Cochrane Database of Systematic Reviews

CAD/CAM versus traditional indirect methods in the

fabrication of inlays, onlays, and crowns (Protocol)

Oen KT, Veitz-Keenan A, Spivakovsky S, Wong YJ, Bakarman E, Yip J

Oen KT, Veitz-Keenan A, Spivakovsky S, Wong YJ, Bakarman E, Yip J.

CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns.
Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD011063.
DOI: 10.1002/14651858.CD011063.

www.cochranelibrary.com

CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
WHAT’S NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol) i
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Protocol]

CAD/CAM versus traditional indirect methods in the

fabrication of inlays, onlays, and crowns

Kay T Oen1 , Analia Veitz-Keenan2 , Silvia Spivakovsky3 , Y Jo Wong1 , Eman Bakarman4 , Julie Yip5

1 Cariology and Comprehensive Care, New York University College of Dentistry, New York, New York, USA. 2 New York University

College of Dentistry, New York, USA. 3 Oral Maxillofacial Pathology, Radiology and Medicine, New York University College of
Dentistry, New York, New York, USA. 4 Restorative Dentistry, King Fahd Hospital, Jeddah, Saudi Arabia. 5 Periodontology and Implant
Dentistry, New York University College of Dentistry, New York, New York, USA

Contact address: Kay T Oen, Cariology and Comprehensive Care, New York University College of Dentistry, 345 East 24th Street,
New York, New York, 10010, USA. kto1@nyu.edu.

Editorial group: Cochrane Oral Health Group.

Publication status and date: Edited (no change to conclusions), published in Issue 4, 2014.

Citation: Oen KT, Veitz-Keenan A, Spivakovsky S, Wong YJ, Bakarman E, Yip J. CAD/CAM versus traditional indirect methods
in the fabrication of inlays, onlays, and crowns. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD011063. DOI:
10.1002/14651858.CD011063.

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effects of all CAD/CAM designed restorations (including inlays, onlays and crowns) for indirect restoration of teeth in
need of a final permanent dental restoration in adults and adolescents with erupted second molars.

To compare the effects of CAD/CAM designed restorations (inlays, onlays, crowns) with restorations (inlays, onlays, crowns) designed
and produced by other available indirect systems.

BACKGROUND 2. the amount of tooth structure remaining: a) intracoronal

Description of the condition
Tooth structure may be missing due to caries, trauma, or man-
made modifications to the teeth for esthetic reasons. In order to
replace, or restore, such missing tooth structure we need dental
materials that are biologically acceptable. They must be compatible
with the surrounding tissues, non-toxic, long lasting and be able to
withstand the forces in the mouth. Restorations can be undertaken
in different ways, with the classification of restorations determined
by:
1. method of placement: a) direct or b) indirect;
(restoration held within the structure of the tooth), or b)
extracoronal (restoration built around a core).
If dental restorations can be placed within the confines of the
remaining walls of the tooth, they are considered intracoronal
and are placed directly by the dentist. Resin-based composites
and amalgam are effective materials for intracoronal restorations.
An inlay is also an intracoronal restoration. The most common
materials for inlays are either metal or ceramic materials. Except
for certain inlays that can be prepared ’directly’ in the mouth by
fabricating a pattern intraorally and then sending this pattern to
the laboratory for producing the final restoration, the majority are
done ’indirectly’.

CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol) 1
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
When a tooth has insufficient tooth structure for an intracoronal
restoration the preferred restoration may be partial coverage such
as an onlay or a veneer, or full coverage like a crown. Extracoronal
restorations require the fabrication of a replica of the tooth by
taking an impression. This is considered an ’indirect’ technique.
Indirect restorations can be made of metal, metal-ceramic, or all-
ceramic materials.
Mechanical durability and precision of fit are mandatory require-
ments for crowns and bridges. The development of various casting
alloys and precise casting systems has contributed to the success-
ful use of metal-based restorations. However, patients’ requests for
more esthetic and biologically ’safe’ materials have led to an in-
creased demand for metal-free restorations. There is also a growing
demand to provide all-ceramic restorations more routinely. New
materials such as highly sintered glass, polycrystalline alumina, zir-
conia-based materials and adhesive monomers, will assist dentists
to meet this demand. In addition, new fabrication systems com-
bined with computer-assisted fabrication systems (dental CAD/
CAM) and various networks are now available. Dental technology
was centered on lost-wax casting technology but we now face a
revolution in crown and bridge fabrication (Miyazaki 2011).
With an aging population demanding improved oral health as well
as esthetics, ceramic materials are the material of choice. Early ce-
ramics materials had limitations. First their brittleness led to lack
of reliability. Secondly, a greater effort and more time was required
due to multiple laboratory steps when compared to metal alloys
and composites (Griggs 2007). Just like all dental materials, ce-
ramics need to meet certain requirements. They need to be bio-
compatible with the surrounding tissues, non-toxic, long lasting
and be able to resist the different forces in the oral cavity. In recent
years the ceramic processing has been simplified. New ceramic for-
mulations are available to address previous shortcomings. This has
led to a reduction in laboratory time and together with new bond-
ing agents make these ceramics an attractive alternative for den-
tists and patients. The use of ceramics as a biomaterial for dental
restorations is a valid option for inlays, onlays, veneers, crowns and
bridges (Höland 2008). Ceramic technology also manufactures an
all-ceramic crown composed of dental ceramic material fired on a
coping of dense-sintered high purity alumina (Andersson 1993).
The production of CAD/CAM titanium ceramic restorations has
also been described (Boeckler 2009). In this technique, titanium
copings milled in CAD/CAM system were subsequently layered
with ceramic material. Continued research points to even more
improvements for the use of ceramics.
Description of the intervention
Traditional fabrication of inlays, onlays and crowns uses a multi-
stage process which involves an indirect technique that requires an
impression and subsequent laboratory completion of the restora-
tion. CAD/CAM systems allow for the production of indirect
restorations in a single visit. CAD/CAM stands for computer-as-
CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
sisted design/computer-assisted manufacture. These systems use
an optical camera to take a virtual impression by creating a three
dimensional image which is forwarded to a software program. This
impression results in a virtual cast on which the restoration is de-
signed. The software then controls a milling process that uses pre-
fabricated blocks of restorative material, either ceramic reinforced
composite or all-ceramic material, to produce the restoration. The
end result is chairside production of the restoration. An alternate
way to utilize CAD/CAM systems is to transmit the digital im-
pression that was taken chairside to the laboratory via the inter-
net. The laboratory then uses the virtual cast to design and mill
the restoration. A third way to produce a CAD/CAM restoration
is to take an optical impression of the traditional stone model
poured from a regular impression and use the subsequent virtual
cast to design and mill the restoration. The majority of long-term
clinical trials on CAD/CAM generated restorations have involved
inlays and onlays. A smaller number have evaluated CAD/CAM
produced crowns. Combined with adhesive bonding techniques
CAD/CAM systems create biocompatible , esthetic restorations
that can be done in a single treatment session, eliminating the need
for follow-up visits.
How the intervention might work
CAD/CAM technology has been introduced with the claim that
accuracy, speed and improved esthetics and durability make this a
viable alternative to multistep indirect techniques.
The use of CAD/CAM in one of three ways to generate esthetic
and well fitting restorations is now possible due to improvement
in technology and ceramic materials. Recent developments in the
handling of digital impressions and the refinements in the process-
ing of digital data have produced accurate virtual casts. This allows
dentists and laboratories to use this technology in a more com-
plementary and synergistic way (Touchstone 2010). Many den-
tists are now considering using CAD/CAM technology to con-
vert conventional impressions to digital impressions and delegat-
ing the design and milling process to the laboratory, without hav-
ing to invest in the milling equipment. Others are embracing the
technology comprehensively by using a combination of chairside
and laboratory digital work flow (Christensen 2009; Touchstone
2010).
Using CAD/CAM can possibly provide the patient with a conve-
nient, esthetic well fitting, durable restoration.
Why it is important to do this review
With the acceptance of CAD/CAM in the dental profession, there
has been a proliferation of new systems (BDJ 2012). It is estimated
that within the next five years there will be over 20 systems avail-
able. It is therefore appropriate to conduct a systematic review to
2
evaluate the effectiveness of all restorations produced by CAD/
CAM technology.
OBJECTIVES
To assess the effects of all CAD/CAM designed restorations (in-
cluding inlays, onlays and crowns) for indirect restoration of teeth
in need of a final permanent dental restoration in adults and ado-
lescents with erupted second molars.
To compare the effects of CAD/CAM designed restorations (in-
lays, onlays, crowns) with restorations (inlays, onlays, crowns) de-
signed and produced by other available indirect systems.
METHODS
Criteria for considering studies for this review
Types of studies
Randomized controlled trials will be included with a follow-up of
a minimum of one year. Cluster-randomized trials and trials of
parallel and split-mouth designs will be included.
Types of participants
Adults/adolescents with permanent teeth requiring an indirect in-
lay, onlay, or full crown restoration in a vital or non-vital tooth.
Types of interventions
Interventions
All CAD/CAM restorations including.
Any kind of ceramic restoration produced by CAD/CAM tech-
nology:
• restorations produced chairside by an in-office system
(digital impression and milling);
• restorations produced from digital impressions that were
transmitted electronically to a laboratory that uses CAD/CAM
milling systems;
• restorations produced from an optical impression taken of a
stone model poured from a conventional impression and sent to
the laboratory to perform a CAD/CAM.
CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Comparison
• Indirect restorations which are designed and manufactured
using a ’conventional’ process.
• Indirect restorations using non-ceramic materials.
Types of outcome measures
Primary outcomes
Survival defined as.
• Success - survival of the restoration without fracture or
chipping, marginal integrity, contacts (occlusal and aproximal).
• Survival of the restoration with minimal chip defects, or
repairs (functioning failure).
• Failure of the restoration: missing, broken, or required
additional attention or replacement.
Secondary outcomes
• Adverse effects (secondary caries, periodontal or endodontic
complications, pain/sensitivity).
• Patient satisfaction.
• Time to insertion.
• Cost.
Search methods for identification of studies
For the identification of studies included or considered for this re-
view, detailed search strategies will be developed for each database
searched. These will be based on the search strategy developed
for MEDLINE (Appendix 1) but revised appropriately for each
database to take account of differences in controlled vocabulary
and syntax rules.The MEDLINE search strategy will combine the
subject search with the Cochrane Highly Sensitive Search Strat-
egy for identifying reports of randomized controlled trials (2008
revision) (as published in box 6.4.c in the Cochrane Handbook for
Systematic Reviews of Interventions, version 5.1.0, updated March
2011) (Higgins 2011).
Electronic searches
We will search the following databases.
• The Cochrane Oral Health Group’s Trial Register (whole
database).
• The Cochrane Central Register of Controlled Clinical
Trials (CENTRAL) (The Cochrane Library, current issue).
• MEDLINE via OVID (1950 to present) (Appendix 1).
• EMBASE via OVID (1980 to present).
• LILACS via BIREME Virtual Health Library (1982 to
present).
3
 • CBM (Chinese Biomedical Literature Database) (1980 to
present).
There will be no restrictions on language or date of publication.
Searching other resources
The reference list of related relevant articles will be explored for
additional trials.
We will search the National Institutes of Health Clinical Trials
Database (http://clinicaltrials.gov) for ongoing trials.
We will attempt to search for unpublished studies if they are avail-
able and contact recognized authorities in the field in an attempt
to collect all the possible data.
Abstracts from scientific meetings and conferences will be searched
for appropriate studies (American Association for Dental Re-
search (AADR) and International Association for Dental Research
(IADR)).
Manual searching of relevant journals will be included. Studies
written in a language other than English will be translated by their
authors and collaborators if needed.
Data collection and analysis
Selection of studies
Titles and abstracts obtained during the search will be screened by
two review authors (Kay T Oen (KTO) and Analia Veitz-Keenan
(AVK)) for inclusion criteria and relevance. Only those articles,
which initially (based on title and abstract) appear to be eligible for
inclusion, but on examination of the full text are found not to be
eligible, will be recorded in the ’Characteristics of excluded studies’
table, together with the reason for exclusion. Full papers of the
accepted studies will be reviewed and screened by KTO and AVK
and disputes will be resolved by discussion. Silvia Spivakovsky (SS)
and Jo Wong (JW) will review the articles and act as arbiters if
there is a discrepancy in the selected studies in the first round.
Julie Yip (JY) will act as final arbiter if necessary and will review
the final edition and check for appropriate methodology and risk
of bias.
Data extraction and management
A data extraction form will be designed specifically for the review.
Data extraction will be performed independently by two review
authors (KTO and AVK). The results will be sent to SS and JW
to verify the accuracy of the data extraction and JY will check for
final accuracy of the results. Study details will be entered in the
’Characteristics of included studies’ table. KTO will enter the final
data after disagreements are resolved.
The following details will be recorded for each study.
CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
• Publication details (e.g. year of publication, language).
• Demographic details of the report.
• Inclusion and exclusion criteria.
• Sample size, method of randomization, allocation
concealment, blinding, type of trial, method of assessing the
outcome, and drop-outs if any.
• Type of intervention.
• Details of the outcomes reported.
• Duration of follow-up.
• Results of the intervention.
• Funding details.
Assessment of risk of bias in included studies
The studies will be assessed by two review authors, independently,
using the criteria suggested by the Cochrane Handbook for System-
atic Reviews of Interventions, Chapter 8 (Higgins 2011). We will
resolve any disagreements on risk of bias through discussion. A
’Risk of bias’ table will be completed for each included study. For
each domain of risk of bias, we will first describe what was reported
to have happened in the study in order to provide a rationale for
the second part, which will involve assigning a judgment of ’low
risk’ of bias, ’high risk’ of bias, or ’unclear risk’ of bias.
Each study will be graded for risk of bias using the following
domains.
• Sequence generation (selection bias).
• Allocation concealment (selection bias).
• Blinding of participants and personnel (performance bias).
• Blinding of outcome assessor (detection bias).
• Completeness of outcome data (attrition bias).
• Risk of selective data reporting (reporting bias).
• Risk of other bias.
Studies will be grouped into the following categories.
• Low risk of bias in all domains (plausible bias unlikely to
seriously alter the results).
• Unclear risk of bias if one or more of the domains are
assessed as unclear.
• High risk of bias (plausible bias that weakens confidence in
the results) if one or more domains are assessed at high risk of
bias.
A summary risk of bias figure will be presented.
Measures of treatment effect
For dichotomous outcomes, we will express the estimate of treat-
ment effect as risk ratios (RR) (e.g. the number of failed restora-
tions in each group) together with 95% confidence intervals (CIs).
For continuous outcomes (such as mean patient satisfaction
scores), where studies used the same scale to measure the outcome,
we will use the mean values and standard deviations reported in
the studies to estimate a mean difference (MD) with 95% CIs.
4
Where different scales are used, we will express the treatment effect
as a standardized mean difference (SMD) and 95% CI.
Unit of analysis issues
It is anticipated that in this review the trials may randomize par-
ticipants or teeth to the interventions. In order to avoid unit of
analysis errors, the review authors will follow the Cochrane Hand-
book for Systematic Reviews of Interventions Chapter 9 (Section 3)
(Higgins 2011). The final analysis will take into account the level
at which the randomization occurred. The number of observa-
tions in the analysis should match the number of ’units’ that were
randomized. Where unit of analysis error is identified, this will be
noted.
Authors will also consider in each study.
• Participants who were individually randomized to one of
the interventions (e.g. single parallel-group clinical trial).
• Participants undergoing more than one intervention (e.g.
split-mouth designs).
• Groups of individuals randomized together to the same
intervention (e.g. cluster randomized controlled trial).
Dealing with missing data
Authors of included trials will be contacted to request missing
data, unclear data or for clarification of the trial methodology.
The analysis will include only the available data (i.e. ignoring
missing data), other than imputing missing standard deviations, as
necessary. The methods used will be those outlined in Section 7.7.3
of the Cochrane Handbook for Systematic Reviews of Interventions
(Higgins 2011) if appropriate. No other imputations or statistical
methods will be used to deal with missing data.
Assessment of heterogeneity
Clinical heterogeneity will be assessed by a minimum of two review
authors who will examine the type of participants, interventions
and outcomes in each study.
We will assess statistical heterogeneity by inspection of the point
estimates and confidence intervals on the forest plots. We will as-
sess the variation in treatment effects by means of Cochran’s test
for heterogeneity and the I2 statistic. We will consider heterogene-
ity to be statistically significant if the P value is < 0.1. A rough
guide to the interpretation of the I2 statistic given in the Cochrane
Handbook for Systematic Reviews of Interventions is: 0% to 40%
might not be important, 30% to 60% may represent moderate
heterogeneity, 50% to 90% may represent substantial heterogene-
ity, 75% to 100% considerable heterogeneity (Higgins 2011).
CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Assessment of reporting biases
If there are more than 10 studies included in a meta-analysis, we
will test for reporting bias by testing for asymmetry in a funnel
plot. If reporting biases are identified, we will carry out analysis
as outlined by Egger 1997 for continuous outcomes and Rücker
2008 for dichotomous outcomes.
Data synthesis
We will conduct a meta-analysis only if there are studies of sim-
ilar comparisons reporting the same outcome measures. We will
combine RRs for dichotomous data, and MD (or SMD) for con-
tinuous data, using random-effects models if there are more than
three studies in the meta-analysis, or fixed-effect models if there
are less than three.
We will use the generic inverse variance method to include data
from split-mouth studies in meta-analyses as described in Section
16.4 of the Cochrane Handbook for Systematic Reviews of Interven-
tions (Higgins 2011). We will report the results from studies not
suitable for inclusion in a meta-analysis in a narrative.
Subgroup analysis and investigation of heterogeneity
The following subgroups will be investigated if possible.
• CAD/CAM all-ceramic restorations/full coverage crowns
versus porcelain fused to metal crowns (PFMs).
• Partial coverage CAD/CAM restorations versus other
indirect partial coverage restorations (Gold/laboratory fabricated
composites and ceramics).
• Posterior restorations versus anterior restorations.
• Types of cements used.
• Pulp status.
Sensitivity analysis
Provided there are sufficient included trials, sensitivity analysis will
be conducted by excluding studies at high and unclear risk of bias.
Presentation of main results
We will produce summary of findings tables for the primary out-
comes of this review using GRADEpro software. The quality of
the body of evidence will be assessed with reference to the overall
risk of bias of the included studies, the directness of the evidence,
the inconsistency of the results, the precision of the estimates, the
risk of publication bias and the magnitude of the effect. The qual-
ity of the body of evidence for each of the primary outcomes will
be categorised as high, moderate, low or very low.
5
 REFERENCES
Additional references
Andersson 1993
Anderson M, Odén A. A new all-ceramic crown. A dense-
sintered, high-purity alumina coping with porcelain. Acta
Odontologica Scandinavica 1993;51(1):59–64.
Anusavice 2012
Anusavice KJ. Standardizing failure, success, and survival
decisions in clinical studies of ceramic and metal-ceramic
fixed dental prostheses. Dental Materials 2012;28(1):
102–11.
BDJ 2012
British Dental Journal (BDJ). Product news: Create
profitable indirect all-ceramic restorations. British Dental
Journal 2012;212:562.
Boeckler 2009
Boeckler AF, Lee H, Stadler A, Setz JM. Prospective
observation of CAD/CAM titanium ceramic single crowns:
a three-year follow up. Journal of Prosthetic Dentistry 2009;
102(5):290–7.
Christensen 2009
Christensen GJ. Impressions are changing: deciding on
conventional, digital or digital plus in-office milling. Journal
of the American Dental Association 2009;140(10):1301–4.
Egger 1997
Egger M, Davey Smith G, Schneider M, Minder C. Bias
in meta-analysis detected by a simple, graphical test. BMJ
1997;315(7109):629–34.
Griggs 2007
Griggs JA. Recent advances in materials for all-ceramic
restorations. Dental Clinics of North America 2007;51(3):
713–27.
Higgins 2011
Higgins JPT, Green S (editors). Cochrane Handbook
for Systematic Reviews of Interventions version 5.1.0
(updated March 2011). The Cochrane Collaboration,
2011. Available from: www.cochrane-handbook.org.
Höland 2008
Höland W, Schweiger M, Watzke R, Peschke A, Kappert
H. Ceramics as biomaterials for dental restoration. Expert
Review of Medical Devices 2008;5(6):729–45.
Miyazaki 2011
Miyazaki T, Hotta Y. CAD/CAM systems available for the
fabrication of crown and bridge restorations. Austalian
Dental Journal 2011;56 Suppl 1:97–106.
Rücker 2008
Rücker G, Schwarzer G, Carpenter J. Arcsine test for
publication bias in meta-analyses with binary outcomes.
Statistics in Medicine 2008;27(5):746–63.
Touchstone 2010
Touchstone A, Nieting T, Ulmer N. Digital transition: the
collaboration between dentists and laboratory technicians
on CAD/CAM restorations. Journal of the American Dental
Association 2010;141 Suppl 2:15S–9S.
∗
Indicates the major publication for the study

APPENDICES

Appendix 1. MEDLINE via OVID search strategy

1. exp Prosthodontics/
2. ((dental or oral or implant$) adj5 crown$).ti,ab.
3. ((dental or oral or implant$) adj5 inlay$).ti,ab.
4. ((dental or oral or implant$) adj5 onlay$).ti,ab.
5. ((dental or oral or implant$) adj5 veneer$).ti,ab.
6. ((dental or oral or implant$) adj5 porcelain$).ti,ab.
7. ((dental or oral or implant$) adj5 laminate$).ti,ab.
8. “indirect restor$”.ti,ab.
9. (prosthodontic$ adj5 restor$).ti,ab.
10. or/1-9
11. Computer-aided design/
12. (CAD or CAM).ti,ab.
13. (computer adj3 (design$ or manufactur$)).ti,ab.
14. (CEREC or “Chairside Economical Restoration or Esthetic Ceramics” or Delcam or Renishaw or “WorkNC Den-
tal”).ti,ab.
CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol) 6
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
15. or/11-14
16. 10 and 15
The above subject search will be linked with the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomized
trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of the
Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 [updated March 2011].

1. randomized controlled trial.pt.

2. controlled clinical trial.pt.
3. randomized.ab.
4. placebo.ab.
5. drug therapy.fs.
6. randomly.ab.
7. trial.ab.
8. groups.ab.
9. or/1-8
10. exp animals/ not humans.sh.
11. 9 not 10

WHAT’S NEW

Date Event Description

9 April 2014 Amended Minor edit.

CONTRIBUTIONS OF AUTHORS
Kay T Oen (KTO): co-ordinating the review, entering data into RevMan.
KTO, Analia Veitz-Keenan (AVK): undertaking searches, data collection and extraction for the review, analysis and interpretation of
data.
KTO: writing to authors of papers for additional information.
KTO, AVK: obtaining and screening data on unpublished studies.
Silvia Spivakovsky (SS), Jo Wong (JW), Julie Yip (JY): arbiters, review of data extraction and analysis.
KTO, AVK, SS, JW, JY, Eman Bakarman (EB): writing the protocol and review.

CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol) 7
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DECLARATIONS OF INTEREST
Kay T Oen, Analia Veitz-Keenan, Silvia Spivakovsky, Y Jo Wong, Eman Bakarman, Julie Yip: no interests to declare.

SOURCES OF SUPPORT

Internal sources
• None, Other.

External sources
• National Institute for Health Research (NIHR), UK.
CRG funding acknowledgement:
The NIHR is the largest single funder of the Cochrane Oral Health Group.
Disclaimer:
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the
Department of Health.
• Cochrane Oral Health Group Global Alliance, UK.
All reviews in the Cochrane Oral Health Group are supported by Global Alliance member organisations (British Association of Oral
Surgeons, UK; British Orthodontic Society, UK; British Society of Paediatric Dentistry, UK; British Society of Periodontology, UK;
Canadian Dental Hygienists Association, Canada; National Center for Dental Hygiene Research & Practice, USA; Mayo Clinic,
USA; New York University College of Dentistry, USA; and Royal College of Surgeons of Edinburgh, UK) providing funding for the
editorial process (http://ohg.cochrane.org/).

CAD/CAM versus traditional indirect methods in the fabrication of inlays, onlays, and crowns (Protocol) 8
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.