Development and assessment of a digital workflow for minimally invasive anterior composite restorations

Thesis Abstract

The increasing demand for esthetically pleasing dental restorations coupled with the need for minimally invasive procedures necessitates the development of a reliable, efficient digital workflow for anterior composite restorations. Traditional restorative techniques often involve subjective procedures with variability in outcomes, prolonged chairside times, and potential for excess removal of healthy tooth structure. This study aims to develop and critically assess a comprehensive digital workflow integrating advanced imaging, computer-aided design (CAD), and computer-aided manufacturing (CAM) technologies to optimize minimally invasive anterior composite restorations. The specific objectives include evaluating the accuracy and predictability of digital smile design in planning, assessing the clinical performance and esthetic stability of restorations fabricated via digital methods over a 12-month follow-up, and comparing patient satisfaction and procedural efficiency against conventional methods. The research adopts a mixed-methods approach, incorporating a prospective, randomized controlled trial alongside qualitative patient interviews. The quantitative component involves enrolling 60 adult patients requiring anterior composite restorations, randomly assigned into two groups a digital workflow group (n=30) utilizing intraoral scanners, 3D planning software, and CAD/CAM fabrication, and a conventional workflow group (n=30) employing traditional chairside procedures. Data collection instruments include calibrated digital intraoral scanners, standardized clinical evaluation forms based on the modified United States Public Health Service (USPHS) criteria, and validated visual analog scales for patient satisfaction. Qualitative data are gathered through semi-structured interviews analyzed via thematic analysis to explore patient perceptions of the digital versus conventional processes. Data analysis employs descriptive statistics to characterize the sample, independent t-tests and chi-square tests to compare procedural times, and repeated measures ANOVA to evaluate changes in esthetic parameters over time. The accuracy of digital planning is assessed via superimposition techniques measuring trueness and precision, analyzed with geometric morphometric methods. Clinical performance data are subjected to Kaplan-Meier survival analysis to estimate restoration longevity, while multivariate regression models identify factors associated with clinical outcomes. Ethical approval and informed consent procedures adhere to standards delineated by pertinent regulatory frameworks. It is anticipated that the digital workflow will demonstrate superior accuracy in preoperative planning, reduced chairside time, and enhanced patient satisfaction. Restorations fabricated digitally are expected to exhibit comparable or improved clinical performance and esthetic stability over the follow-up period compared to conventional restorations. The findings are projected to elucidate the clinical feasibility, advantages, and potential limitations of integrating digital technologies into minimally invasive anterior restorative dentistry. This research aims to contribute significantly to evidence-based practice by establishing standardized digital protocols that enhance procedural predictability and patient-centered outcomes. The study's key contributions will include validating the clinical utility of digital workflows in anterior restoration, identifying critical factors influencing esthetic and functional longevity, and providing a framework for adopting digital dentistry within everyday clinical practice. The results will inform dental practitioners, researchers, and academic curricula on the efficacies and practical considerations of digital integration in minimally invasive restorative procedures. Furthermore, the study will recommend strategies for improving digital technology accessibility and training to promote broader implementation. In conclusion, this research underscores the potential of digital workflows to transform anterior composite restoration practices, making them more predictable, efficient, and patient-friendly. Recommendations will emphasize adopting digital diagnostic and fabrication tools as standard practice, advancing training modules for dental professionals, and encouraging further longitudinal studies to validate long-term outcomes of digital restorative strategies. The findings aim to shape future guidelines and policies aimed at optimizing esthetic restorative care through innovative digital solutions.