Dr. Giovanni Ioime
• He graduated in 2005 from the University of Naples “Federico II” school of Dentistry and Prosthodontics, Naples Federico Il.
Tutor from 2006 to 2010 in the research department “Conservative dentistry” directed by prof. Sandro Rengo.
• Perfected in Endodontics and surgical endodontics with Prof A. Castellucci Perfected in cosmetic dentistry with Dr Mauro Fradeani and Prof Lorenzo Vanini. Second level master’s degree in Digital Dentistry obtained at the Federico II University of Naples.
• Strong digitized approach at his clinic and as a consultant, including 3D printing solutions.
Giovanni Lagna, Antonino Romeo, Ludovica Gagliardi
introduction
introduction
The decade from 2015 to 2025 has represented a period of extraordinary transformation in dentistry. Technologies that 10 years ago seemed experimental or limited to specialized centers have now become widespread tools, fully integrated into daily clinical practice. The very concept of “digital dentistry” is no longer confined to a niche but has become a recognized standard of care across numerous clinical and academic settings.
Three main drivers have driven this evolution:
- Digital data acquisition, with increasingly precise intraoral scanners (IOS), cone beam computed tomography (CBCT) accessible in private practices, and facial scanners used as a “virtual facebow.”
- Advanced design, through increasingly intuitive computer-aided design (CAD) software enhanced by artificial intelligence (AI), capable of integrating complex datasets into a unified virtual patient.
- In-office manufacturing, initially led by milling systems, but more recently revolutionized by 3D printing, and in particular by digital press stereolithography (DPS).
This article aims to provide a technical and clinical analysis of these innovations, with particular focus on the role of IOS and 3D printing, highlighting how DPS has overcome historical limitations of polymeric additive materials.
ios: From Innovation to Clinical Standard
ios: From Innovation to Clinical Standard
At the beginning of the decade, IOS was perceived as an interesting but not entirely reliable alternative to conventional impressions. Its limitations included difficulties in capturing full arches, unstable stitching algorithms, and high equipment costs.
From 2015 to today, progress has been remarkable. Current IOS can capture a complete arch in just a few minutes with accuracy (trueness and precision) suitable for full-arch implant-supported rehabilitations. Improved stitching algorithms have minimized cumulative errors, and user-friendly interfaces allow even non-expert operators to achieve high-quality scans.
Clinically, applications are now vast. In fixed prosthodontics on natural teeth and implants, IOS eliminates errors caused by impression material deformation and streamlines communication with the laboratory, which receives a ready-to-design STL or PLY file. In complete dentures, IOS allows fully digital workflows based on functional scanning. In orthodontics, IOS has almost completely replaced traditional impressions, becoming the foundation for clear aligners and digital treatment simulations. In guided implant surgery, IOS is an essential step for guide design and preoperative validation.
Another crucial value of IOS lies in longitudinal monitoring: the ability to compare scans taken months or even years apart allows assessment of wear, tooth migration, and orthodontic relapse with a level of precision unattainable with plaster models.
“The combination of CBCT and IOS now forms the foundation of guided implant surgery workflows.”
CBCT and Facial Scanning: Toward the 3D Virtual Patient
CBCT and Facial Scanning: Toward the 3D Virtual Patient
Alongside IOS, CBCT has become a routine technology in private practice. It enables immediate volumetric diagnostics and extremely accurate surgical planning. The combination of CBCT and IOS now forms the foundation of guided implant surgery workflows, allowing implants to be placed predictably while respecting anatomical structures.
A further milestone has been the integration of facial scanning. Whereas craniofacial relationships were once recorded mechanically with a facebow, today they can be digitally transferred into CAD systems. Initially expensive and complex, dedicated facial scanners are now accompanied by agile smartphone-based solutions that offer rapid and sufficiently accurate capture.
Merging IOS, CBCT, and face scan data can generate a digital twin of the patient. This 3D model enables prosthetic and surgical planning that integrates function, aesthetics, and biomechanics, enabling highly personalized treatments.
Digital Manufacturing: Milling and 3D Printing
Digital Manufacturing: Milling and 3D Printing
The ability to manufacture restorations in-office has been the natural completion of the digital workflow. Computerized numerical control (CNC) milling dominated the first phase of this revolution, enabling highly precise zirconia, lithium disilicate, and metal restorations. However, high costs, maintenance complexity, and inherent waste limited widespread adoption, especially in smaller practices.
3D printing radically changed the landscape. Initially applied to models, it soon expanded to provisional restorations, surgical guides, bite splints, and even complete dentures. The ability to fabricate devices within hours, directly from digital files, made 3D printing indispensable.
Technically, the main dental 3D printing technologies are:
- Stereolithography (SLA), which uses a laser to polymerize resin layer by layer.
- Digital light processing (DLP), which cures entire layers simultaneously with a digital projector.
- Liquid crystal display (LCD)/masked stereolithography (MSLA), more affordable systems using LED matrix screens.
Each has specific advantages in speed, cost, and accuracy, but all can deliver clinically acceptable precision.
The real breakthrough came with the development of high-performance resins. From standard model resins, the field evolved to biocompatible intraoral-certified materials, and eventually to ceramic-filled composites with significantly improved mechanical and optical properties. This shift has enabled 3D printing to move beyond provisional applications into the area of definitive restorations.
A particularly important advantage is in full-arch implantology. With 3D printing, clinicians can now provide an immediate provisional restoration directly after implant surgery, designed on guided planning and precisely adapted to the actual implant positions. This approach eliminates the need for relining, reduces chair time, and delivers a stable, functional restoration within hours of surgery. Clinically, this translates to greater predictability, improved patient comfort, and simplified prosthetic management at a critical stage of the treatment process.
Overall, the clinical benefits of 3D printing are extensive, including rapid turnaround, reduced costs, extreme personalization, easy reproducibility in case of fracture or loss, reduced cumulative errors, and environmental sustainability compared to subtractive methods. The ability to modify a design and reprint a new device in a short time further increases therapeutic flexibility.
“With 3D printing, clinicians can now provide an immediate provisional restoration directly after implant surgery.”
A particularly important advantage is in full-arch implantology. With 3D printing, clinicians can now provide an immediate provisional restoration directly after implant surgery, designed on guided planning and precisely adapted to the actual implant positions. This approach eliminates the need for relining, reduces chair time, and delivers a stable, functional restoration within hours of surgery. Clinically, this translates to greater predictability, improved patient comfort, and simplified prosthetic management at a critical stage of the treatment process.
Overall, the clinical benefits of 3D printing are extensive, including rapid turnaround, reduced costs, extreme personalization, easy reproducibility in case of fracture or loss, reduced cumulative errors, and environmental sustainability compared to subtractive methods. The ability to modify a design and reprint a new device in a short time further increases therapeutic flexibility.
Digital Press Stereolithography (DPS): The New Frontier
Digital Press Stereolithography (DPS): The New Frontier
Despite progress, conventional printed resins have always had an inherent limitation: suboptimal density due to the layered nature of polymerization. This limitation resulted in porosity, reduced mechanical strength, and limited aesthetics, making printed resins unsuitable for definitive restorations under functional load.
DPS was developed to overcome this issue. By combining additive photopolymerization with a digital pressing process, DPS significantly increases material density and minimizes porosity. For the first time, this makes it possible to use hybrid resins with extremely high ceramic filler content (up to 70%), previously incompatible with conventional additive processes.
Restorations produced with DPS demonstrate mechanical and optical properties comparable to milled materials: flexural strength, elastic modulus, and color stability approach those of zirconia and lithium disilicate. Clinically, this means that single crowns, veneers, and inlays/onlays can now be fabricated chairside as definitive restorations, with dramatically reduced production times and without the material waste typical of milling.
DPS has two key strengths: it maintains the speed and efficiency of 3D printing while enabling the use of high-performance restorative materials that were previously exclusive to subtractive manufacturing. This ability positions DPS as a disruptive technology, likely to redefine the balance between additive and subtractive methods and emerge as the gold standard for single-unit resin-ceramic restorations.
CAD Software and Artificial Intelligence
CAD Software and Artificial Intelligence
All these technologies gain coherence within modern CAD software, which has undergone parallel evolution in recent years.
The most advanced CAD programs now integrate AI modules capable of automating complex tasks: segmentation, prosthetic design based on morphological libraries, and optimization of occlusal thickness and contacts.
AI reduces operator-dependent variability, accelerates design processes, and enhances predictability. The synergy between advanced CAD, IOS, CBCT, and technologies such as DPS represents the culmination of a decade of continuous innovation.
Future Perspectives
Future Perspectives
Looking ahead, 3D printing clearly stands at the core of digital dentistry. No longer limited to models or provisionals, it is emerging as a production system capable of managing the full spectrum of clinical applications: implantology, fixed prosthodontics, and complete dentures. The ability to print full-arch provisionals immediately after implant surgery, without relining, marks a turning point in immediate loading rehabilitation.
Meanwhile, the development of increasingly sophisticated biocompatible resins and the introduction of DPS pave the way for definitive restorations in high-performance materials with mechanical and optical properties comparable to milled ceramics.
In the near future, one can envision a workflow in which IOS and CBCT data feed into AI-powered CAD software, which, within hours, produces definitive printed restorations ready for chairside delivery.
Therefore, the future of digital dentistry is inseparably linked to 3D printing as the key technology, reshaping treatment timelines, costs, and modalities in clinical practice.
“IOS has consolidated its central role, and CBCT and facial scanning have enabled the construction of the virtual patient; however, above all, it has been 3D printing that has redefined clinical practice.”
Conclusions
Conclusions
The decade from 2015 to 2025 has radically transformed digital dentistry, elevating it from niche innovation to a global standard of care. IOS has consolidated its central role, and CBCT and facial scanning have enabled the construction of the virtual patient; however, above all, it has been 3D printing that has redefined clinical practice.
Today, the ability to print full-arch provisionals immediately after implant surgery, to fabricate customized devices in hours, and to access high-performance materials via DPS makes 3D printing not just a useful tool but the true driving force behind the evolution of the digital workflow.
The integration of digital acquisition, AI-powered CAD design, and high-performance 3D printing points to a future where dentistry will be increasingly precise, predictable, rapid, and accessible, with positive impacts on both clinical efficiency and patient experience.
REFERENCES
1) Mangano FG, et al. Intraoral scanners in dentistry: a review. BMC Oral Health. 2017;17:149.
2) Srivastava G, et al. Accuracy of intraoral scanner for edentulous arches: a systematic review. J Prosthodont Res. 2023.
3) Gehrke P, et al. Factors impacting intraoral scanning accuracy in implant dentistry. Materials. 2024;17:500.
4) Bornstein MM, et al. Cone beam computed tomography in implant dentistry. Int J Oral Maxillofac Implants. 2014;29(Suppl):55–77.
5) Jacobs R, et al. CBCT in implant dentistry: recommendations. J Oral Rehabil. 2018;45(7):538-550.
6) Jindanil T, et al. Smartphone facial scanning in dentistry. Orthod Craniofac Res. 2024;27(1):18–29.
7) Andrews J, et al. Validation of 3D facial imaging with iPhone TrueDepth. J Prosthet Dent. 2023;130(5):579-587.
8) Abuduwaili K, et al. Comparison of photogrammetry, IOS and conventional impressions. BMC Oral Health. 2025;21:636.
9) Pozzi A, et al. Photogrammetry vs IOS in complete-arch implant impressions. Clin Implant Dent Relat Res. 2025.
10) Zou J, Li L. Passive fit verification of frameworks from photogrammetry scans. J Prosthet Dent. 2024;131(4):756-759.
11) Tahayeri A, et al. 3D printing in dentistry: an overview. Dent Mater. 2020;36(1):54-68.
12) Dawood A, et al. 3D printing in dentistry. Br Dent J. 2015;219(11):521–529.
13) Miyazaki T, et al. Dental CAD/CAM and CNC milling. Dent Mater J. 2009;28(1):44-56.
14) Joo HJ, et al. Mechanical properties of highly filled hybrid resins. Dent Mater J. 2021;40(2):374–381.
15) Zingari F, et al. Predictability of IOS error for full-arch implant scans. J Prosthodont Res. 2023;67(3):343-350.