A Simulation-Based Comparison of Freehand and Clear Mold-Guided Anterior Composite Restorations Placed by Dental Students

To compare the esthetic outcomes, geometric accuracy, and procedural efficiency of maxillary anterior composite restorations fabricated using a conventional freehand technique and a clear mold-guided technique on typodonts in a controlled, within-subject educational model.

Twenty-one clinical-level dental students restored maxillary anterior teeth (#7-10) on duplicate typodonts using both techniques in a randomized, within-subject simulation study. For the freehand technique, restorations were completed using conventional composite placement and contouring procedures. For the mold-guided technique, a transparent mold generated from a digital wax-up guided composite placement and tooth morphology. Restoration time was recorded. Completed restorations were evaluated independently by three blinded faculty members using a standardized esthetic assessment. Geometric accuracy was quantified by comparing intraoral scans with a reference model using root mean square (RMS) deviation analysis. Data were analyzed using paired statistical tests (α = 0.05).

Inter-rater reliability for esthetic evaluation was excellent (ICC = 0.925). The clear mold-guided technique produced significantly higher esthetic scores than the freehand technique across all parameters and for the overall esthetic score (p < 0.001). Geometric accuracy was significantly improved, with lower RMS deviation values (0.29 ± 0.06 mm vs. 0.43 ± 0.07 mm; p < 0.001). Procedural efficiency was also enhanced, requiring less time to complete (92.25 ± 15.53 min vs. 135.81 ± 20.15 min; p < 0.001).

Compared with the freehand technique, the clear mold-guided technique produced higher esthetic scores, lower RMS deviation values, and reduced procedure time, more accurately reproducing the planned tooth morphology while requiring less operator time.