ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Decrease in Cost and Time for Single Unit Implant Supported Crowns Fabricated by a Digital Workflow
Clinical Question For clinicians providing treatment of posterior single-unit implant-supported crowns, will the adoption of a digital workflow provide significant benefits in terms of time and cost, compared to using a conventional approach?
Clinical Bottom Line The adoption of a digital workflow for production of implant-supported single unit crowns would bring great benefits to a dental practice. Overall cost/time analysis of production is greatly reduced for both clinical and laboratory aspects compared to conventional workflow. Time-efficiency analysis of digital workflow was greatly increased resulting in reduced lab time, and chair time for both clinician and patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25179680Joda/201420 patientsProspective Cohort Study
Key resultsProsthetic treatment was analyzed for both clinical and laboratory work including cost (Swiss Francs – CHF), productivity rates, and cost minimization. The digital approach cost for direct treatment was 1815.35 CHF, compared to conventional cost of 2119.65 CHF (P=0.0004). The difference in cost was significant, 304.30 CHF ($302 USD) less for digital workflow than conventional. Total costs for laboratory work was 941.95 CHF for the digital group, compared to 1245.64 CHF for the conventional approach (P = 0.003). Lastly, clinical productivity rate resulted quite higher for digital workflow with 29.64 CHF/min, whereas conventional yielded 24.37CHF (P=0.002). Overall analysis of cost reduction was determined to be 18% less, using a digital workflow.
#2) 26394340Joda/201520 patients (receiving single-tooth replacements in posterior sites)Prospective Cohort Study
Key resultsBoth workflows (digital and conventional) allowed for crowns to be provided within two clinical appointments, while time-efficiency analysis of mean total production time (clinical + laboratory) was significantly different. The mean standard deviation of total time for the digital workflow process was 185.4 +/- 17.9 min, compared to 223.0 +/-26.2 min. using a conventional approach (P=0.0001). Results showed a decrease of nearly 40 minutes for the digital process, making overall treatment time about 16% faster. Clinical treatment time was moderately reduced with 27.3 +/- 3.4 min. for the digital group, compared to 33.2 +/- 4.9 min. for the control group (P=0.0001). Significant results were demonstrated in mean laboratory work time, with 158.1 +/- 17.2 min. for digital workflow, compared to 189.8 +/- 25.3 minutes for the control group (P=0.0001). This study demonstrated how patient chair-time and laboratory production times can both see significant increases in efficiency by decreasing time, while utilizing a digital workflow (intraoral scanning plus CAD/CAM technology).
Evidence Search Digital[All Fields] AND ("workflow"[MeSH Terms] OR "workflow"[All Fields]) AND implant[All Fields] AND ("crowns"[MeSH Terms] OR "crowns"[All Fields] OR "crown"[All Fields])
Comments on
The Evidence
Validity: Joda/2014: I think the results analyzed using the Wilcoxon signed-rank test yielded somewhat valid results. Although the patient group wasn’t large, the data (cost & time) are quantifiable, and procedures utilized (clinical & lab) are repeatable for single-unit implant supported crown restorations. Joda/2015: I think these results are valid, due to the fact that time-efficiency analysis is easily calculated for any clinical procedure and laboratory work from beginning to end of treatment. The group size used for this study was not very large, yet treatment and procedure time is constant for all steps involved in treating cases with single-unit implant supported crowns. Perspective: Joda/2014: Although the amount of data collected was sufficient to make conclusions on overall cost/time efficiency of a digital workflow, I would really like to see this study conducted at different dental offices. The overall increase in efficiency is definitely proven, yet every dental practice runs differently and uses different systems, operations, and lab partnerships. Joda/2015: The decrease in overall time is very significant when utilizing a digital workflow vs. a conventional one. To further validate this study, it should be done at multiple dental clinics to include discrepancies that could result from operators, as well as operations.
Applicability Digitalization in dentistry has built incredible momentum in recent years. More and more dentists are becoming familiarized with the use of sophisticated dental equipment, which at the same time can be a large initial investment as this equipment can be costly. Initial investment may be the biggest reason why some clinicians still doubt whether transitioning to a dental workflow would bring benefits to their practice. These studies prove the adoption of a digital workflow can reduce time and costs, benefitting both the dental practice as well as it's patients. This proves that a utilizing full digital workflow for production of single-unit implant supported crowns is a very feasible option for dentists who often provide this type of treatment to their patients.
Specialty/Discipline (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Digital Workflow, Dental Crown, Implants, CAD/CAM
ID# 3237
Date of submission: 04/25/2017spacer
E-mail gonzalezco@livemail.uthscsa.edu
Author Cesar Gonzalez
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Marianela Villareal Garza, DDS
Faculty mentor/Co-author e-mail VillarrealGa@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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