Assessment of selective laser–melted removable partial denture frameworks compared with conventionally cast frameworks: A randomized crossover noninferiority trial

STATEMENT OF PROBLEM: Selective laser-melted (SLM) frameworks have emerged as a digital alternative to conventionally cast metal frameworks for removable partial dentures (RPDs). However, evidence comparing patient-reported outcomes between these fabrication methods remains limited. PURPOSE: The purpose of this randomized crossover noninferiority trial was to compare oral health-related quality of life (OHRQoL), patient satisfaction, and clinician-reported outcomes in patients rehabilitated with RPDs fabricated using either conventionally cast or SLM metal frameworks. MATERIAL AND METHODS: Twelve partially edentulous adults were randomly assigned to one of 2 treatment sequences: SLM→Cast or Cast→SLM. Each RPD was worn for 4 months before crossover. Therefore, for each patient 2 RDPs were fabricated following standardized conventional or digital workflows while maintaining identical prosthetic designs for each patient. OHRQoL and satisfaction were assessed at baseline and up to 4 months using the Geriatric Oral Health Assessment Index (GOHAI), OHIP-G14, and numerical rating scales. The primary endpoint was noninferiority of SLM RPDs based on the between-treatment difference in GOHAI scores at 4 months, with a prespecified noninferiority margin (Δ) of 3 GOHAI units. Nonparametric Brunner-Langer models for longitudinal data were used to compare outcomes while accounting for within-subject correlation of repeated measurements (α=.05). RESULTS: GOHAI scores improved after insertion of both RPD types. The treatment difference in GOHAI at 4 months was 0.44 (95% CI, -1.05-1.94), with the upper confidence limit remaining below Δ, demonstrating noninferiority of SLM RPDs. No significant differences between fabrication methods were found for OHIP-G14, overall satisfaction, stability, mastication, phonetics, esthetics, cleansability, or smell perception (P>.05). Improvements over time were significant across most domains, reflecting functional adaptation independent of framework type. Biological and technical complications, as well as maintenance requirements, were similar between groups. Patients tended to prefer the RPD worn last. CONCLUSIONS: RPDs with SLM frameworks are noninferior to conventionally cast frameworks, providing comparable short-term improvements in OHRQoL and patient satisfaction. These findings support SLM frameworks as a reliable patient-centered alternative to conventionally cast metal frameworks.