Digital strategies for interocclusal records in edentulous patients aim to record stable jaw relations by scanning the buccal surfaces of an interocclusal device that is subsequently aligned to the edentulous arches. Yet, predictability remains limited by the lack of stable jaw positions and rigid references for alignment. This narrative reviews current evidence and proposes various digital registration strategies, whereby virtual datasets are aligned within a single coordinate system and patient-relevant references, such as occlusal vertical dimension and centric relations, are incorporated. These strategies are organized by clinical scenarios: no pre-existing prosthesis, existing complete removable dentures, pre-surgical records, and existing fixed implant-supported restorations. Accuracy improves as the registration shifts from removable to fixed interocclusal devices, and stable references have a bigger impact than the choice of surface-registration algorithm. A concise option tree translates these principles into scenario-specific pathways. Evidence gaps remain, with few clinical studies that assess and compare digital interocclusal records with conventional workflows in edentulous patients. Due to the challenges in obtaining accurate occlusal registrations in both digital and conventional workflows, the most reliable pathway includes a physical interocclusal scanning device that supplies stable geometry for digital registration, followed by verification with a prototype try-in.
The functional rehabilitation of an edentulous patient is underpinned by capturing a record of the maxillary and mandibular arches in centric relation (CR) at an appropriate occlusal vertical dimension (OVD). Interocclusal records for edentulous arches are difficult to capture due to the lack of teeth to stabilize the jaw position. In conventional workflows, rigid and well-fitting record bases and wax rims establish OVD and CR, and enable facebow transfers and articulator mounting before fabricating the definitive prosthesis (Powers & Craig 1978; al Elsheikh & Abdel-Hakim 1995; McCord & Grant 2000; Nazir et al. 2012; Doshi et al. 2024). Digital workflows aim to record the same stable jaw relations by scanning the buccal surfaces of an interocclusal device which is subsequently aligned to the edentulous arch scans or digitized impressions/master casts (Att et al. 2019). While the accuracy can be comparable, depending on the specific workflow utilized, it can be affected by the surface-registration behavior and mobility of the soft tissues (Chinam et al. 2023). Registration errors can manifest as uneven occlusal contacts requiring occlusal adjustment at try-in or delivery of the prosthesis, or if undiagnosed may lead to mucosal ulcerations in removable prostheses, or with fixed rehabilitations this would increase the risk of technical and mechanical complications (Piehslinger et al. 1995; Morneburg & Pröschel 2011).
Many edentulous patients present with existing complete dentures or implant-supported fixed dental prostheses that can serve as the initial reference once fit and occlusion have been confirmed. A minority may present without any prosthesis, thus the prosthodontic workflow must begin from scratch with all patient-relevant references determined by the clinician (Att et al. 2019). Pre-extraction records, phonetics and incisal display guide tooth position. No single method is universally definitive, so clinicians must weigh these factors when defining the patient-relevant references (Fayz & Eslami 1988; Abduo 2012).
Digital interocclusal records succeed when stable references are present. Stable record bases and wax rims achieve this mechanically on the dental articulator, while digital workflows achieve it by creating explicit reference geometries that the software can recognize. That geometry may range from an existing complete denture to a provisional implant-supported fixed dental prosthesis, permitting articulation without soft tissue references (Lo Russo et al. 2020; Jin et al. 2021; Hamilton et al. 2024). The record is then verified clinically with a prototype and accepted when the occlusal contacts behave as predicted. This review aims to synthesize evidence-based guidelines on digital interocclusal records for edentulous patients.