Impact of Digital Impressions on Prosthodontic Restoration Outcomes in Primary Care Clinics

Thesis Abstract

The shift from conventional impression techniques to digital impressions has increased efficiency and precision in prosthodontic workflows, yet evidence on its impact within primary care clinics remains fragmented, potentially influencing restoration fit, patient satisfaction, and long-term oral health outcomes. This study investigates how digital impression workflows affect prosthodontic restoration outcomes in real-world primary care settings, addressing gaps related to external validity and practice variability. Aims The primary aim is to evaluate whether digital impressions improve restoration fit, marginal integrity, and complication rates compared with conventional impressions in primary care clinics. Secondary aims include assessing patient-reported experience, technician workload, and chairside time; exploring practitioner attitudes toward digital workflows; and identifying contextual factors that modulate outcomes in diverse primary care environments. Specific objectives (1) quantify differences in marginal fit and occlusal accuracy between digitally and conventionally captured restorations; (2) compare restoration complication rates (adjustments, remakes) over a 12-month follow-up; (3) evaluate patient satisfaction and comfort using validated scales; (4) analyze chairside time and workflow efficiency; (5) examine clinician and dental technician acceptance and perceived barriers using a mixed-methods approach; (6) develop a contextual model of factors predicting successful digital impression adoption in primary care. Methodology A pragmatic, multi-site, prospective cohort design will be employed across 12 primary care clinics. The study population comprises adult patients requiring single-unit or short-span prosthodontic restorations. Based on power calculations to detect a small-to-moderate effect size (d=0.4) with 80% power and alpha 0.05, 240 participants will be recruited (120 digital impression cases and 120 conventional cases), with stratified randomization by site to balance operator experience. Data collection will utilize standardized instruments (1) objective measures of fit via silicone replica microleakage and measured marginal discrepancy using a digital caliper; (2) restoration longevity tracked through clinical inspections at 6- and 12-month intervals; (3) patient-reported outcomes via the Patient Satisfaction with Dental Prosthetics scale and the Acceptance of Digital Dentistry inventory; (4) workflow metrics captured through time-motion analyses; and (5) qualitative insights from semi-structured interviews with dentists, dental assistants, and laboratory technicians. Validity will be strengthened through calibration sessions for evaluators, pilot testing of instruments, and inter-rater reliability checks (Cohen’s kappa). Reliability will be ensured by training and using standardized protocols across sites. Data analysis will integrate quantitative and qualitative approaches. Descriptive statistics will summarize baseline characteristics. Inferential analyses will include mixed-effects linear models to compare marginal fit and occlusal accuracy, adjusting for clustering by site and practitioner experience; survival analysis (Kaplan–Meier) for restoration longevity; and generalized estimating equations (GEE) for repeated measures of patient satisfaction and workflow efficiency. Regression analyses will identify predictors of successful digital impression adoption, including clinic workflow maturity, device type (intraoral scanner model), and operator training. The qualitative component will use thematic analysis guided by the Technology Acceptance Model and the Diffusion of Innovations framework, with data triangulation to contextualize quantitative findings. The study is expected to show that digital impressions yield superior marginal accuracy and comparable or reduced chairside time when combined with streamlined workflows, translating into lower revision rates and higher patient satisfaction in multiple primary care settings. However, variability across clinics in device performance, operator proficiency, and laboratory communication is anticipated, informing a contextual model of digital impression success. Contributions to knowledge include (a) robust, multicenter evidence on the clinical performance of digital impressions in primary care prosthodontics; (b) an empirically derived framework linking workflow maturity, device choice, and clinician training to restoration outcomes; and (c) practical implications for policy and continuing education in community dental practice. The study will conclude with actionable recommendations for standardizing digital impression protocols, targeted operator training, and strategies to optimize patient-centered outcomes, alongside suggestions for future longitudinal research examining long-term prosthodontic success in diverse primary care contexts.