applied

sciences
Editorial
Digital versus Conventional Workflow in Oral Rehabilitations:
Current Status
Arthur Rodriguez Gonzalez Cortes

Department of Dental Surgery, Faculty of Dental Surgery, University of Malta, MSD 2090 Msida, Malta;
arthur.nogueira@um.edu.mt

In recent years, computer-aided design and computer-aided manufacturing (CAD-

CAM) technology has developed along with its applications in dentistry, including several
new techniques that are used in oral rehabilitation applications [1–8]. These techniques
usually differ from conventional analog techniques regarding the way in which impressions
are obtained (e.g., conventional impressions vs. intraoral scanning) or the way restorations
are designed and produced (e.g., conventional waxing and casting vs. CAD-CAM). The
general advantages that digital workflow involving CAD-CAM has over conventional
workflow include faster treatment times, shorter appointments, reduced patient discomfort,
no need to use plaster models and better predictability [9,10]. Another key feature of digital
workflow is the ability to merge and superimpose three-dimensional (3D) meshes from
different imaging examinations to create a virtual patient, which enhances virtual treatment
planning and communication with patients [11]. The general disadvantages of digital work-
flow that have been described include purchasing and managing costs, as well as a learning
curve [9]. Nevertheless, it is also important to understand differences in quantitative
outcomes such as trueness and precision between digital and conventional workflows.
One of the most commonly investigated quantitative comparisons in digital dentistry
is between conventional impressions and intraoral scans. In comparison to conventional





 impressions, intraoral scanning (IOS) has been considered to be more accurate in regard to
Citation: Cortes, A.R.G. Digital the outcomes of resulting CAD-CAM crowns and short-span fixed partial dentures [12–14].
versus Conventional Workflow in Several articles have found marginal gap values lower than 60 µm for CAD-CAM dental
Oral Rehabilitations: Current Status. crowns produced using IOS, whereas gap values up to 183 µm were found for crowns
Appl. Sci. 2022, 12, 3710. https:// produced using conventional impressions [12]. One finding that is found across multi-
doi.org/10.3390/app12083710 ple studies is that ensuring the accuracy of intraoral scans of long-span and completely
edentulous arches it is still challenging [15].
Received: 24 March 2022
Conventional impressions can also be digitalized to enable the execution of digital
Accepted: 28 March 2022
Published: 7 April 2022
workflows by using CBCT or desktop optical scanners. The latter, however, has been found
to offer significantly lower gaps for CAD-CAM crowns (reported to be around 50–60 µm),
Publisher’s Note: MDPI stays neutral as compared to the former (reported to be higher than 100 µm) [16–18]. The acquisition
with regard to jurisdictional claims in parameters of CBCT also seem to have an influence on the results, as one study found that
published maps and institutional affil-
a voxel size of 0.125 mm led to better results in comparison to other values [16].
iations.
In addition to the differences between conventional and digital impressions, CAD
studies have also focused on assessing and comparing different software programs and
methods for use in the digital design of dental prosthesis [19,20]. Virtual waxing was found
to be affected not only by subgingival finish lines of the scanned preparations and the IOS
Copyright: © 2022 by the author.
Licensee MDPI, Basel, Switzerland.
device used [19], but also by the operator’s clinical experience and educational background,
This article is an open access article
as prosthodontists with basic CAD training were shown to outperform dental professionals
distributed under the terms and who had CAD certificates but less clinical experience [20].
conditions of the Creative Commons In terms of production, studies assessing conventional and CAD-CAM methods in
Attribution (CC BY) license (https:// the manufacture of dental prosthesis have compared CAD-CAM with pressed ceramic
creativecommons.org/licenses/by/ restorations [21–25]. While for dental crowns, CAD-CAM was found to have significantly
4.0/). better adaptation than pressed ceramics [21,22], most of the studies concerning laminate

Appl. Sci. 2022, 12, 3710. https://doi.org/10.3390/app12083710 https://www.mdpi.com/journal/applsci

Appl. Sci. 2022, 12, 3710 2 of 3

veneers found a different pattern, with similar [23,24] or worse adaptation using CAD-
CAM [25].
Regarding resin restorations, previous studies have concluded that CAD-CAM (i.e.,
milled and 3D-printed) outperform conventional (i.e., manually constructed) interim resin
crowns in terms of adaptation [26] and mechanical resistance [27]. On the other hand, there
is controversy in the literature regarding comparisons between 3D-printed and milled resin
restorations. A recent study found that a five-axis milling device is more accurate and faster
but has a lower production rate and higher costs compared to a low-cost LCD 3D-printer
to produce CAD-CAM dental crowns [28]. Nevertheless, another study on dental implants
that compared a high-end DLP 3D-printer and a four-axis milling device found better
adaptation for 3D-printed resin crowns compared to the milled and conventional crowns
produced in the study [29]. Other previous in vitro studies found similar results between
milling and 3D printing [26,27]. Significant differences in the marginal gaps of CAD-CAM
crowns have also been found between milling devices with different numbers of axes [30].
In conclusion, the interpretation of research assessing CAD-CAM methods and com-
paring them to conventional methods should be performed carefully, as the materials and
methodologies used vary considerably among the studies. It is important to understand
that several variables can affect the outcomes of CAD-CAM restorations and prostheses
during either image acquisition (e.g., IOS device, operator, technique, or anatomy), CAD
(e.g., software or operator) or CAM phases (e.g., device, manufacturing material, CAM
protocol, or finishing). It has also been suggested that digital dentistry has the potential to
play important roles in preventive dentistry, public health, and even dental education [31].
Despite this evidence and several other upcoming clinical trends [31,32], the lack of clinical,
prospective, long-term comparative studies on digital dentistry is a sign that the train of
digital dentistry research still has its first wagon.

Funding: This editorial work received no special funding.

Acknowledgments: The Guest Editor wishes to acknowledge all of the authors and the
anonymous reviewers.
Conflicts of Interest: The author declares no conflict of interest.

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