CAD-CAM vs Analog Occlusal Splints: Comparative Study on Occlusal Adjustments

In a pilot study published in the Journal of Esthetic and Restorative Dentistry, dental experts have delved into the world of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices, examining their performance in comparison to analog methods when it comes to occlusal adjustments. 

Conducted by a team of dental professionals including Alvaro Blasi DDS, CDT, Víctor Henarejos-Domingo DDS, MSc, Ricardo Palacios-Bañuelos DDS, MSc, Carla Vidal-Ponsoda DDS, MSc, Conrado Aparicio MSc, PhD, and Miguel Roig MD, DMD, PhD, this study aims to shed light on the potential advantages of fully digital workflows in dental practice.

Methodology and Participants

The pilot study involved eight participants who received two distinct occlusal devices. One set of devices was fabricated using a fully analog workflow, while the other set followed a fully digital process. 

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To assess volumetric changes in these occlusal devices, each was scanned before and after occlusal adjustments, and the data were analysed using reverse engineering software. Additionally, three independent evaluators employed semi-quantitative and qualitative comparisons, utilising visual analog scales and dichotomous evaluations. 

The statistical validity of the results was confirmed through the Shapiro-Wilk test for normal distribution assumptions and dependent t-Student tests for paired variables, with a significance level set at p < 0.05.

Key Findings

The 3-Dimensional (3D) analysis of the occlusal devices yielded a root mean square value. Notably, the average root mean square values were found to be higher for the analog technique (0.23 ± 0.10 mm) compared to the digital technique (0.14 ± 0.07 mm). However, it’s important to note that these differences did not reach statistical significance (paired t-Student test; p = 0.106) between the two fabrication techniques.

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When evaluating the visual analog scale values, significant differences emerged between the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) techniques (p < 0.001). Moreover, variations in the assessments of the three evaluators were observed, with evaluator 3 displaying statistically significant differences compared to the other evaluators (p < 0.05). 

However, all three evaluators achieved agreement in the qualitative dichotomous evaluation in 62% of cases, with at least two evaluators concurring in 100% of evaluations.

Implications and Conclusions

This pilot study’s findings have significant implications for the field of dentistry. The research suggests that occlusal devices fabricated through a fully digital workflow may require fewer occlusal adjustments compared to those produced using an analog workflow. While the observed differences in root mean square values did not reach statistical significance, the clinical significance of this reduction in adjustments cannot be overlooked.

The potential benefits of digital workflows in occlusal device fabrication include reduced chair time, potentially enhancing the overall experience for both patients and clinicians. These findings indicate that incorporating digital workflows into the creation of occlusal devices could be a promising avenue for dental professionals.

It is important to acknowledge that this study has limitations, including its relatively small sample size and focus solely on occlusal adjustments at the insertion visit. Future research may explore the broader clinical wear and adjustment needs of occlusal devices on subsequent recalls.

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