prosthetic components. Failure of the prosthesis was considered a need for replacement. Complications were classified as technical and/or biological [3,4,6,8,9].
The random effects model was adopted for all statistical analyses. Heterogeneity was considered significant for p < 0.1. Heterogeneity was assessed using the Q (χ2) method, and the I2 value will be measured. The I2 statistical value was used to analyze the heterogeneity variations, and I2 above 75 (0–100) was considered to indicate relevant heterogeneity [26,27,28]. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was utilized to assess the certainty of evidence for the outcome analyzed. The domains evaluated were risk of bias, inconsistency, indirectness, imprecision, and publication bias. These variables were categorized as high, moderate, low, and very low, providing a nuanced understanding of the evidence. The findings were then compiled and summarized using the GRADEpro Guidance Development Tool (www.gradepro.org).

3. Results

Based on the analysis considering all search terms, it was possible to select 33,975 articles related to the proposed theme. After reading the titles and abstracts, 20 studies corresponding to the inclusion and exclusion criteria were selected. The articles’ complete reading highlighted some studies on rehabilitation with single implants, partial dentures, and issues not covered by the PICO criteria. After excluding these articles, 11 studies were selected to compose the sample [3,4,6,8,9,20,21,22,23,24,25], as shown in Figure 1.
The main information can be seen in Table 1. All included research can be considered in the last 10 years (2015–2024). Regarding the distribution of these researches, 5 were carried out in Europe/Asia [3,4,6,9,20], 4 in the United States [21,23,24,25], and 2 in Egypt [8,22].
In the sample, only four studies were considered randomized controlled clinical trials [6,8,20,22], and four were prospective studies [3,4,9,21], of which two studies performed randomization [3,4]. Moreover, three studies were retrospective [23,24,25]. The most prolonged follow-up period performed was 48 months [20], with 4 studies performing an average follow-up of 12 months [3,4,9,23], while 2 studies performed follow-up for 24 months [6,8].
Five studies performed only digital impression analysis without considering a control group [3,9,23,24,25]. Six studies compared the group that received prostheses made by the digital flow to the group that received prostheses made conventionally [4,6,8,20,21,22].
A total of 325 patients were included in the studies evaluated, covering 393 implants in which the impression was made using the conventional method. On the other hand, 958 implants were scanned intraorally for the production of complete implant-supported prostheses. The mean age of the included patients was 62.21, with a minimum of 41 years and a maximum of 89 years [3,4,6,8,9,23]. In five studies, it was not possible to identify the mean age of the participants [20,21,22,24,25].
Four studies considered the placement of implants in the maxillary region [6,8,9,21]; two considered only rehabilitation of the mandible [22,25]. Five studies performed rehabilitations in the maxilla and mandible [3,4,20,23,24]. Regarding the number of implants, three studies used four implants for full-arch rehabilitation [3,4,20], while one study used four implants for overdenture retention [9]. Two studies used six implants for full-arch-type rehabilitation [6,8]. In one study, it was not possible to specify the number of implants for fixation of the prostheses [23]. The other studies varied the number of implants for retention of the prostheses between four and six implants [21,24,25]. Two studies compared the conventional versus digital method for fabricating overdentures [9,22]. This data can be found in Table 1 and Table 2 for the studies included in the results [3,4,6,8,9,20,21,22,23,24,25].
When analyzing the quantitative data in Table 2, it was observed that 133 patients received 146 implant-supported prostheses with 100% survival [3,4,6,9,20,23]. Regarding the materials used for the prosthesis infrastructure, there was diversity among the options: unspecified metal [3], CoCr [4,22], titanium [6,8,21,23], zirconia [20,24,25], and PEEK-type thermoplastic polymer [9].
Of the 393 implants placed in the control group and 958 implants in the digital group, 98–100% survived in the periods analyzed (1 to 4 years). Regarding the dimensions of the implants, there was a predominance of lengths of 13 and 15 mm, with the smallest measurement considered being 8 mm [9] and the smallest diameter of 3.3 mm [9,20].
There was significant heterogeneity regarding the protocol used for implant transfers; five studies performed impressions with an open tray and splinting of the transfers using a rigid connector, being ortho wire and/or composite or acrylic resin [6,8,9,22,25]. Four studies performed conventional transfer without splinting of the components [20,21,23,24]; one study did not make precise the method used for transfer [4]. Regarding the digital group transfer, three studies performed splinting of the scan bodies [6,8,20], while four authors did not perform splinting of the scan bodies [9,21,22,24]. Three studies do not make it clear whether or not the scan bodies were splinted [3,4,23]. Papaspyridakos et al. [25] used adhesives containing hemispheres along the palate during scanning as an auxiliary strategy for scanner recognition on the edentulous ridge.
Regarding the marginal adaptation of prostheses, eight studies performed analyses on this issue [3,4,6,9,20,21,23,25], indicating 100% adaptation. However, one study presented 80% adaptation of the infrastructure pieces [9], and another presented 86.7% adaptation [25], both in a digital group.
Regarding technical and biological complications, a study with a full-arch prosthesis was identified that presented screw loosening in the conventional group [4]. Other studies presented infrastructure misadaptation, peri-implantitis, fracture of the provisional prosthesis, chipping and fracture of zirconia, screw loosening, fracture of the definitive prosthesis, implant loss [8,9,20,23,25], and decementation of zirconia [23]. Mangano et al. [9] indicated a fracture of the overdenture tooth in two patients. In general, there were fewer complications for the conventional impression and digital groups, as observed in Table 2 [3,4,6,8,9,20,21,22,23,24,25].
All included studies indicated the viability of digital scanning as an alternative to conventional impressions. However, Papaspyridakos et al. [25] emphasized that the number of implants and type of scan body used in the scanning procedure imply a difference in the accuracy of implant positioning when compared to the digital technique with the conventional one. Likewise, Mangano et al. [9] highlighted the need for rescanning in 20% of the cases in their sample.

3.1. Meta-Analysis

3.1.1. Technical and Biological Complications

For the item complications in prostheses, four studies were included in the evaluation. A random-effects analysis revealed no significant difference in technical and biological failures (RR: 0.79, 95% CI: 0.56–1.13, p = 0.19, Figure 2). The observed heterogeneity was Chi2 = 2.40 (p = 0.3, I2 = 0%), Figure 2.

3.1.2. Marginal Bone Loss

For the marginal bone loss item, four studies allowed an assessment. Based on random effects, there was no significant difference in the marginal bone loss item between the groups compared (MD: −0.01, 95% CI: −0.02–0.000, p = 0.15, Figure 3). No heterogeneity was observed in the assessment (Chi2 = 0.63, p = 0.89, or between studies I2 = 0), Figure 3.

3.1.3. Time Required for Scanning and Clinical Impression

The meta-analysis conducted with two clinical studies allowed us to evaluate the procedure time for the rehabilitations performed by intraoral scanning and conventional methods considering the implant level (total of scanned/impression dental implants). There was a significant difference between the groups, presenting a mean difference (MD) of −9.18 min (95% CI: −11.93 to −6.43, p < 0.00001, Figure 4). The Chi2 of heterogeneity was 9.34 (p = 0.002, I2 = 89%), Figure 4.
The meta-analysis conducted with two clinical studies allowed us to evaluate the procedure time for the group of rehabilitations made by the intraoral scanning method and the conventional group considering the level of patients treated (total of scanned/impression patients). There was a significant difference between the groups, presenting an MD of −9.02 min (95% CI: −11.73 to −6.3, p < 0.00001, Figure 5). The Chi2 of heterogeneity was 2.08 (p = 0.15, I2 = 52%), Figure 5.
The meta-analysis conducted with two clinical studies allowed us to evaluate the number of times rescanning or new impressions at the level of dental implants was necessary. There was a significant difference between the groups, presenting RR of 3.19 (95% CI: 1.20 to 8.47, p < 0.02, Figure 6). The Chi2 of heterogeneity was 0.02 (p = 0.88, I2 = 0%), Figure 6.
The meta-analysis conducted with two clinical studies allowed us to evaluate the number of times that rescanning or new impressions were necessary at the patient level. There was a significant difference between the groups, presenting RR of 3.17 (95% CI: 1.32 to 7.62, p = 0.010, Figure 7). The Chi2 of heterogeneity was 0.03 (p = 0.87, I2 = 0%), Figure 7.

3.2. Risk of Bias in Studies

As we delved into the analyses considering the groups (conventional impression and test group), the studies’ heterogeneity was low in the technical and biological failure category (I2 = 17%). However, in the time analysis situation, the heterogeneity was high when considering implants and patients. The analyses of complication rates for the digital and conventional groups, retakes, and marginal bone loss indicated less heterogeneity.
The ROBvis tool was used to analyze biases in the randomized controlled clinical studies included in the sample. In general, the studies performed adequately on sample composition and data analysis, with only one study presenting some notes related to the measurement of outcomes, as shown in Figure 8.
Regarding the analysis of the other studies, which were not randomized and clinically controlled but with the domain of an intervention, the Cochrane scale for non-randomized clinical studies (Risk Of Bias In Non-Randomized Studies—of Interventions (ROBINS-I) was applied, identifying that the main limitations were the absence of a control group (conventional technique), or only punctual analysis comparing the software but not establishing a clinical follow-up of the oral rehabilitations developed or not making the period analyzed evident, as shown in Figure 9.

3.3. Evaluating the Certainty of Evidence

The overall quality of evidence regarding the main outcomes was assessed as ranging from low to moderate, according to the GRADE approach. Factors such as limitations in study design, inconsistencies, indirectness, and publication bias played a significant role in this evaluation. Specifically, the evidence concerning clinical execution time at both the implant and patient levels, as well as the number of retakes for scanning and impressions, was rated as low. This was due to many reasons, including issues with random sequence generation and allocation concealment, a small patient sample, a reduced number of studies, and significant heterogeneity (I2 > 40%). Additional details can be found in the Supplementary Material S1.

4. Discussion

This systematic review primarily aimed to evaluate the clinical evidence concerning the survival rates and complications associated with full-arch implant-supported prostheses created using digital methods compared to those obtained through conventional impression techniques. The clinical studies included in the review consistently demonstrated positive outcomes in rehabilitation treatments. This topic is significant because the effectiveness and accuracy of scanning to acquire single and partial implant-supported prostheses are well-documented in the literature [5,29]. However, to scan completely edentulous arches, there are still challenges related to angular divergences, soft tissue scanning, and distance between implants. These factors can affect prosthetic adaptation and influence both complication rates and the survival of oral rehabilitations [5,30].
Regarding implant positioning, the study by Papaspyridakos et al. [24] identified a difference of 85 ± 25 μm between the position of the implants in the digital and conventional groups. At the same time, Chochlidakis et al. [21] found 162 ± 77 μm. Papaspyridakos et al. [25] emphasized that the number of implants and type of scan body used in the scanning can result in differences in the accuracy of implant positioning when comparing the digital with the conventional technique. In their study, the authors describe that the least distortion was observed in cases that used four implants and cylindrical scan bodies. Chochlidakis et al. [21] did not find statistically significant differences despite also evaluating such aspects. Basic clinical studies that evaluated discrepancies in conventional models describe values within a range of 150 to 200 μm as clinically acceptable limits [31,32]. This supports the conclusion that all studies included in this systematic review indicated the viability of digital scanning as an alternative to conventional impressions, considering final positioning adjustments.
This aspect is directly related to the level of adaptation of the prostheses. Among the studies evaluated, there were reports of the need for new prosthesis fabrication due to maladaptation of the infrastructures. Therefore, radiographic analysis and precise verification of the prostheses should be considered for the correct clinical outcome [9,25]. Mangano et al. [9] emphasized the need for rescanning, which in their study reached 20% of the digital group so the final design of the overdentures would be clinically acceptable. Given the clinically acceptable passivity and adaptation for both methods, these findings corroborate that the complication rates were statistically equivalent for both groups. Only four studies were included and evaluated in the meta-analysis for technical and biological complications [4,6,8,20], and no significant differences were observed between the groups. This underscores the importance of our research. It is worth noting that the follow-up period ranged from 12 to 48 months.
Only two studies allowed data collection and analysis regarding the need for additional time in case of repetition [4,6]. The studies demonstrated that the digital group presented twice the number of repetitions than the control group. These results should be taken into account since several studies state that the working time for the digital method is reduced when compared to the working time for the conventional method; however, such studies do not consider the need for repetition time [29,33]. In this context, it is important to highlight the need for adaptation to the software being used, the specific commercial brand, and proficiency in the scanning technique. Additionally, proper positioning and fixation of the scan body are crucial. Other factors related to the patient should also be considered, such as limitations in mouth opening, excessive saliva production, movements during scanning in addition to accumulation of registration, angulation errors, and presence of alveolar mucosa [22]. These factors can complicate the scanning process [10,22], particularly in edentulous arches, and may result in a higher number of repetitions needed to obtain accurate scans.
As the team’s learning curve improves, more favorable results can be achieved [6,9]. This allows for the possibility of repeating the scan to become a straightforward variable that can be executed quickly. This contributes positively to the clinical performance of CAD/CAM prostheses. So, it is crucial for professionals to be able to detect potential defects in the scans at the initial stage.
In addition, it is important to recognize that an increased number of implants placed in the maxilla or variations in arch curvature can lead to the accumulation of errors during the scanning process. This highlights the need for further studies in the field, particularly those assessing inaccuracies in the 3D stage [3,8,21]. Nevertheless, scanning provides a 3D preview that enables real-time verification of the scan [6].
When it comes to the impression of edentulous areas, the key difference between conventional and digital methods is the handling of soft tissues, a process that is more straightforward with conventional impressions [34]. However, the correct positioning of the mucosa is equally vital in both methods. This correct positioning is essential for the prosthesis to be properly fitted, reducing the risk of food impaction and ensuring effective hygiene [34,35]. In the case of the digital method, the challenge lies in accurately reading and identifying edentulous margins, coupled with the increased potential for changes in mucosal positioning due to mucosal hyperextension during the digital impression removal technique. These challenges can lead to a lower satisfaction rate and difficulties in adapting the implant-supported prosthesis to the adjacent tissues. It’s worth noting that the sample included in this review did not show any unfavorable results for the proposed treatments.
Despite this, the results contemplated in the sample demonstrated that there were no statistical differences regarding marginal bone loss [4,6,8,20] and the number of technical or biological complications [3,4,6,8] when comparing digital group and the control group. When analyzing the types of technical complications reported, these are related to daily clinical practice regardless of the method of obtaining, with clinical analysis of the patient, monitoring, and control of parafunctional habits being relevant, as highlighted in the literature [8,9,20,23,25].
It should be emphasized that there is a need for adaptation to the use of software, mastery of the technique, and aspects related to patients, such as limitations in opening the mouth, exaggerated presence of saliva, patient movements during scanning, and presence of areas of alveolar mucosa, which reflect the greater difficulty in obtaining the scan [10], especially in edentulous arches. Thus, more favorable results can be obtained as the team’s learning curve evolves [6]. However, it is worth highlighting the improved control offered by the hybrid flow. This approach allows the use of a conventional impression, which in turn enables a fusion of the traditional technique with CAD/CAM technology. This means that a professional can execute a precise conventional impression with enhanced control of fluids and mucosal positioning, followed by model scanning to leverage the benefits of traditional mucosal impressions. This is associated with adequate marginal adaptation [3,4,6,20,21,23] and a wider range of materials available for prosthesis manufacturing using the CAD/CAM method [9,20,24,25].
Given the diversity of studies in the literature, the need to standardize intraoral scanning methods is highlighted since each operating system determines a scanning method and sequence. Although the technique is well-established for obtaining single and partial implant-supported prostheses [33], the challenges are more significant in edentulous arches and may require the use of guides and additional devices to reproduce the distance between implants faithfully [3,6,20]. In other aspects, it is crucial to recognize advances in digital smile planning (Smile Design), as well as facial scanning. This control is evident in the improved planning of oral rehabilitation in terms of aesthetics and enhanced communication between professionals and patients. Patients also play a crucial role in this process, as they emphasize the relevance of previewing a treatment for analyzing the proposed treatment [20]. This ability to preview their treatment reassures them. Notably, facial scanning of the patient is a key aspect, providing information about the patient’s face in 3D. This has been highlighted as a differential for analysis by both the professional and the patient [9].
The benefits of intraoral scanning extend beyond cases of edentulous patients. The literature has also emphasized the role of digital workflows in enhancing patient care, particularly in the use of conventional fixed and removable prostheses and maxillofacial prostheses [36,37,38]. Maxillofacial prostheses are described using the fully digital workflow [38]. However, challenges are reported in the literature regarding the costs of the fully digital workflow, especially in developing countries [9,37].
Regarding the quality analysis of the articles, it is observed that there is a predominance of studies with longitudinal follow-up, with 4 prospective studies [3,4,9,21] and 4 controlled and randomized clinical trials [6,8,20,22], with a minimum follow-up period of 12 months and a maximum of 48 months. The main limitations raised during the bias analysis are related to the absence of sample calculation, deficiency in calculating the power of the test, and use of a convenience sample, in addition to studies that presented results with missing data, lack of standardization in the preparation of the results analyses, and difficulty in extrapolating the specificity and accuracy data found. The analysis of the certainty of the evidence also revealed a small sample in the studies evaluated and a lack of clear and consistent definitions of randomization and reinforces the need for longitudinal clinical follow-up studies in the area, especially with information on survival and complications of implant-supported prostheses, as well as clinical and laboratory execution time.
Furthermore, several types of scan bodies are available on the market, and there are differences regarding the method of use, such as the need for additional calibration devices, such as palatal demarcation spheres or even splinting of the scan bodies. In this context, the heterogeneity of the studies allows us to establish, with reservations, the indication for all clinical cases, which underlies meticulous planning for the execution of the treatment and the need for more controlled and randomized clinical studies on the subject.

5. Conclusions

  • The survival rates and predictability of full-arch fixed prostheses created using the intraoral scanning method are comparable to those achieved with conventional impression techniques.
  • The rates of technical and biological complications, as well as marginal bone loss, have shown similar outcomes for both the intraoral scanning method and conventional impressions.
  • The clinical time required to perform procedures was significantly shorter when using the intraoral scanning method compared to the conventional technique, both at the implant and patient levels. However, the number of repeated procedures was lower with the traditional impression method. It is important to note that only a limited number of studies were included in this analysis.
  • More prospective and controlled clinical studies are needed to strengthen clinical practices and recommendations.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/app15020533/s1, S1. Summary of findings and details of the GRADE assessment for the main outcomes of this systematic review; S2: Summary of main outcomes of this systematic review.

Author Contributions

Conceptualization, F.L.V., M.C. and J.F.S.J.; data curation, F.L.V., M.C., J.R.A.C.F., E.A.F.B., H.F.F.O. and T.A.P.; writing & original draft, F.L.V., M.C., J.R.A.C.F., E.A.F.B., H.F.F.O., T.A.P. and J.F.S.J.; review & editing, F.L.V., M.C. and J.F.S.J. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by FAPESP, grant number 20/00471-7, and CAPES, Scholarship number 88887.987036/2024-00.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created in this Systematic Review; rather, a meta-analysis was performed by combining existing data. All the quantitative data are readily available in this study. The information and original contributions of this study, along with any additional data, can be obtained on request from the corresponding author (esterbordini@usp.br) or project supervisor (jf.santiagojunior@usp.br).

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. PRISMA diagram indicating the selection of proposed articles.
Figure 1. PRISMA diagram indicating the selection of proposed articles.
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Figure 2. Comparison between technical and biological complications for digitally scanned implants versus conventional impression methods [4,6,8,20].
Figure 2. Comparison between technical and biological complications for digitally scanned implants versus conventional impression methods [4,6,8,20].
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Figure 3. Marginal bone loss for digitally scanned implants versus conventional impression method [4,6,8].
Figure 3. Marginal bone loss for digitally scanned implants versus conventional impression method [4,6,8].
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Figure 4. Meta-analysis for clinical execution time (min), implant level [4,6].
Figure 4. Meta-analysis for clinical execution time (min), implant level [4,6].
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Figure 5. Meta-analysis for clinical execution time (min), patient level [4,6].
Figure 5. Meta-analysis for clinical execution time (min), patient level [4,6].
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Figure 6. Number of retakes for scanning and impression, implant level [4,6].
Figure 6. Number of retakes for scanning and impression, implant level [4,6].
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Figure 7. Number of retakes for scanning and impression, patient level [4,6].
Figure 7. Number of retakes for scanning and impression, patient level [4,6].
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Figure 8. Analysis of randomized controlled clinical studies—ROB scale—Cochrane [6,8,20,22].
Figure 8. Analysis of randomized controlled clinical studies—ROB scale—Cochrane [6,8,20,22].
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Figure 9. Risk analysis using the ROBINS-I scale [3,4,9,21,23,24,25].
Figure 9. Risk analysis using the ROBINS-I scale [3,4,9,21,23,24,25].
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MDPI and ACS Style

Vieira, F.L.; Carnietto, M.; Cerqueira Filho, J.R.A.; Bordini, E.A.F.; Oliveira, H.F.F.; Pegoraro, T.A.; Santiago Junior, J.F. Intraoral Scanning Versus Conventional Methods for Obtaining Full-Arch Implant-Supported Prostheses: A Systematic Review with Meta-Analysis. Appl. Sci. 2025, 15, 533. https://doi.org/10.3390/app15020533

AMA Style

Vieira FL, Carnietto M, Cerqueira Filho JRA, Bordini EAF, Oliveira HFF, Pegoraro TA, Santiago Junior JF. Intraoral Scanning Versus Conventional Methods for Obtaining Full-Arch Implant-Supported Prostheses: A Systematic Review with Meta-Analysis. Applied Sciences. 2025; 15(2):533. https://doi.org/10.3390/app15020533

Chicago/Turabian Style

Vieira, Fernanda L., Maísa Carnietto, José R. A. Cerqueira Filho, Ester A. F. Bordini, Hiskell F. F. Oliveira, Thiago A. Pegoraro, and Joel F. Santiago Junior. 2025. "Intraoral Scanning Versus Conventional Methods for Obtaining Full-Arch Implant-Supported Prostheses: A Systematic Review with Meta-Analysis" Applied Sciences 15, no. 2: 533. https://doi.org/10.3390/app15020533

APA Style

Vieira, F. L., Carnietto, M., Cerqueira Filho, J. R. A., Bordini, E. A. F., Oliveira, H. F. F., Pegoraro, T. A., & Santiago Junior, J. F. (2025). Intraoral Scanning Versus Conventional Methods for Obtaining Full-Arch Implant-Supported Prostheses: A Systematic Review with Meta-Analysis. Applied Sciences, 15(2), 533. https://doi.org/10.3390/app15020533

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