Digital vs Conventional Prosthetic Rehab & Occlusal Analysis in Edentulous Patients

To ensure randomization and reduce order effects, participants will be randomly assigned to Group 1 or Group 2 using a stratified randomization approach in Microsoft Excel. A computer-generated random number will determine group allocation, ensuring that both groups have a balanced distribution based on age, gender, and oral health status. The randomization process will assign participants to either receive conventional dentures first (Group 1) or digital dentures first (Group 2), with a washout period between treatments. By randomizing the sequence of denture delivery, this method will control for potential biases in patient-reported outcomes (OHIP-14, DSQ) and clinical assessments, ensuring that the order of treatment does not influence the study results.

The following outcomes will be analysed:

• Quality of life (Qol) through Oral Health Impact Profile (OHIP-14)
• Patient reported outcomes (PROMS)
• Occlusal analysis - through conventional and digital analysis devices
• Costs
• Number of appointments
• Time AccuracyOutcome Measures The primary outcome of this study is the assessment of occlusal analysis using conventional and digital techniques.

The secondary outcomes include:

• Oral health-related quality of life (OHRQoL), measured using the validated Oral Health Impact Profile (OHIP-14).
• Patient-reported outcomes (PROMs), assessed through the Denture Satisfaction Questionnaire (DSQ), evaluating comfort, aesthetics, speech, and functional satisfaction.
• Number of appointments, recorded as the total number of visits required for fabrication and delivery of both conventional and digital dentures.
• Time efficiency, measured by recording the clinical duration required for key stages such as impressions and final insertions.
• Denture accuracy, assessed through 3D scanning and superimposition analysis using Geomagic Control X software, quantifying deviations between the designed and fabricated dentures. Clinical evaluation of fit, retention, and stability will also be conducted using a standardized grading scale.
• Cost-effectiveness, evaluated using a model adapted from McKenna et al. (2014), where the total cost per patient is divided by the OHIP-14 improvement score to yield a cost per one-point improvement in quality of life. This is benchmarked against the minimally important difference (MID), defined as a 5-point improvement:

Cost-effectiveness ratio = Total cost per patient / OHIP-14 improvement score Benchmark = Cost per point × 5 This model provides a practical and meaningful way to interpret cost relative to patient-perceived improvement, supporting decisions on the integration of digital denture workflows.

The factors will be analyzed through a combination of validated patient-reported outcome measures, digital and conventional assessment techniques, and cost-effectiveness evaluations. Quality of life (QOL) will be assessed using the Oral Health Impact Profile (OHIP-14), a validated measure of oral health-related quality of life, while patient-reported outcomes (PROMS) will be evaluated using the Denture Satisfaction Questionnaire (DSQ) to assess patient satisfaction with comfort, aesthetics, speech, and function of conventional and digital dentures. Occlusal analysis will be conducted using both conventional and digital methods. Articulating paper will be used to assess occlusal contact number and occlusal contact area through visual inspection, while T-Scan and Modjaw will provide quantitative measurements of occlusal force distribution and balance between conventional and digitally fabricated dentures.

Cost, time efficiency, and accuracy will be compared between fabrication techniques. The total number of clinical visits and time spent on clinical and laboratory procedures will be recorded to determine workflow efficiency. A comparative cost analysis will evaluate direct expenses (materials, fabrication) and indirect costs (adjustments, remakes). Denture accuracy will be assessed through 3D scanning and superimposition analysis using Geomagic Control X software, quantifying deviations between the designed and fabricated dentures. Additionally, the fit, retention, and stability of the dentures will be evaluated using a standardized clinical grading scale. Additionally, Accuracy is defined as "the degree to which the result of a measurement, calculation, or specification conforms to the correct value or a standard" . In this study, accuracy pertains to how closely the fabricated complete dentures whether produced via digital or conventional methods match their intended designs and clinical specifications.

To evaluate this:

• Digital Dentures: The fabricated digital dentures will be scanned, and their STL files will be superimposed onto the original CAD designs using Geomagic Control X software. This process will generate a color-coded deviation map, quantifying discrepancies between the designed and fabricated dentures.
• Conventional Dentures: Similarly, conventional dentures will be digitized to obtain their STL files. These will be superimposed onto the corresponding digital designs using the same software and methodology. This allows for a direct, quantitative comparison of the accuracy between conventional and digital fabrication methods.
• Occlusal Accuracy: Occlusal accuracy will be assessed by evaluating the contact points and force distribution. For conventional dentures, articulating paper will be used to mark occlusal contacts, which will then be scanned to create digital models. These models will be superimposed onto the original designs using Geomagic Control X to analyze the location and distribution of occlusal contacts. For digital dentures, occlusal contacts will be assessed through the digital workflow, and similar superimposition techniques will be applied. This approach enables a comprehensive comparison of occlusal accuracy between the two fabrication methods.

By employing these standardized digital superimposition techniques, the study ensures a consistent and objective assessment of denture accuracy across both fabrication workflows, encompassing both the overall fit and occlusal parameters.