Accuracy and Precision of a Novel Digital Impression Workflow with Artificial Intelligence Based Integrated Tool for All-on-X Rehabilitations: A Multicenter Prospective Cohort Study

Background: Digital workflows have significantly improved accuracy and predictability in implant prosthodontics; however, full-arch rehabilitations in completely edentulous patients remain challenging due to the need for precise implant position transfer and passive fit of prosthetic frameworks. Although artificial intelligence (AI)–assisted digital workflows have shown promising results in vitro, prospective clinical evidence remains limited. This study aimed to clinically evaluate the accuracy of a novel AI-integrated digital impression workflow (SmartX) for all-on-X full-arch implant-supported rehabilitations. Methods: This prospective observational case series included 10 completely edentulous patients rehabilitated with all-on-X implant-supported full-arch prostheses. Digital impressions were obtained using extended SmartFlag scan bodies combined with an AI-assisted SmartX workflow and an intraoral scanner. Clinical accuracy was evaluated using visual and tactile inspection, the one-screw (Sheffield) test, and a screw resistance test, all recorded as dichotomous outcomes (acceptable passive fit: yes/no). Secondary outcomes included implant and prosthesis survival rates and the incidence of biological or technical complications. Patients were followed for a minimum of 6 months. Results: A total of 54 implants were placed (mean: 5.4 implants per patient), with no dropouts during follow-up. All cases demonstrated acceptable passive fit according to all accuracy assessments (100% positive outcomes). Progressive screw tightening revealed a consistent angular displacement of approximately 60° in all cases. Implant and prosthesis survival rates were 100%, and no biological or technical complications were observed during the follow-up period. Conclusions: Within the limitations of this prospective clinical study, the SmartX AI-assisted digital workflow combined with extended scan bodies demonstrated high clinical accuracy for full-arch implant-supported rehabilitations. This approach appears to be a reliable and clinically feasible option for digital full-arch prosthodontics. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.