Németh Anna, Vitai Viktória, Kelemen Kata, Teutsch Brigitta, Szabó Bence, Gerber Gábor, Varga Gábor, Fazekas Réka, Hegyi Péter, Borbély Judit
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Prosthodontics, Semmelweis University, Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
J Dent. 2025 Feb;153:105527. doi: 10.1016/j.jdent.2024.105527. Epub 2024 Dec 19.
Numerous studies have been conducted on the adaptation of dental restorations fabricated by additive (AM) and subtractive manufacturing (SM); however, the results are conflicting. This systematic review and meta-analysis aimed to evaluate the fit and trueness of fixed restorations made by AM compared to SM.
Studies investigating internal fit, marginal fit, and trueness of fixed prostheses were involved.
The protocol was registered in PROSPERO (registration number CRD42022323090). An electronic search was performed with a predefined search query across four medical databases on the 6th of September 2023.
A total of 57 eligible studies were included and sub-grouped by material type (metals, ceramics, acrylic resins, composites). The outcomes were specified as internal fit, marginal fit, and trueness expressed in micrometer (µm). Further subgrouping was based on measurement area: axial, occlusal, and marginal. When we analyzed marginal fit, there were no statistically significant differences between the two techniques in any of the subgroups. The measurement of internal fit metal and ceramic restorations provided no significant differences. However, milled acrylic resin restorations showed a significantly higher occlusal gap compared to 3D printed prostheses with 39.12 µm (95 % CI: 12.44; 65.79). In the case of trueness, a statistically significant difference was observed between ceramic AM and SM restorations with -47.76 µm (95 % CI: -95.51; -0.00). QUIN and GRADE Pro tools were used to evaluate the risk of bias and certainty of evidence.
Fixed restorations manufactured with additive manufacturing are valid alternatives to subtractive manufacturing in the digital workflow.
Additive manufacturing is an accurate and cost-effective manufacturing method of digital workflow, especially for metal and resin fixed restorations. Once the challenges in ceramics manufacturing are addressed, AM will show more significant promise in the field.
关于增材制造（AM）和减材制造（SM）所制作的牙科修复体的适应性，已经开展了大量研究；然而，结果相互矛盾。本系统评价和荟萃分析旨在评估与减材制造相比，增材制造制作的固定修复体的适合性和精确性。
纳入了研究固定修复体内部适合性、边缘适合性和精确性的研究。
该方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号CRD42022323090）。于2023年9月6日使用预定义的检索式在四个医学数据库进行了电子检索。
共纳入57项符合条件的研究，并按材料类型（金属、陶瓷、丙烯酸树脂、复合材料）进行亚组划分。结果指定为以微米（µm）表示的内部适合性、边缘适合性和精确性。进一步的亚组划分基于测量区域：轴向、咬合面和边缘。当我们分析边缘适合性时，在任何亚组中两种技术之间均无统计学显著差异。内部适合性金属和陶瓷修复体的测量结果无显著差异。然而，与3D打印修复体相比，铣削丙烯酸树脂修复体的咬合面间隙显著更高，为39.12 µm（95%置信区间：12.44；65.79）。在精确性方面，陶瓷增材制造和减材制造修复体之间观察到统计学显著差异，为-47.76 µm（95%置信区间：-95.51；-0.00）。使用QUIN和GRADE Pro工具评估偏倚风险和证据确定性。
在数字工作流程中，增材制造制作的固定修复体是减材制造的有效替代方案。
增材制造是数字工作流程中一种准确且具有成本效益的制造方法，尤其适用于金属和树脂固定修复体。一旦解决了陶瓷制造中的挑战，增材制造在该领域将展现出更显著的前景。
