DESIGN: A triple-armed, double-blind randomized controlled trial with cross-over design investigated patient-reported satisfaction and objective dental evaluation of a 3-unit, monolithic zirconium dioxide (ZrO2), implant-supported fixed dental prosthesis (iFDP) fabricated with 2 completely digital workflows and 1 mixed analog-digital workflow. CASE SELECTION: Participants enrolled required rehabilitation of 2 dental implants in posterior region of either of the arches with a 3-unit, ZrO2 iFDP. A total of 20 participants received the 3 types of ZrO2, iFDP fabricated by 3 different methods. Thus, a total of 60 iFDPs were fabricated in the study. 20 iFDP were fabricated by complete digital workflow by using 3Shape Trios 3 Intraoral scanner (IOS) and 3 Shape designing software (Test-1). In second group (Test-2) 20 iFDPs were fabricated by using Dental Wings Virtuo Vivo IOS and Dental Wings original software (DWOS) for CAD designing. 20 iFDPs (control) were fabricated by mixed analogue-digital workflow by using Polyether impression and Exocad Lab software. The primary clinical outcome was blinded, subjective evaluation on visual analogue scale (VAS) by the participant, and an objective evaluation on VAS by a dentist at the time of prosthetic try-in of each of the 3 types of prosthesis. Secondary outcome was patients' perception about the impression procedures in the 3 different workflows on VAS. STUDY TIMELINE: The study was conducted at 2 instances during the prosthetic rehabilitation. The primary outcomes were assessed at the time of prosthetic try-in. The secondary outcome was observed after the impression session. DATA ANALYSIS: Clinical parameters were measured on VAS from 0 to 100 score. For the primary outcome, VAS score was recorded for each iFDP as observed for patient perception (satisfaction) and dentist evaluation (objective). The perception about impression was also recorded on VAS. Descriptive analysis of all scores was done by mean and standard deviation. ANOVA test was used for comparisons among the 3 different types of iFDP. Tukey's HSD was used for pairwise comparisons within ANOVA. Linear regression analyses was done to compare overall satisfaction of the patients and the dentist within each group. The level of significance was set at α = 0.05. RESULTS: After the start of recruitment in January 2020, there were no losses and exclusions. VAS for patient satisfaction was higher than VAS for dentist evaluation. Patient satisfaction among Test-1, Test-2, and Control showed no significant difference (P = 0.876). Dentist satisfaction among workflows were also not significantly different (P = 0.22). The relationship between VAS scores of patients and dentists was weak for Test-1 (R-value = -0.424, P = 0.062), Test-2 (R-value = 0.116, P = 0.068), and Control (R-value = -0.183, P = 0.441). Significant differences for patients' perceptions related to the treatment time for impression procedure (P = 0.005), convenience of impression procedure (P <
0.002), bad oral taste with the impression procedure (P <
0.002), and nausea with the impression procedure (P <
0.002) were observed. CONCLUSIONS: Subjective patient satisfaction was similar when comparing iFDPs fabricated with 3 different workflows. Objective dentist evaluation was also similar when comparing the 3 types of iFDPs. However, patient satisfaction of the workflow was higher than dentist evaluation, although there was no correlation between the two. Lower VAS in dentist's evaluation has been attributed to strict standardized clinical criteria and critical expert view. The study also reveals that patients have a favorable perception and preference in favor of digital impressions as compared to use of elastomeric impression materials.