In the past two decades, interest in computer-aided design/computer-aided manufacturing (CAD-CAM) technologies for complete fixed denture has increased, such that these technologies are now widely used in dentistry.1  Important improvements have been made in full-arch rehabilitation using implants, and automated procedures based on CAD-CAM techniques have been developed and applied to various phases of the manufacturing workflow.27  For example, the ability to produce complete dentures using CAD-CAM technology provides high process reliability, and many authors have published reports on this subject.813  Moreover, digitalization enables conversion of the complete denture into a complete-arch interim restoration, as well as transfer of the vertical dimension of occlusion into the final full-arch fixed restoration.14,15  Other authors developed systems that were successfully employed to create virtual face replicas for comprehensive diagnosis and treatment planning based on esthetic data.16,17 

However, before beginning any digital process, an evaluation of the provisional complete denture (PD) is needed for assessment of masticatory efficiency, occlusion, and esthetic parameters. After implementing the necessary corrections for improvement of esthetics and occlusion, the PD may be used for the implants guided surgery and for digital design of the final full-arch prosthesis. From a prosthetic point of view, once the clinical comfort of the patient is obtained with the complete denture, the clinical challenge is to transfer all occlusal, functional, and esthetic PD features to the final implant-supported fixed prosthesis. To the best of our knowledge, there are minimal data regarding digital transfer of the occlusion in edentulous patients from the modified PD to the final full-arch prosthesis; moreover, a method to clinically perform corrections on 3D-manufactured resin PD replicas of the definitive prosthesis, and to digitally integrate these modifications into a definitive digital design, has not yet been described. The rationale of this digital procedure is to simplify the clinical steps for the construction of a full-arch fixed prosthesis on implants, by using the preoperative complete denture as a try-in test and copying its final features in the definitive fixed prosthesis.

The main aim of this report is to detail the digitalization process used to transfer data from the PD to the final fixed restoration on implants and to achieve and integrate all occlusal, esthetic, and phonetic parameters into the complete digital workflow.

The workflow is applicable to complete denture wearer scheduled for full-arch prosthetic rehabilitation on implants, and begins with PD revision prior to implant surgery. The base of the complete denture must be relined with a silicone material (Elite HD+ Light Body; Zhermack) or with a soft relining material (Coe-Soft, GC Inc) to account for differences between the osteomucosa and the PD base. To ensure a success with this digital protocol, the accurate record must communicate 6 key factors: midline, centric relation, occlusal vertical dimension (OVD), anterior tooth size, lip support, and incisal edge location. Esthetic parameters are corrected with a build-up of central incisor used as a “guide tooth” (Figure 1): by adding composite material (Tetric Evo, Ivoclar Vivadent) to the incisal edge, the esthetics of the smile line can be evaluated and modified in accordance with the esthetic parameters of the lower and upper lips, as well as the age and chief complaint of the patient. Concomitantly, the occlusal plan may be modified in accordance with the Camper plane: in this case, variations of the occlusal profile must be drawn on the buccal aspect of the denture posterior teeth and measured according to each dental element (Figure 2). Digital impressions of the PD on both mucosal (Figure 3) and buccal surfaces are then made at chairside using an intraoral scanner (True Definition Scanner [TDS]; 3M ESPE).

Figures 1-6.

Figure 1. Esthetic parameters are informed by a composite central incisor, used as a “guide tooth.” Figure 2. The occlusal profile is drawn on the buccal aspect of the denture posterior teeth and measured according to each dental element. Figure 3. Digital impressions on both the mucosal and buccal surfaces of the interim complete denture (PD) are made using an intraoral scanner. Figure 4. The design of the PD is modified for integration into the digital design of the final rehabilitation. Figure 5. The modified PD replica is 3D-manufactured and used as a clinical try-in during the final clinical check. Figure 6. The PD is used to create the radiographic guide for computed tomography scans.

Figures 1-6.

Figure 1. Esthetic parameters are informed by a composite central incisor, used as a “guide tooth.” Figure 2. The occlusal profile is drawn on the buccal aspect of the denture posterior teeth and measured according to each dental element. Figure 3. Digital impressions on both the mucosal and buccal surfaces of the interim complete denture (PD) are made using an intraoral scanner. Figure 4. The design of the PD is modified for integration into the digital design of the final rehabilitation. Figure 5. The modified PD replica is 3D-manufactured and used as a clinical try-in during the final clinical check. Figure 6. The PD is used to create the radiographic guide for computed tomography scans.

Close modal

For the occlusion, if any discrepancy exists between the PD and the correct centric relation, a new intermaxillary registration may be recorded (UTS-CAD, Ivoclar Vivadent) Then, the maxillomandibular relationship of the patient may be scanned as is, using the dental scanner (TDS; 3M-ESPE), and resulting Standard Tessellation Language (STL) file can be sent to the laboratory. The entire procedure may be carried out during the first appointment. When the PD and its occlusion are digitalized in accordance with all corrections and measurements, the digital design of the PD is consequently integrated (Figure 4) into a new project for final rehabilitation (Exocad Dental CAD, Exocad). This project is used to 3D print (Micro, EnvisionTEC) the resin prototype (Prototype polyamide-resin; 3D Systems), and the modified PD replica is used as a clinical try-in during the final check of the esthetics (Figure 5). The vertical dimension of occlusion, Spee arch conformation, Camper plane orientation, smile design, phonetics, and occlusion are finally incorporated into the virtual articulator for subsequent construction of the surgical template for the implants, and for creating successive provisional and final full-arch prostheses on implants (Figure 6). The implant-guided surgery is set up on digital software (Nobel Clinician; Nobel Biocare) for 3D-manufacture of the surgical guide. Flapless surgery is performed and, using the scan bodies of the implants, digital impressions of both the maxillary and mandibular arches are made in the oral cavity with an intraoral scanner (TDS). To register the occlusion while the scan abutments remain in the same position of the impressions, the radiographic guide is applied, and the morphology is modified to allow embracement of the scan abutments when the patient is in occlusion: corresponding to the scan bodies, a hole for each scan body is realized on the radiographic guide, thereby creating a window in the buccal aspect of the resin base to enable the intraoral scanner to clearly visualize the scan body during the digital impression (Figure 7). In this manner, the software (TDS) registers the maxillomandibular relationship of edentulous arches with implants, according to the centric relation previously determined with the PD. This allows for superimposition of the STL file of each single arch on the STL file of the scan bodies in the correct occlusion (Figure 8). Using Geomagic software (Geomagic), three landmarks are created in the scan bodies of both the single arch digital impressions and the bite impression. The center of the screw hole of each scan abutment is used as the landmark, as it is consistently visible in both impressions: this allows superimposition of the STL files (single arch and arches in occlusion) and achievement of an appropriate occlusal position for the virtual articulator (3-Shape Articulator; Zahn Dental). A potential difficulty during bite recording is that scan bodies may interfere with the occlusal plane. If this occurs, customized and reduced scan abutments should be used. The virtual articulator is used to design the complete-arch interim restoration (CIR) for immediate loading on implants, as a copy of the modified PD (Figure 9). A 3-month follow-up is deemed appropriate for optimization of patient comfort according to the new occlusal, functional, and esthetic parameters. When all parameters are adjusted in accordance with the clinical needs and the patient's chief complaint, digital impressions of the CIR are made in the oral cavity using a protocol described previously,18  and transferred to the final digital design of the framework.

Figures 7–11.

Figure 7. The concept of occlusal transfer. A digital impression of the occlusion is created to allow the software to register the occlusal relationship of the upper and lower arches, according to the occlusion previously determined using the PD; this relationship then serves as a radiographic guide. Figure 8. Superimposition of the two full-arch impression STL files (brown) onto the occlusal registration file (blue). Figure 9. The provisional fixed prosthesis (CIR) is a copy of the revised PD. Figure 10. (a) Metal framework; (b) 3D-manufactured pink resin; (c) Cementation of the framework. Figure 11. Full-arch rehabilitation of the upper and lower arches.

Figures 7–11.

Figure 7. The concept of occlusal transfer. A digital impression of the occlusion is created to allow the software to register the occlusal relationship of the upper and lower arches, according to the occlusion previously determined using the PD; this relationship then serves as a radiographic guide. Figure 8. Superimposition of the two full-arch impression STL files (brown) onto the occlusal registration file (blue). Figure 9. The provisional fixed prosthesis (CIR) is a copy of the revised PD. Figure 10. (a) Metal framework; (b) 3D-manufactured pink resin; (c) Cementation of the framework. Figure 11. Full-arch rehabilitation of the upper and lower arches.

Close modal

The framework is designed according to the dental positions: using the digital version of the artificial teeth (Bonartic; Candulor), retention pins for acrylic/composite teeth are digitally projected within the metal framework to occupy the standard hole in each artificial tooth. When the design is completed (Exocad Dental CAD), the cobalt/chrome (Co/Cr) framework is manufactured using a milling machine (Program Mill PM7; Ivoclar Vivadent) and clinically checked. As an alternative, as in the exemplificative case presented herein, a direct technique may be used to set the acrylic teeth in the pink resin body of the prosthesis: the pink resin body of the prosthesis is digitally designed and manufactured according to the teeth contour, and the resin teeth are directly cemented using Ivobase CAD Bond (Ivoclar Vivadent) into the specifically designed slots of the pink resin. Then, the pink resin is cemented to the metal framework using Multilink Hybrid Abutment (Ivoclar Vivadent; Figure 10a through 10c) to ensure adequate embrasure and to allow hygienic home care and maintenance. Then, the prosthesis is delivered to the patient (Figure 11).

This protocol allowed for digital transfer of all occlusal, esthetic, and functional parameters from the PD to the CIR for the immediate loading on implants. After the optimization of patient comfort, the CIR parameters were directly transferred to the final digital full-arch implant-supported fixed prosthesis design. This protocol reduced the procedure time, and the laboratory costs (to a maximum of 1200 euros for each full-arch prosthesis), by using a 3D-milling process to manufacture the chrome/cobalt framework and the pink resin body, and by using artificial resin/composite teeth.

In the past decade, CAD-CAM technologies for dentistry have improved the production of full-arch rehabilitations using implants for edentulous patients. The protocol reported in this pilot study described the completion of the digital workflow, using the digital technology to achieve and integrate all steps of prosthesis manufacturing, since the provisional complete denture to the full-arch fixed prosthesis on implants.

Several studies have reported equal or superior results to conventional processes in terms of the marginal fit of implants using metal frameworks.7,1922  Conventional procedures (waxing, casting, and refinishing) are increasingly being replaced by modern CAD-CAM techniques; framework costs are reduced by laser-melting, milling, or hybrid technologies, as noble metals are not used for 3D printing. The rapid prototyping process allows milled frameworks of smaller dimensions to be obtained, and a metal structure may be designed more successfully when the framework is created in accordance with tooth positions predetermined by the CIR.

Moreover, use of a digital protocol improves accuracy during the creation of impressions. For digital impression data, Ender et al23,24  reported mean accuracy at the framework/implant interface to within 40.3 ± 14.1 to 58.6 ± 15.8 μm, depending on the system used. Patzelt et al25  reported accuracy using the digital impression technique to within 38 to 333 μm, depending on the oral scanner used. Meanwhile, Guth et al26  noted 13/17 μm minimum/maximum differences in measurements between oral scanners, and Flugge et al27  reported a 50-μm mean gap at the implant interface. Gimenez et al2831  investigated the accuracy of full-arch impressions of scan abutments using an intraoral scanner, and found a mean error of less than 70 μm. Ciocca et al7  reported a mean 3D-positioning error of between 41 ± 23 and 82 ± 30 μm when using a single digital impression system. Other factors, such as the scanning protocol26  and operator skill,31  may reduce the final accuracy of the impression. Milling technology enables production of more accurate metal frameworks than conventional lost-wax techniques.2,5,18,32,33  Several studies have provided evidence of an effect of misfit of prototype frameworks at the interface of the implant platform on long-term outcomes.3440 

The digital workflow presented in this study describes the use of digital technology to transfer occlusal, esthetic, and functional parameters from the PD to the CIR, and then to the final prosthesis of upper and lower totally edentulous patients using implants, thereby reducing the working time and cost of full-arch rehabilitation. The intraoral scanner simplifies conventional implant impression procedures: application of a resin splint between transfer abutments is no longer necessary, and no impression or casting material is used to generate the model, thereby eliminating the influence of material bias on the accuracy of the final result.

Digital recording of the centric occlusion is the main challenge when making digital impressions of implants of edentulous upper and lower arches. The interocclusal record of the final fixed restoration should copy the occlusion determined by reference to the PD and CIR occlusion; this often requires switching to a conventional analogic procedure using a facial bow and stone models, with devices being constructed by the dental technician. To the best of our knowledge, few studies have described a digital method to register the occlusion of two opposing completely edentulous arches when a full-arch restoration using implants is scheduled.14,15 

In this study, a new digital approach was proposed for registering occlusion, using the same diagnostic radiographic guide adapted for scan abutments on implants. The template was modified to permit construction of open windows in its occlusal and buccal aspects, to in turn allow fitting even when the scan abutments remain screwed in the same position of the digital impression of the single arch (Figure 7). This modification of the radiographic guide, which represents a copy of the PD, facilitates the digital record of the occlusion: the digital record of the scan abutments in the buccal aspect is sufficient to detect the landmarks necessary for the superimposition. These landmarks are the centers of the screw holes of the scan abutments, which can be geometrically determined and manually marked on the digital impressions (single arches and occlusal registration STL files). The Geomagic software (3D Systems) then finds the best-fitting superimposition tool and the upper and lower single arch impressions are positioned in occlusion on the digital articulator.

The occlusion, esthetic, and functional parameters of the CIR teeth are transferred from the provisional fixed prosthesis to the final design, according to the protocol described by Monaco et al.18  If deemed clinically necessary, the 3D printing prototyping process allows reproduction of the resin replica for the final clinical try-in, so all esthetic and functional parameters can be tested before manufacture of the definitive prosthesis. A further advantage of this protocol is the time and cost reductions that it affords: a reduced number of clinical appointments are required and the maximum total cost of the CAD-CAM procedures (ie, design and manufacture of the final prosthesis) is 1,200 euros for each full-arch prosthesis.

A potential disadvantage of this protocol is the need for specialized instruments to create the digital impression (ie, an intraoral scanner) and a specialized manufacturing process (ie, SLM, milling, or hybrid technology). Further studies should focus on the digitalization of pink resin manufacturing processes for full-arch restorations, and on improvement of teeth-mounting in the virtual articulator.

Within the limitation of this pilot study, CAD-CAM technologies provide a viable complete digital workflow for full-arch rehabilitation using implants for edentulous patients. A preoperative PD is constructed with consideration of the final esthetic, functional, and occlusal requirements of the fixed full-arch prosthesis. Digital technology allows accurate transfer of occlusion parameters from the PD to the CIR, and finally to the design of the metal framework of the fixed full-arch prosthesis, thereby reducing time and costs.

Abbreviations

Abbreviations
CAD-CAM:

computer-aided design/computer-aided manufacturing

CIR:

complete-arch interim restoration

PD:

provisional denture

STL:

Standard Tessellation Language

TDS:

True Definition Scanner

3D:

three-dimensional

Authors declare no conflict of interest.

1. 
Beuer
F,
Schweiger
J,
Edelhoff
D.
Digital dentistry: an overview of recent developments for CAD/CAM generated restorations
.
Br Dent J
.
2008
;
204
:
505
511
.
2. 
Stawarczyk
B,
Lümkemann
N,
Eichberger
M,
Wimmer
T.
Accuracy of digitally fabricated wax denture bases and conventional completed complete dentures
.
Dent J
.
2017
;
5
:
36
42
.
3. 
Venezze
AC,
Ghensi
P,
Stellini
E,
Magaz
VR,
Bressan
E.
Double duplicate technique for CAD/CAM full-arch immediate loading: a technical description and case report
.
Int J Periodontics Restorative Dent
.
2018
;
38
:
209
216
.
4. 
Hassan
B,
Greven
M,
Wismeijer
D.
Integrating 3D facial scanning in a digital workflow to CAD/CAM design and fabricate complete dentures for immediate total mouth rehabilitation
.
J Adv Prosthodont
.
2017
;
9
:
381
386
.
5. 
Oh
JH,
An
X,
Jeong
SM,
Choi
BH.
A digital technique for fabricating an interim implant-supported fixed prosthesis immediately after implant placement in patients with complete edentulism
.
J Prosthet Dent
2019
;
121
:
26
31
.
6. 
Contrepois
M,
Sireix
C,
Soenen
A,
Pia
JP,
Lasserre
JF.
Complete denture fabrication with CAD/CAM technology: a case report
.
Int J Esthet Dent
.
2018
;
13
:
66
85
.
7. 
Ciocca
L,
Meneghello
R,
Monaco
C,
Savio
G,
Scheda
L,
Gatto
MR,
Baldissara
P.
In vitro assessment of the accuracy of digital impressions prepared using a single system for full-arch restorations on implants
.
Int J Comput Assist Radiol Surg
.
2018
;
13
:
1097
1108
.
8. 
Wimmer
T,
Gallus
K,
Eichberger
M,
Stawarczyk
B.
Complete denture fabrication supported by CAD/CAM
.
J Prosthet Dent
.
2016
;
115
:
541
546
.
9. 
Inokoshi
M,
Kanazawa
M,
Minakuchi
S.
Evaluation of a complete denture trial method applying rapid prototyping
.
Dent Mater J
.
2012
;
31
:
40
46
.
10. 
Infante
L,
Yilmaz
B,
McGlumphy
E.,
Finger
I.
Fabricating complete dentures with CAD/CAM technology
.
J Prosthet Dent
.
2014
;
111
:
351
355
.
11. 
Baba
NZ,
AlRumaih
HS,
Goodacre
BJ,
Goodacre
CJ.
Current techniques in CAD/CAM denture fabrication
.
Gen Dent
.
2016
;
64
:
23
28
.
12. 
McLaughlin
JB,
Ramos
V
Jr.
Complete denture fabrication with CAD/CAM record bases
.
J Prosthet Dent
.
2015
;
114
:
493
497
.
13. 
Schweiger
J,
Güth
JF,
Edelhoff
D,
Stumbaum,
J.
Virtual evaluation for CAD/CAM-fabricated complete dentures
.
J Prosthet Dent
.
2017
;
117
:
28
33
.
14. 
Fang
Y,
Fang
JH,
Jeong
SM,
Choi
BH.
A technique for digital impression and bite registration for a single edentulous arch
.
J Prosthodont
.
2019
;
28
:
e519
e523
.
15. 
Hassan
B,
Gimenez Gonzalez B, Tahmaseb A, Greven M, Wismeijer D. A digital approach integrating facial scanning in a CAD-CAM workflow for complete-mouth implant-supported rehabilitation of patients with edentulism: a pilot clinical study
.
J Prosthet Dent
.
2017
;
117
:
486
492
.
16. 
Da Silveira
AC,
Daw
JL
Jr,
Kusnoto
B,
Evans
C,
Cohen
M.
Craniofacial applications of three-dimensional laser surface scanning
.
J Craniofac Surg
.
2003
;
14
:
449
456
.
17. 
Mankovich
NJ,
Samson
D,
Pratt
W,
Lew
D,
Beumer
J
3rd.
Surgical planning using three-dimensional imaging and computer modeling
.
Otolaryngol Clin North Am
.
1994
;
27
:
875
889
.
18. 
Monaco
C,
Scheda
L,
Ciocca
L,
Zucchelli
G.
The prototype concept in a full digital implant workflow
.
J Am Dent Assoc
.
2018
;
149
:
918
923
.
19. 
Al-Fadda
SA,
Zarb
GA,
Finer
Y.
A comparison of the accuracy of fit of 2 methods for fabricating implant-prosthodontic frameworks
.
Int J Prosthodont
.
2007
;
20
:
125
131
.
20. 
Jemt T1, Bäck T, Petersson A.
Precision of CNC-milled titanium frameworks for implant treatment in the edentulous jaw
.
Int J Prosthodont
.
1999
;
12
:
209
215
.
21. 
Drago
C1,
Saldarriaga
RL,
Domagala
D,
Almasri
R.
Volumetric determination of the amount of misfit in CAD/CAM and cast implant frameworks: a multicenter laboratory study
.
Int J Oral Maxillofac Implants
.
2010
;
25
:
920
929
.
22. 
Presotto
AGC,
Barão
VAR,
Bhering
CLB,
Mesquita
MF.
Dimensional precision of implant-supported frameworks fabricated by 3D printing
.
J Prosthet Dent
.
2019
;
122
:
38
45
.
23. 
Ender
A,
Mehl
A.
Full arch scans: conventional versus digital impressions – an in-vitro study
.
Int J Comput Dent
.
2011
;
14
:
11
21
.
24. 
Ender
A,
Mehl
A.
Influence of scanning strategies on the accuracy of digital intraoral scanning systems
.
Int J Comput Dent
.
2013
;
16
:
11
21
.
25. 
Patzelt
SB,
Emmanouilidi
A,
Stampf
S,
Strub
JR,
Att
W.
Accuracy of full-arch scans using intraoral scanners
.
Clin Oral Investig
.
2014
;
18
:
1687
1694
.
26. 
Güth
JF1,
Keul
C,
Stimmelmayr
M,
Beuer
F,
Edelhoff
D.
Accuracy of digital models obtained by direct and indirect data capturing
.
Clin Oral Investig
.
2013
;
17
:
1201
1208
.
27. 
Flügge
TV,
Schlager
S,
Nelson
K,
Nahles
S,
Metzger
MC.
Precision of intraoral digital dental impressions with iTero and extraoral digitization with the iTero and a model scanner
.
Am J Orthod Dentofacial Orthop
.
2013
;
144
:
471
478
.
28. 
Giménez
B,
Özcan
M,
Martínez-Rus
F,
Pradíes
G.
Accuracy of a digital impression system based on active triangulation technology with blue light for implants: effect of clinically relevant parameters
.
Implant Dent
.
2015
;
24
:
498
504
.
29. 
Gimenez
B,
Özcan
M,
Martinez-Rus
F,
Pradíes
G.
Accuracy of a digital impression system based on parallel confocal laser technology for implants with consideration of operator experience and implant angulation and depth
.
Int J Oral Maxillofac Implants
.
2014
;
29
:
853
862
.
30. 
Gimenez
B,
Özcan
M,
Martınez-Rus
F,
Pradíes
G.
Accuracy of a digital impression system based on active wavefront sampling technology for implants considering operator experience, implant angulation and depth
.
Clin Implant Dent Relat Res.
2015
;
17 Suppl 1:e54–e64.
31. 
Gimenez-Gonzalez
B,
Hassan
B,
Özcan
M,
Pradíes
G.
An in vitro study of factors influencing the performance of digital intraoral impressions operating on active wavefront sampling technology with multiple implants in the edentulous maxilla
.
J Prosthodont
.
2017
;
26
:
650
655
.
32. 
Lin
WS,
Chou
JC,
Metz
MJ,
Harris
BT,
Morton
D.
Use of intraoral digital scanning for a CAD/CAM-fabricated milled bar and superstructure framework for an implant-supported, removable complete dental prosthesis
.
J Prosthet Dent
.
2015
;
113
:
509
515
.
33. 
Hassan
B,
Greven
M,
Wismeijer
D.
Integrating 3D facial scanning in a digital workflow to CAD/CAM design and fabricate complete dentures for immediate total mouth rehabilitation
.
J Adv Prosthodont
.
2017
;
9
:
381
386
.
34. 
Akçin
ET,
Güncü
MB,
Aktaş
G,
Aslan
Y.
Effect of manufacturing techniques on the marginal and internal fit of cobalt-chromium implant-supported multiunit frameworks
.
J Prosthet Dent
.
2018
;
120
:
715
720
.
35. 
Mai
HN,
Kwon
TY,
Hong
MH,
Lee
DH.
Comparative study of the fit accuracy of full-arch bar frameworks fabricated with different presintered cobalt-chromium alloys
.
Biomed Res Int.
2018
;
5.
36. 
Bhering
CL,
Marques Ida S, Takahashi JM, Barão VA, Consani RL, Mesquita MF. Fit and stability of screw-retained implant-supported frameworks under masticatory simulation: influence of cylinder type
.
J Prosthodont
.
2016
;
25
:
459
465
.
37. 
Karl
M,
Carretta
R,
Higuchi
KW.
Passivity of fit of a novel prefabricated implant-supported mandibular full-arch reconstruction: a comparative in vitro study
.
Int J Prosthodont
.
2018
;
31
:
440
442
.
38. 
Maminskas
J,
Puisys
A,
Kuoppala
R,
Raustia
A,
Juodzbalys
G.
The prosthetic influence and biomechanics on peri-implant strain: a systematic literature review of finite element studies
.
J Oral Maxillofac Res.
2016
;
7:e4. 2016;7:e4:1–11.
39. 
Bhering
CL,
Marques Ida S, Takahashi JM, Barão VA, Consani RL, Mesquita MF. The effect of casting and masticatory simulation on strain and misfit of implant-supported metal frameworks
.
Mater Sci Eng C Mater Biol Appl
.
2016
;
62
:
746
751
.
40. 
Katsoulis
J,
Takeichi
T,
Sol Gaviria A, Peter L, Katsoulis K. Misfit of implant prostheses and its impact on clinical outcomes. Definition, assessment and a systematic review of the literature
.
Eur J Oral Implantol
.
2017
;
10
:
121
138
.