Journal of Prosthetic Dentistry

Digital versus conventional workflow for the fabrication of physical casts for fixed prosthodontics: A systematic review of accuracy

Published:February 04, 2021DOI:


      Statement of problem

      A consensus on the accuracy of additively manufactured casts in comparison with those fabricated by using conventional techniques for fixed dental prostheses is lacking.


      The purpose of this systematic review was to determine the accuracy of additively manufactured casts for tooth- or implant-supported fixed dental prostheses in comparison with that of gypsum casts.

      Material and methods

      This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42020161006). Eight databases were searched in December 2019 and updated in September 2020. Studies evaluating the dimensional accuracy of additively manufactured casts for fixed dental prostheses in comparison with that of gypsum casts were included. An adapted checklist for reporting in vitro studies (Checklist for Reporting In vitro Studies guidelines) was used to assess the risk of bias.


      Eight studies evaluating tooth-supported fixed dental prosthesis casts and 7 studies evaluating implant-supported fixed dental prosthesis casts were eligible for this review. Gypsum casts showed greater accuracy (trueness and precision) in most studies, although additively manufactured casts also yielded highly precise data. One study was associated with a low risk of bias, 9 with a moderate risk of bias, and 5 with a high risk of bias.


      In vitro studies showed that additively manufactured casts and gypsum casts share similar accuracy within the acceptable range for the fabrication of casts. The quality of scanned data, additive manufacture technology, printing settings, and postprocessing procedures plays an essential role in the accuracy of additively manufactured casts. Clinical studies are required to confirm these findings.
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        • Almeida e Silva J.S.
        • Erdelt K.
        • Edelhoff D.
        • Araújo É.
        • Stimmelmayr M.
        • Vieira L.C.C.
        • et al.
        Marginal and internal fit of four-unit zirconia fixed dental prostheses based on digital and conventional impression techniques.
        Clin Oral Investig. 2014; 18: 515-523
        • Arezoobakhsh A.
        • Shayegh S.S.
        • Jamali Ghomi A.
        • Hakimaneh S.M.R.
        Comparison of marginal and internal fit of 3-unit zirconia frameworks fabricated with CAD-CAM technology using direct and indirect digital scans.
        J Prosthet Dent. 2020; 123: 105-112
        • Abduo J.
        • Yin L.
        Fits of implant zirconia custom abutments and frameworks: a systematic review and meta-analyses.
        Int J Oral Maxillofac Implants. 2019; 34: 99-114
        • Lin W.S.
        • Harris B.T.
        • Özdemir E.
        • Morton D.
        Maxillary rehabilitation with a CAD/CAM-fabricated, long-term interim and anatomic contour definitive prosthesis with a digital workflow: A clinical report.
        J Prosthet Dent. 2013; 110: 1-7
        • Papaspyridakos P.
        • Chen Y.
        • Gonzalez-Gusmao I.
        • Att W.
        Complete digital workflow in prosthesis prototype fabrication for complete-arch implant rehabilitation: A technique.
        J Prosthet Dent. 2019; 122: 189-192
        • Beretta M.
        • Poli P.P.
        • Tansella S.
        • Aguzzi M.
        • Meoli A.
        • Maiorana C.
        Cast-free digital workflow for implant-supported rehabilitation in a completely edentulous patient: A clinical report.
        J Prosthet Dent. 2021; 125: 197-203
        • Mangano F.
        • Margiani B.
        • Admakin O.
        A novel full-digital protocol (SCAN-PLAN-MAKE-DONE®) for the design and fabrication of implant-supported monolithic translucent zirconia crowns cemented on customized hybrid abutments: a retrospective clinical study on 25 patients.
        Int J Environ Res Public Health. 2019; 16: 317
        • Joda T.
        • Ferrari M.
        • Brägger U.
        Monolithic implant-supported lithium disilicate (LS2) crowns in a complete digital workflow: A prospective clinical trial with a 2-year follow-up.
        Clin Implant Dent Relat Res. 2017; 19: 505-511
        • Kim W.T.T.
        Accuracy of dental models fabricated by CAD/CAM milling method and 3D printing method.
        J Oral Res. 2018; 7: 127-133
        • Revilla-León M.
        • Özcan M.
        Additive manufacturing technologies used for processing polymers: current status and potential application in prosthetic dentistry.
        J Prosthodont. 2019; 28: 146-158
        • Patzelt S.B.M.
        • Bishti S.
        • Stampf S.
        • Att W.
        Accuracy of computer-aided design/computer-aided manufacturing–generated dental casts based on intraoral scanner data.
        J Am Dent Assoc. 2014; 145: 1133-1140
        • Ender A.
        • Mehl A.
        Accuracy of complete-arch dental impressions: A new method of measuring trueness and precision.
        J Prosthet Dent. 2013; 109: 121-128
        • Kim G.B.
        • Lee S.
        • Kim H.
        • Yang D.H.
        • Kim Y.-H.
        • Kyung Y.S.
        • et al.
        Three-dimensional printing: basic principles and applications in medicine and radiology.
        Korean J Radiol. 2016; 17: 182-197
        • Jockusch J.
        • Özcan M.
        Additive manufacturing of dental polymers: An overview on processes, materials and applications.
        Dent Mater J. 2020; 39: 345-354
        • Dawood A.
        • Marti B.M.
        • Sauret-Jackson V.
        • Darwood A.
        • Marti Marti B.
        • Sauret-Jackson V.
        • et al.
        3D printing in dentistry.
        Br Dent J. 2015; 219: 521-529
        • Liu Q.
        • Leu M.C.
        • Schmitt S.M.
        Rapid prototyping in dentistry : technology and application.
        Int J Adv Manuf Technol. 2006; 29: 317-335
        • Kessler A.
        • Hickel R.
        • Reymus M.
        3D printing in dentistry-state of the art.
        Oper Dent. 2020; 45: 30-40
        • Camardella L.T.
        • de Vasconcellos Vilella O.
        • Breuning H.
        Accuracy of printed dental models made with 2 prototype technologies and different designs of model bases.
        Am J Orthod Dentofac Orthop. 2017; 151: 1178-1187
        • Arnold C.
        • Monsees D.
        • Hey J.
        • Schweyen R.
        Surface quality of 3D-printed models as a function of various printing parameters.
        Materials (Basel). 2019; 12: 1970
        • Hofmann M.
        3D printing gets a boost and opportunities with polymer materials.
        ACS Macro Lett. 2014; 3: 382-386
        • Dugal R.
        • Railkar B.
        • Musani S.
        Comparative evaluation of dimensional accuracy of different polyvinyl siloxane putty-wash impression techniques-in vitro study.
        J Int Oral Heal. 2013; 5: 85-94
        • Bukhari S.
        • Goodacre B.J.
        • AlHelal A.
        • Kattadiyil M.T.
        • Richardson P.M.
        Three-dimensional printing in contemporary fixed prosthodontics: A technique article.
        J Prosthet Dent. 2018; 119: 530-534
        • van Noort R.
        The future of dental devices is digital.
        Dent Mater. 2012; 28: 3-12
        • Barenghi L.
        • Barenghi A.
        • Cadeo C.
        • Blasio A Di
        Innovation by computer-aided design/computer-aided manufacturing technology: a look at infection prevention in dental settings.
        Biomed Res Int. 2019; 2019: 6092018
        • Bohner L.
        • Gamba D.D.
        • Hanisch M.
        • Marcio B.S.
        • Tortamano Neto P.
        • Laganá D.C.
        • et al.
        Accuracy of digital technologies for the scanning of facial, skeletal, and intraoral tissues: A systematic review.
        J Prosthet Dent. 2019; 121: 246-251
        • Rehmann P.
        • Sichwardt V.
        • Wöstmann B.
        Intraoral scanning systems: need for maintenance.
        Int J Prosthodont. 2017; 30: 27-29
        • Revilla-León M.
        • Jiang P.
        • Sadeghpour M.
        • Piedra-Cascón W.
        • Zandinejad A.
        • Özcan M.
        • et al.
        Intraoral digital scans—Part 1: Influence of ambient scanning light conditions on the accuracy (trueness and precision) of different intraoral scanners.
        J Prosthet Dent. 2020; 124: 372-378
        • Revilla-León M.
        • Subramanian S.G.
        • Özcan M.
        • Krishnamurthy V.R.
        Clinical study of the influence of ambient light scanning conditions on the accuracy (trueness and precision) of an intraoral scanner.
        J Prosthodont. 2020; 29: 107-113
        • Ammoun R.
        • Suprono M.S.
        • Goodacre C.J.
        • Oyoyo U.
        • Carrico C.K.
        • Kattadiyil M.T.
        Influence of tooth preparation design and scan angulations on the accuracy of two intraoral digital scanners: an in vitro study based on 3-dimensional comparisons.
        J Prosthodont. 2020; 29: 201-206
        • Resende C.C.D.
        • Barbosa T.A.Q.
        • Moura G.F.
        • Tavares L do N
        • Rizzante F.A.P.
        • George F.M.
        • et al.
        Influence of operator experience, scanner type, and scan size on 3D scans.
        J Prosthet Dent. 2021; 125: 294-299
        • Revilla-León M.
        • Fogarty R.
        • Barrington J.J.
        • Zandinejad A.
        • Özcan M.
        Influence of scan body design and digital implant analogs on implant replica position in additively manufactured casts.
        J Prosthet Dent. 2020; 124: 202-210
        • Sim J.Y.
        • Jang Y.
        • Kim W.C.
        • Kim H.Y.
        • Lee D.H.
        • Kim J.H.
        Comparing the accuracy (trueness and precision) of models of fixed dental prostheses fabricated by digital and conventional workflows.
        J Prosthodont Res. 2019; 63: 25-30
        • Al-Imam H.
        • Gram M.
        • Benetti A.R.
        • Gotfredsen K.
        Accuracy of stereolithography additive casts used in a digital workflow.
        J Prosthet Dent. 2018; 119: 580-585
        • Cho S.H.
        • Schaefer O.
        • Thompson G.A.
        • Guentsch A.
        Comparison of accuracy and reproducibility of casts made by digital and conventional methods.
        J Prosthet Dent. 2015; 113: 310-315
        • Choi J.W.
        • Ahn J.J.
        • Son K.
        • Huh J.-B.
        Three-dimensional evaluation on accuracy of conventional and milled gypsum models and 3D printed photopolymer models.
        Materials (Basel). 2019; 12: 3499
        • Vögtlin C.
        • Schulz G.
        • Deyhle H.
        • Jäger K.
        • Liebrich T.
        • Weikert S.
        • et al.
        Comparison of denture models by means of micro computed tomography.
        Developments in X-Ray Tomography. 2012; VIII: 85061S
        • Alshawaf B.
        • Weber H.P.P.
        • Finkelman M.
        • El Rafie K.
        • Kudara Y.
        • Papaspyridakos P.
        Accuracy of printed casts generated from digital implant impressions versus stone casts from conventional implant impressions: A comparative in vitro study.
        Clin Oral Implants Res. 2018; 29: 835-842
        • Park M.-E.
        • Shin S.-Y.
        Three-dimensional comparative study on the accuracy and reproducibility of dental casts fabricated by 3D printers.
        J Prosthet Dent. 2018; 119: 861.e1-861.e7
        • Buda M.
        • Bratos M.
        • Sorensen J.A.
        Accuracy of 3-dimensional computer-aided manufactured single-tooth implant definitive casts.
        J Prosthet Dent. 2018; 120: 913-918
        • Bohner L.
        • Hanisch M.
        • De Luca Canto G.
        • Mukai E.
        • Sesma N.
        • Neto P.T.
        Accuracy of casts fabricated by digital and conventional implant impressions.
        J Oral Implantol. 2019; 45: 94-99
        • Revilla-León M.
        • Gonzalez-Martín Ó
        • Pérez López J.
        • Sánchez-Rubio J.L.
        • Özcan M.
        Position accuracy of implant analogs on 3D printed polymer versus conventional dental stone casts measured using a coordinate measuring machine.
        J Prosthodont. 2018; 27: 560-567
        • Olea-Vielba M.
        • Jareño-García D.
        • Methani M.M.
        • Martinez-Klemm I.
        • Revilla-León M.
        Accuracy of the implant replica positions on the complete edentulous additive manufactured cast.
        J Prosthodont. 2020; 29: 780-786
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gøtzsche P.C.
        • Ioannidis J.P.A.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
        • Parize H.
        • Tardelli J.
        • Bohner L.
        • Sesma N.
        • Muglia V.
        • dos Reis A.
        Accuracy of additive manufactured casts compared to gypsum casts for fixed dental prosthesis: a systematic review.
        PROSPERO Int Prospect Regist Syst Rev. 2020; : 1-10
        • International Organization for Standardization
        ISO 5725-2:2019. Accuracy (trueness and precision) of measurement methods and results — Part 2: Basic method for the determination of repeatability and reproducibility of a standard measurement method.
        International Organization for Standardization, Geneva2019
        • Krithikadatta J.
        • Datta M.
        • Gopikrishna V.
        CRIS Guidelines (checklist for reporting in-vitro studies): A concept note on the need for standardized guidelines for improving quality and transparency in reporting in-vitro studies in experimental dental research.
        J Conserv Dent. 2014; 17: 301-304
        • Hoffman M.
        • Cho S.-H.
        • Bansal N.K.
        Interproximal distance analysis of stereolithographic casts made by CAD-CAM technology: An in vitro study.
        J Prosthet Dent. 2017; 118: 624-630
        • Mahrous A.
        • Aboulmagd I.
        Accuracy and reproducibility of 3D printed dies versus stone dies.
        Egypt Dent J. 2018; 64: 2871-2877
        • Serag M.
        • Nassar T al
        • Avondoglio D.
        • Weiner S.
        A comparative study of the accuracy of dies made from digital intraoral scanning vs. elastic impressions: an in vitro study.
        J Prosthodont. 2018; 27: 88-93
        • Martani N.S.
        Trueness of stereolithographic model compared to conventional model using cad/cam prosthesis with digital photographs.
        Sulaimani Dent J. 2019; 6: 38-44
        • McLean J.W.
        • von Fraunhofer J.A.
        The estimation of cement film thickness by an in vivo technique.
        Br Dent J. 1971; 131: 107-111
        • Joda T.
        • Matthisson L.
        • Zitzmann N.U.
        Impact of aging on the accuracy of 3D-printed dental models: an in vitro investigation.
        J Clin Med. 2020; 9: 1436
      1. New American Dental Association Specification No. 25 for dental gypsum products.
        J Am Dent Assoc. 1972; 84: 640-644
        • Kim K.M.
        • Lee J.S.
        • Kim K.N.
        • Shin S.W.
        Dimensional changes of dental impression materials by thermal changes.
        J Biomed Mater Res. 2001; 58: 217-220
        • Dostalova T.
        • Kasparova M.
        • Kriz P.
        • Halamova S.
        • Jelinek M.
        • Bradna P.
        • et al.
        Intraoral scanner and stereographic 3D print in dentistry - Quality and accuracy of model - New laser application in clinical practice.
        Laser Phys. 2018; 28: 125602
        • Prithviraj D.R.
        • Bhalla H.K.
        • Vashisht R.
        • Sounderraj K.
        • Prithvi S.
        Revolutionizing restorative dentistry: an overview.
        J Indian Prosthodont Soc. 2014; 14: 333-343