A double-blind randomized crossover trial comparing the esthetic outcomes of CAD-CAM provisional restorations fabricated using CBCT and IOS acquisition methods

Objectives

This double-blind randomised crossover trial aimed to compare the aesthetic outcomes of CAD-CAM manufactured provisional restorations created using cone beam computed tomography (CBCT) and intraoral scanners (IOS) acquisition methods.

Methods

Twelve participants (mean-age: 38 ± 5 years) requiring full mouth rehabilitation were included in this crossover trial. Two sets of identical CAD-CAM provisional restorations, differing only in the method of data acquisition (A: CBCT, B: IOS), were fabricated. Restorations were cemented for two weeks, with washout period between interventions. Esthetic evaluations were conducted using clinician and patient-reported outcome questionnaires. Both parametric and non-parametric tests were used to account for data variability: Mann-Whitney U test compared pink esthetic score (PES), white esthetic score (WES), and modified US Public Health Service (USPHS) score. An unpaired t-test compared Oral Health Impact Profile- Aesthetic Questionnaire (OHIP-Aes) scores and Orofacial Esthetic scores.

Results

Clinician-reported outcomes showed significantly better esthetic scores for provisional restorations fabricated using CBCT compared to IOS. CBCT scored higher in Pink Esthetic Score (PES) [Mean rank: CBCT = 16.00, IOS = 9.00; P = 0.012] and White Esthetic Score (WES) [Mean rank: CBCT = 17.25, IOS = 7.75; P < 0.001]. No significant differences were observed for Modified USPHS scores across groups [Mean rank: CBCT = 11.38, IOS = 13.63; P = 0.221]. Patient-reported outcomes indicated no significant differences between groups in OHIP-Aes scores [CBCT = 1.25 ± 1.76, IOS = 1.58 ± 1.62; P = 0.635] or Orofacial Esthetic Index (OFEI) scores [CBCT = 65.75 ± 1.54, IOS = 65.50 ± 1.62; P = 0.703].

Conclusion

Both CBCT and IOS acquisition techniques provide aesthetically satisfactory CAD-CAM provisional restorations. CBCT demonstrated significantly higher clinician-reported esthetic outcomes for both pink and white esthetic scores. While patient satisfaction was similar for both methods, CBCT offers practical advantages, including the elimination of separate diagnostic appointments, making it a preferred choice for enhanced esthetic outcomes in CAD-CAM provisional restorations.

Clinical implications

CBCT acquisition methods yield significantly better clinician-reported esthetic outcomes for CAD-CAM provisional restorations compared to IOS. Additionally, CBCT eliminates the need for separate diagnostic appointments, reducing treatment time and number of visits, while both methods provide similar satisfactory patient-reported outcomes.

Clinical trial registration number

Approval number: CTRI/2023/03/050410.