title: A digital approach integrating facial scanning in a CAD-CAM workflow for complete-mouth implant-supported rehabilitation of patients with edentulism: A pilot clinical study.
abstract: BACKGROUND
  Complete-mouth implant-supported rehabilitations are challenging because of the multiple surgical and prosthetic steps involved in clinical evaluations to assure passive prosthesis fit and optimal esthetic and functional outcomes. As a result, these rehabilitations are usually associated with substantial clinical time, patient discomfort, and high treatment cost.
  
  
  OBJECTIVE
  The purpose of this pilot clinical study was to evaluate a novel digital approach integrating digital intraoral dental and extraoral facial scanning information to design and mill a computer-aided design and computer-aided manufacturing (CAD-CAM) implant-retained prosthesis for patients with complete edentulism.
  
  
  METHODS
  Ten patients in need of complete-mouth rehabilitation were included in this pilot study. Digital intraoral records were obtained through optical scanning the duplicate interim prosthesis using a laboratory scanner, while digital extraoral records were obtained through facial scanning using an in-office scanner. The scanned impressions and occlusal records were used to create a virtual tooth arrangement, which was matched to the patient's 3-dimensional face scan to create a virtual clinical evaluation phase. After applying the necessary adjustments, the virtual arrangement was submitted to a CAM procedure where a 5-axis industrial milling machine was used to fabricate an interim prosthesis.
  
  
  RESULTS
  Digital intraoral and extraoral records were integrated and used to fabricate CAD-CAM milled interim prostheses, which were inserted and assessed for clinical fit, occlusion/articulation, and esthetics. The prostheses remained in function for at least 6 months with no notable technical or biological complications except for 1 prosthesis that fractured.
  
  
  CONCLUSIONS
  A novel digital workflow incorporating facial scanning in a CAD-CAM workflow was used to fully digitally design and mill 10 implant-retained interim prostheses. More research is required to further develop and assess the accuracy and applicability of this approach.
authors.affiliation: Assistant Professor, Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. Electronic address: b.hassan@acta.nl.
authors.forename: Bassam
authors.initials: B
authors.lastname: Hassan
authors.affiliation: Assistant Professor, Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Gimenez Gonzalez
authors.affiliation: Associate Professor, Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
authors.forename: Ali
authors.initials: A
authors.lastname: Tahmaseb
authors.affiliation: Professor, Department of Prosthodontics, Vienna School of Interdisciplinary Dentistry, Medical University Vienna, Vienna, Austria.
authors.forename: Marcus
authors.initials: M
authors.lastname: Greven
authors.affiliation: Professor and Head, Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wismeijer
mesh_terms: D017076:Computer-Aided Design; D003735:Dental Casting Technique; D019094:Dental Prosthesis, Implant-Supported / Q000379:methods*; D003779:Denture Design / Q000379:methods*; D003824:Denture, Complete; D006801:Humans; D009066:Mouth, Edentulous / Q000000981:diagnostic imaging / Q000601:surgery*; D010865:Pilot Projects; D011861:Radiography, Dental / Q000379:methods