Perceptions, experiences, and adoption barriers regarding digital occlusal devices among dental professionals in Turkey: a cross-sectional survey of dentists and dental technicians
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Abstract Background: Digitally fabricated occlusal devices are increasingly recognised as a viable alternative to their conventionally produced counterparts. However, real-world acceptance and adoption barriers among dental professionals remain poorly characterised. Evidence simultaneously capturing the perspectives of both dentists and dental technicians is notably lacking. The objective of this study is to investigate perceptions, clinical experiences, and adoption barriers related to digital occlusal device technology among dental professionals in Turkey, and to compare the perspectives of dentists and dental technicians. Methods: A cross-sectional, web-based survey was conducted between September 2025 and April 2026 among, dental professionals in Turkey. In total, 250 valid questionnaires involving 127 dentists and 123 dental technicians were obtained. The 43-item questionnaire covered demographics, digital competency, technology experiences, and three open-ended questions analysed by thematic content analysis. Between-group comparisons were performed using the chi-square test, Mann–Whitney U test, and Kruskal–Wallis H test (α = 0.05). Results: A statistically significant difference was found between dentists and technicians in cost perception with dentists more frequently rating costs as high (60.6% and 37.4%). Dentists also reported greater difficulty accessing digital technology. Professionals who had received formal digital device training reported significantly higher digital competency scores than untrained counterparts (means 3.57 and 3.21; p = 0.026). Among dentists, years of experience was significantly associated with competency. In contrast, no significant between-group differences were observed for perceived production speed, clinical fit, patient satisfaction, durability, or future adoption expectations. Notably, 78.5% of all participants agreed that digital production is faster, 76.8% reported improved patient satisfaction, and 89.5% expected digital devices to become more widespread. Qualitative analysis identified high cost (61.1%), infrastructure deficiency (36.3%), and lack of training (29.5%) as the leading barriers to adoption. Conclusions: Turkish dental professionals demonstrate broad consensus regarding the clinical value and future potential of digital occlusal devices, while diverging significantly on cost perception and access. The primary barriers to adoption are economic and structural rather than clinical. Formal training was the strongest modifiable predictor of digital competency. Investment in affordable, curriculum-integrated education and supportive cost-reduction policies are recommended to accelerate digital device adoption.
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Perceptions, experiences, and adoption barriers regarding digital occlusal devices among dental professionals in Turkey: a cross-sectional survey of dentists and dental technicians | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perceptions, experiences, and adoption barriers regarding digital occlusal devices among dental professionals in Turkey: a cross-sectional survey of dentists and dental technicians Hakan Cetiner, Erkin Ozcan, Elif Pak-Tunc, Beril Bayraktar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9558087/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Digitally fabricated occlusal devices are increasingly recognised as a viable alternative to their conventionally produced counterparts. However, real-world acceptance and adoption barriers among dental professionals remain poorly characterised. Evidence simultaneously capturing the perspectives of both dentists and dental technicians is notably lacking. The objective of this study is to investigate perceptions, clinical experiences, and adoption barriers related to digital occlusal device technology among dental professionals in Turkey, and to compare the perspectives of dentists and dental technicians. Methods: A cross-sectional, web-based survey was conducted between September 2025 and April 2026 among, dental professionals in Turkey. In total, 250 valid questionnaires involving 127 dentists and 123 dental technicians were obtained. The 43-item questionnaire covered demographics, digital competency, technology experiences, and three open-ended questions analysed by thematic content analysis. Between-group comparisons were performed using the chi-square test, Mann–Whitney U test, and Kruskal–Wallis H test (α = 0.05). Results: A statistically significant difference was found between dentists and technicians in cost perception with dentists more frequently rating costs as high (60.6% and 37.4%). Dentists also reported greater difficulty accessing digital technology. Professionals who had received formal digital device training reported significantly higher digital competency scores than untrained counterparts (means 3.57 and 3.21; p = 0.026). Among dentists, years of experience was significantly associated with competency. In contrast, no significant between-group differences were observed for perceived production speed, clinical fit, patient satisfaction, durability, or future adoption expectations. Notably, 78.5% of all participants agreed that digital production is faster, 76.8% reported improved patient satisfaction, and 89.5% expected digital devices to become more widespread. Qualitative analysis identified high cost (61.1%), infrastructure deficiency (36.3%), and lack of training (29.5%) as the leading barriers to adoption. Conclusions: Turkish dental professionals demonstrate broad consensus regarding the clinical value and future potential of digital occlusal devices, while diverging significantly on cost perception and access. The primary barriers to adoption are economic and structural rather than clinical. Formal training was the strongest modifiable predictor of digital competency. Investment in affordable, curriculum-integrated education and supportive cost-reduction policies are recommended to accelerate digital device adoption. Digital occlusal device CAD/CAM dentistry Dental professionals Cross-sectional survey Turkey Temporomandibular disorders Prosthodontics Background Temporomandibular disorders (TMD) are a very prevalent condition that, according to some investigators, are present in considerable amount of adolescents and adults (1). TMDs have been recognized as non-dentogenic pain in the orofacial region with a prevalence of 20–50% among the adult population. The multifactorial etiology of TMD requires an interdisciplinary treatment but the recommended initial dental intervention is a reversible treatment with occlusal devices relieving tensions and pain in 50–80% of the patients. Occlusal devices with individualized occlusal surfaces are considered the gold standard regarding their risk-benefit ratio (2). Creating an ideal occlusion through an occlusal device therapy with resulting harmonization and relaxation of the masticatory system leads to a reorganization of intramuscular and intraarticular functional patterns and pain relief of the strained muscle groups (1–3). In recent years, the digital production of occlusal devices alongside conventional fabrication techniques has started to gain momentum. Digital dentistry altered the traditional workflows by introduction of digital dental technology such as intraoral scanners, advanced fabrication processes involving computer-aided design and manufacturing (CAD/CAM) technologies and 3D printing (4). Intraoral scanners facilitate the collection of precise digital records and specially programmed software makes it possible to extensively analyse the case and virtually design the prosthetic structures in the treatment planning phase. Several studies state that digital dental procedure has improved the time effciency of laboratory fabrication process and clinical procedures when compared to conventional dental techniques (5,6). Among the clinical applications of these technologies, digitally fabricated occlusal devices have been an alternative to conventionally produced devices. The digital workflow for the fabrication of stabilization devices includes computerized optical impressions of the upper and lower jaw, a digital bite registration, a computer-aided design (CAD), and a computer-aided manufacturing (CAM). The CAM process can either be performed by subtractive techniques such as milling of polymer blocks or additive techniques such as line-stereolithography, digital light processing, or material jetting (7,8) Although digital technologies for fabricating occlusal devices offer significant advantages, users’ knowledge and technical proficiency are very important and highly affect their integration into routine dental practice. However, evidence regarding the real-world acceptance, perceived clinical value, and adoption barriers of this technology among dental professionals remains limited. The primary aim of the present study was therefore to investigate the perceptions, clinical experiences, and adoption barriers related to digital occlusal device technology among dental professionals in Turkey, with a specific focus on comparing the perspectives of dentists and dental technicians. The secondary objectives were: (1) to determine whether formal training in digital device technology is associated with higher self-reported digital competency; (2) to identify the predominant barriers to adoption from the professionals' own perspectives; and (3) to explore whether years of experience, workplace setting, or professional specialisation influences attitudes towards digital devices. By simultaneously capturing both the clinical and the laboratory viewpoint within a single study, this research addresses a gap in the literature where these two professional groups are rarely examined together. The hypothesis of the study is that dentists and dental technicians differ significantly in their cost perceptions and perceived access difficulties, and also show broad consensus regarding clinical efficacy, production speed advantages, and the future potential of digital device technology. Methods Study design, participants and sampling This study employed a cross-sectional, web-based survey design to evaluate the perceptions, experiences, and adoption barriers related to digital occlusal device technology among dental professionals in Turkey. Participants were recruited through a non-probability, purposive sampling strategy via professional dental networks, university department mailing lists, and social media platforms (LinkedIn, WhatsApp groups, and Instagram dental professional communities). The inclusion criteria were (i) licensed dentists actively practising in Turkey or (ii) certified dental technicians working in dental laboratories or clinical settings. No minimum experience threshold was required for inclusion. Participation was voluntary and anonymous; no incentives were provided. The online questionnaire was administered via Google Forms between September 2025 and April 2026. A total of 250 valid responses were obtained: 127 dentists (50.8%) and 123 dental technicians (49.2%). The survey was closed upon reaching the predetermined sample size. No personally identifiable information was collected. Ethical approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. The research protocol was approved by the Institutional Review Board of İstanbul Atlas University (E-22686390-050.99-66537). All methods were carried out in accordance with relevant guidelines and regulations. All participants provided informed digital consent before completing the questionnaire. Instruments Questionnaire comprised 43 items organised into five thematic sections: (1) demographic and professional background (profession, age, sex, geographic location, educational level, years of experience, and workplace type); (2) digital technology competency and prior training (self-reported digital competency on a 5-point Likert scale, and prior digital device training); (3) profession-specific items for dentists (clinical usage frequency, indications, efficacy perceptions, and cost assessment) and for dental technicians (production process evaluation, material preferences, precision assessment, and time savings); (4) shared items for all participants addressing production speed, cost, durability, clinical fit, patient satisfaction, learning curve, long-term outcomes, and future outlook; and (5) three open-ended questions exploring areas for improvement, cost-reduction strategies, and barriers to adoption. The questionnaire was developed specifically for this study. The instrument was originally developed in Turkish and reviewed by two academic specialists in prosthodontics for face and content validity prior to distribution. No formal psychometric validation (e.g., Cronbach’s alpha) was performed, as the majority of items were single-response categorical or ordinal questions rather than multi-item scales. An English-language version of the questionnaire is provided as Additional file 1. Statistical Analysis All analyses were performed using Python (version 3.12; SciPy library, version 1.13). Descriptive statistics were reported as frequencies and percentages for categorical variables, and as mean ± standard deviation (SD) or median with interquartile range (IQR) for continuous and ordinal variables. Between-group differences for categorical variables were assessed using the chi-square test (χ²) of independence. For ordinal variables (e.g., digital competency scores), the Mann–Whitney U test was applied for two-group comparisons (dentists vs. dental technicians; trained vs. untrained), and the Kruskal–Wallis H test was used for comparisons across three or more independent groups (e.g., age categories, years of experience). Post-hoc pairwise comparisons following significant Kruskal–Wallis results were conducted using Dunn's test with Bonferroni correction where applicable. A significance level of α = 0.05 was adopted for all tests. Responses to the three open-ended questions (areas for improvement, cost-reduction steps, and barriers to adoption) were analysed using thematic content analysis. Responses were first segmented into comma-separated thematic units; two independent researchers then classified all themes into categories based on semantic patterns. Inter-rater agreement was assessed using Cohen's kappa (κ), and discrepancies were resolved through discussion until consensus was reached. Because multiple themes could be identified within a single response, the sum of theme frequencies exceeds the total number of respondents. Open-ended findings were interpreted in an integrated manner alongside the quantitative results from closed-ended items (Table 1 ). Table 1 Summary of statistical tests applied Comparison Statistical Test Applicable To Outcome Variable Type Between-group differences (dentists vs. technicians) Chi-square (χ²) All participants Categorical (nominal/ordinal) Digital competency score comparison Mann–Whitney U All participants Ordinal (1–5 scale) Effect of training on competency Mann–Whitney U All participants Ordinal Years of experience vs. competency Kruskal–Wallis H Each group separately Ordinal Age group vs. competency Kruskal–Wallis H All participants Ordinal Open-ended responses Thematic content analysis All participants Qualitative Based on the existing literature and clinical rationale, the following primary hypotheses were formulated prior to analysis: H1: Dentists and dental technicians differ significantly in their perception of digital device cost. H2: The two professional groups differ in their perceived difficulty of accessing digital dental technology. H3: Professionals who have received formal digital device training report higher digital competency scores than untrained counterparts. H4: Years of clinical experience among dentists is associated with self-reported digital competency. H5: No statistically significant between-group differences exist in perceived production speed, clinical fit, patient satisfaction, durability, or expectations for future adoption — indicating broad consensus across professions. Secondary exploratory analyses examined the influence of age, sex, workplace type (for dentists), laboratory type (for dental technicians), and professional specialisation on technology adoption and competency outcomes. These analyses were not hypothesis-driven and results are interpreted with appropriate caution. Results Participant Characteristics A total of 250 dental professionals completed the survey: 127 dentists (50.8%) and 123 dental technicians (49.2%). The majority were male (52.8%), aged between 20 and 40 years (68%), and based in Istanbul (48.6%). Most dentists worked in private clinics (41.3%) or university settings (35.7%), with prosthodontics being the most represented specialisation (43.3%). Among technicians, 70.7% worked in private laboratories. Mean self-reported digital competency was 3.38 ± 1.22 on a 5-point scale, with 70.3% of respondents reporting prior experience with digital devices and only 48.4% having received formal training in this technology (Table 2 ). Table 2 Sociodemographic characteristics of participants Variable Total (n = 250) Dentists (n = 127) Dental Technicians (n = 123) Sex Male 132 (52.8%) — — Female 118 (47.2%) — — Age group 20–30 years 84 (33.6%) — — 31–40 years 86 (34.4%) — — 41–50 years 43 (17.2%) — — ≥51 years 37 (14.8%) — — Prior experience with digital device 175 (70.3%) — — Received digital device training 121 (48.4%) — — Digital competency score (1–5), mean ± SD 3.38 ± 1.22 3.44 ± — 3.33 ± — —: Data not separately reported for sub-groups in this variable. Cost Perception (H1) A statistically significant difference was identified between dentists and dental technicians in their perception of digital device cost (χ² = 13.79, p = 0.001). Dentists were more likely to rate the cost as high (60.6%) compared to technicians (37.4%), while technicians more frequently selected “moderate” (52.0% vs. 33.1%) (Table 3 ). Table 3 Between-group differences in perceptions and attitudes toward digital occlusal splints among dentists and dental technicians (N = 250). Variable Dentists (n = 127) Statistical Test p-value n (%) n (%) H1: Cost Perception of Digital Splints High 77 (60.6%) 46 (37.4%) χ² = 13.79, df = 2 0.001** Moderate 42 (33.1%) 64 (52.0%) Low 6 (4.7%) 11 (8.9%) H2: Difficulty Accessing Digital Technology Yes (difficulty reported) 45 (35.4%) 28 (22.8%) χ² = 3.94, df = 1 0.047* No 81 (63.8%) 92 (74.8%) H3: Effect of Formal Training on Digital Competency Trained (mean ± SD) 3.57 ± 1.16 — Mann–Whitney U = 9041.5 0.026* Untrained (mean ± SD) 3.21 ± 1.25 — H4: Years of Experience vs. Competency (Dentists only) 0–5 years (mean ± SD) 2.89 ± 1.10 — Kruskal–Wallis H = 10.02 0.018* 6–10 years (mean ± SD) 3.37 ± 1.09 — 11–20 years (mean ± SD) 3.69 ± 1.12 — >20 years (mean ± SD) 3.75 ± 1.11 — H5: Consensus Findings (No Significant Between-Group Differences) Digital production faster 100 (78.7%) 94 (76.4%) χ² = 0.62, df = 1 0.432 Patient satisfaction increased 97 (76.4%) 85 (69.1%) χ² = 0.00, df = 1 0.954 Will become more widespread 113 (89.0%) 109 (88.6%) χ² = 1.36, df = 1 0.243 Will replace conventional methods 91 (71.7%) 90 (73.2%) χ² = 1.25, df = 1 0.263 More education needed 117 (92.1%) 111 (90.2%) χ² = 0.03, df = 1 0.875 Clinical fit superior to conventional 79 (62.2%) 71 (57.7%) χ² = 2.50, df = 2 0.286 Durability: moderate to high 109 (85.8%) 109 (88.6%) χ² = 1.41, df = 2 0.494 SD = standard deviation; df = degrees of freedom; — = not applicable to this group. *p < 0.05; **p < 0.01. Dentists: n = 127; Dental Technicians: n = 123; Total: N = 250. Access Difficulty (H2) Dentists reported greater difficulty in accessing digital dental technology compared to technicians (χ² = 3.94, p = 0.047) (Table 3 ). Training and Digital Competency (H3) Professionals who had received formal digital device training reported significantly higher self-assessed digital competency scores (mean 3.57) compared to those without training (mean 3.21; Mann–Whitney U = 9041.5, p = 0.026) (Table 3 ). Experience and Competency (H4) Among dentists, years of clinical experience was significantly associated with self-reported digital competency (Kruskal–Wallis H = 10.02, p = 0.018). Practitioners in the 6–20-year experience range reported the highest competency scores, while those with over 20 years showed a relative decline. The result was non-significant among dental technicians (p = 0.214) (Table 3 ). Consensus Findings (H5) No statistically significant between-group differences were found for perceived production speed (p = 0.432), clinical fit (p = 0.286), patient satisfaction (p = 0.954), durability (p = 0.494), learning curve (p = 0.843), or future adoption expectations (p = 0.243–0.263). Across both groups, 78.5% agreed that digital production is faster than conventional methods, 76.8% reported increased patient satisfaction, and 89.5% believed digital devices would become more widespread in the future (Table 3 ). Findings from open-ended questions Theme frequencies and findings for each question are presented below. Areas for Improvement (n = 247) Analysis of participants' responses regarding areas needing improvement revealed two dominant themes: cost reduction (59.5%; n = 147) and training and awareness for clinicians and technicians (54.7%; n = 135). Increasing widespread adoption ranked third (47.8%; n = 118), while improving durability (17.4%; n = 43) and ease of production (15.4%; n = 38) were cited less frequently (Table 4 ). Table 4 Thematic frequency analysis of areas requiring improvement in digital occlusal splint technology (Open-ended Question 1; n = 247). Rank Theme n % of respondents* 1 Cost reduction 147 59.5% 2 Training and awareness for clinicians and technicians 135 54.7% 3 Increasing widespread adoption 118 47.8% 4 Improving durability 43 17.4% 5 Simplifying the production process 38 15.4% 6 Improving ease of use 21 8.5% 7 Strengthening technical support services 16 6.5% 8 Expanding training programmes 16 6.5% *Percentages exceed 100% as respondents could select multiple themes. Total respondents: n = 247. Steps to Reduce Costs (n = 244) Proposals for reducing digital device costs were spread across a wide range of strategies. The most frequently suggested step was provision of free or affordable training programmes (39.3%; n = 96), followed by use of more affordable materials (35.2%; n = 86), streamlining the production process (31.6%; n = 77), and expanding batch production methods (29.1%; n = 71). Government-backed incentive programmes (8.6%; n = 21) and reduction of material import taxes (8.6%; n = 21) were highlighted as policy-level solutions (Table 5 ). Table 5 Proposed steps for reducing digital occlusal splint costs as identified by survey respondents (Open-ended Question 2; n = 244). Rank Proposed Step n % of respondents* 1 Provision of free or affordable training for clinicians and technicians 96 39.3% 2 Use of more affordable materials 86 35.2% 3 Streamlining the production process 77 31.6% 4 Expansion of batch production methods 71 29.1% 5 Reducing production costs through adoption of new technologies 69 28.3% 6 Government-backed incentive programmes 21 8.6% 7 Reduction of material import taxes 21 8.6% 8 Increasing domestic production capacity 16 6.6% 9 Adopting more competitive pricing policies 16 6.6% *Percentages exceed 100% as respondents could select multiple themes. Total respondents: n = 244. Barriers to Adoption (n = 190) A total of 190 responses regarding the primary reasons for non-adoption of digital device technology were categorised using keyword-based thematic coding. High cost was identified by a clear margin as the predominant barrier to adoption (61.1%; n = 116), followed by insufficient infrastructure and equipment (36.3%; n = 69) and lack of training and knowledge (29.5%; n = 56). Adherence to traditional methods and resistance to change were cited by 13.2% (n = 25) of respondents, while shortage of qualified technicians accounted for 7.9% (n = 15). Notably, the rate of cost-related non-adoption was nearly identical across both professional groups (61% among dentists and 61% among dental technicians), indicating that the cost barrier affects both groups equally. Infrastructure and equipment deficiency emerged as a comparatively more pronounced barrier among dentists (38%) than technicians (34%) (Table 6 ). Table 6 Barriers to adoption of digital occlusal splint technology, stratified by professional group (Open-ended Question 3; n = 190). Barrier Theme n % Total* Dentists (n = 102) Dental Technicians (n = 88) High cost 116 61.1% 62 (60.8%) 54 (61.4%) Insufficient infrastructure / equipment 69 36.3% 39 (38.2%) 30 (34.1%) Lack of training / knowledge 56 29.5% 29 (28.4%) 27 (30.7%) Adherence to traditional methods / resistance to change 25 13.2% 13 (12.7%) 12 (13.6%) Shortage of qualified technicians 15 7.9% 7 (6.9%) 8 (9.1%) Distrust of digital technology 1 0.5% 1 (1.0%) 0 (0.0%) *Percentages exceed 100% as respondents could identify multiple barriers. Keyword-based thematic coding applied. Total respondents: n = 190 (102 dentists, 88 dental technicians). Integrated Interpretation with Quantitative Findings The open-ended findings form a coherent and consistent whole with the results obtained from quantitative analyses. The statistically significant difference in cost perception between the two groups identified in the closed-ended items (χ²=13.79; p = 0.001) is corroborated by the 61% recurrence of the cost theme in open-ended responses across both groups. Similarly, the significant effect of training on competency (p = 0.026) aligns with training and awareness emerging as the second most frequently cited theme (54.7%) in the areas-for-improvement question. Discussion This study provides a cross-sectional comparison of dentists and dental technicians regarding digital occlusal device perceptions in Turkey. The hypothesis of the study was that dentists and dental technicians differ significantly in their cost perceptions and perceived access difficulties, and also show broad consensus regarding clinical efficacy, production speed advantages, and the future potential of digital device technology. The principal finding showed that the two groups share broad consensus on clinical outcomes while diverging significantly on cost. According to the results of the study, the hypothesis was accepted. From a technology adoption perspective, the results of this study suggests that the primary barrier to wider digital occlusal device use in Turkey is not clinical scepticism but economic constraint. This finding supports H1. A likely explanation for the differential in the present study is that dentists view cost from the patient-billing and treatment-planning perspective, whereas technicians evaluate it against production inputs and laboratory overhead. This interpretation is supported by the qualitative data, in which cost-related concerns recurred at equal rates (61%) across both groups in open-ended responses, suggesting that although the magnitude of the barrier differs, its structural origin is shared. These results correspond to the findings of the Jordanian cross-sectional study by Hatamleh et al. [ 8 ], in which cost was the leading adoption barrier and dentists and technicians diverged in their economic assessments of digital workflows. Results also shows similarity with the findings of Shin et al. that shows the pattern documented in Southeast Asia [ 9 ]. It implies that efforts to improve adoption should focus on cost-reduction policies, subsidised training, and scalable production models rather than on changing clinical attitudes, which appear already favourable. Also, Hall et al. [ 10 ] reported that high equipment cost was the dominant barrier to digital adoption among Egyptian dentists, a finding mirrored in Pakistan and Malaysia, where cost was cited by 54.5% and 47.2% of professionals respectively [ 11 ]. The comparatively high rate in the present Turkish sample (61.1% of non-adopters) situates Turkey alongside higher-barrier regional contexts. The open-ended responses further illuminate the structural character of this barrier: participants proposed not only market mechanisms such as more affordable materials or batch production but also state-level interventions like government incentive programmes, import tax reductions. This finding supports the recommendations of Shin et al. [ 9 ] that tailored, country-specific educational and financial strategies are needed to promote adoption. In this study, dentists reported greater difficulty in accessing digital dental technology compared to technicians. In the open-ended data, infrastructure and equipment deficiency emerged as a barrier among 38% of dentists versus 34% of technicians, reinforcing the statistically observed pattern. This result partially supports H2. Dentists reported difficulty in accessing digital dental technology may be the result of infrastructure gaps and equipment costs that disproportionately affect clinical rather than laboratory settings and may reflect the higher capital investment required for chairside digital workflows (intraoral scanners, digital articulation systems) compared to laboratory-based CAD/CAM units, which are increasingly accessible through shared or outsourced production models. The high consensus on clinical outcomes observed in the present study. Particularly the 62% rated clinical fit as superior to conventional methods and the 76.8% observed improved patient satisfaction and these are well supported by the current experimental literature. Sun et al. [ 12 ] demonstrated that fully digital device workflows based on individual mandibular movement recording produced clinically accurate, well-fitting devices while reducing chairside time. Herpel et al. [ 13 ] found in a randomised pilot trial that 3D-printed and milled devices produced comparable patient satisfaction scores after three months of use. Qin et al. [ 14 ] similarly reported that digitally fabricated devices were non-inferior to conventional ones in pain relief and craniomandibular index scores in TMD patients, while significantly reducing production time. The comprehensive review by Şimunović et al. [ 15 ] confirmed that 3D-printed devices meet ISO mechanical standards. These convergent findings provide a strong evidence-based foundation for the favourable perceptions observed in this study population. A significant association between formal digital device training and self-reported competency (p = 0.026) was found and the result confirmed H3. This finding gains added weight in the context of the open-ended data, where 54.7% of respondents identified training and awareness programmes as the most important area for improvement, and 39.3% proposed free or subsidised training as the most effective cost-reduction measure. The result aligns with Nassani et al. [ 16 ], who found that structured CAD/CAM exercises in predoctoral curricula significantly increased students’ confidence and adoption intentions. It also resonates with the technology readiness framework employed by Schnitzler et al.[ 17 ], in which innovativeness and optimism, that are both trainable dimensions, were positive predictors of digital equipment use. Acharya et al. [ 18 ], comparing dental practitioners and technicians on 3D printing knowledge, similarly found that formal training was the strongest single predictor of self-reported practice. Zhu et al. [ 19 ] also reported structured educational exposure as a key predictor of technology engagement and suggested that informal on-the-job exposure is widespread but insufficient to develop full competency.These findings suggest that investment in formal, structured training represents a high-leverage intervention for expanding digital occlusal device adoption in Turkey. Years of clinical experience among dentists was significantly associated with self-reported digital competency supporting H4 and showed the highest competency scores in the 6–20-year experience while those with over 20 years showed a relative decline. This inverted U-shaped pattern is explained by Schnitzler et al. study [ 17 ], in which mid-career professionals exhibit the greatest adoption readiness, whereas very senior practitioners may be less motivated to integrate new digital workflows. The non-significant result among dental technicians (p = 0.214) may reflect the more standardised, protocol-driven nature of laboratory-based digital tasks, which can be acquired independently of career stage through targeted technical training. A key strength of this study is the simultaneous inclusion of both dentists and dental technicians which is a rare design in the existing literature. Hatamleh et al. [ 8 ] is one of the few exceptions, having surveyed both groups, though with a substantially smaller sample (n = 90). The present study’s design enabled the direct comparison that revealed cost perception as the key divergence point, while simultaneously confirming clinical consensus. This finding has practical implications for the clinic–laboratory interface: it suggests that digital device adoption programmes must be co-designed with both stakeholder groups, addressing the distinct cost concerns of each rather than applying a single strategy. No statistically significant between-group differences in perceptions and attitudes toward digital occlusal devices among dentists and dental technicians were found and this result fully confirms H5. These results correlate with the report of Şimunović et al. [ 15 ], which concluded that 3D-printed occlusal devices are clinically non-inferior to conventional ones and offer advantages in patient-reported comfort and production efficiency. The finding that both dentists and technicians converge on clinical outcomes, despite diverging on cost, suggests that perceived barriers to adoption are primarily economic and structural rather than clinical or technical in nature. Findings from open-ended questions suggest that confidence in the clinical potential of the technology is high, but that structural improvements in accessibility and human resource capacity are still needed. Addressing the cost barrier requires not only market-driven mechanisms but also investment in training and public policy instruments. The quantitative findings reflect not only statistical significance, but also the real-world experiences of practitioners in the field. Several limitations of this study should be acknowledged. The use of purposive sampling and online recruitment may have introduced selection bias, potentially over-representing professionals with pre-existing interest in digital technologies. 48.6% of participants were based in Istanbul, limiting the geographic representativeness of the findings for smaller cities and rural areas of Turkey, where digital infrastructure may be less developed. All measures were self-reported, and the digital competency scale used was not formally validated. The cross-sectional design precludes causal inference; specifically, it is not possible to determine whether training improves competency or whether more competent practitioners are more likely to seek training. Future longitudinal studies and randomised educational interventions are warranted to address this directionality question. Also the questionnaire did not distinguish between milled (subtractive) and 3D-printed (additive) digital device fabrication methods, which differ in cost, accuracy, and material properties [ 7 , 11 ]. Conclusions This cross-sectional survey of 250 Turkish dental professionals demonstrated that dentists and dental technicians share strong consensus regarding the clinical efficacy, production speed, patient comfort, and future potential of digital occlusal device technology, while diverging significantly in their cost perceptions. High cost and insufficient training were identified as the predominant barriers to adoption by both groups. Formal digital device training was significantly associated with higher self-reported competency, and years of clinical experience was a significant predictor of digital competency among dentists. The dual-profession design of this study provides a more complete picture of the clinic–laboratory ecosystem than single-group surveys and reveals that adoption strategies must address economic and educational barriers simultaneously. These findings support the development of subsidised training programmes, curriculum reform in dental education, and public policy measures to reduce equipment and material costs, as coordinated priorities for expanding digital device integration in dental practice. Abbreviations TMD: Temporomandibular disorder; CAD/CAM: Computer-aided design/computer-aided manufacturing; SD: Standard deviation; IQR: Interquartile range; χ²: Chi-square statistic; H: Kruskal–Wallis H statistic; U: Mann–Whitney U statistic; κ: Cohen’s kappa; ISO: International Organization for Standardization; IRB: Institutional Review Board. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. The research protocol was approved by the Institutional Review Board of Istanbul Atlas University (E-22686390-050.99-66537). All participants provided informed digital consent before completing the questionnaire. Clinical trial number Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no specific funding for this work. Authors’ contributions HC conceived and designed the study. EO collected the data. EPT performed the statistical analysis. BB drafted the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Alonso-Royo R, Sanchez-Torrelo CM, Ibanez-Vera AJ, Zagalaz-Anula N, Castellote-Caballero Y, Obrero-Gaitan E, Rodriguez-Almagro D, Lomas-Vega R. Validity and reliability of the Helkimo Clinical Dysfunction Index for the diagnosis of temporomandibular disorders. Diagnostics.2021;11(3):472. https://doi.org/10.3390/diagnostics11030472 Patzelt SBM, Krügel M, Wesemann C, Pieralli S, Nold J, Spies BC, Vach K, Kohal RF. In vitro time efficiency, fit and wear of conventionally-versus digitally-fabricated occlusal splints.Materials.2022;15(3):1085. https://doi.org/10.3390/ma15031085 Okeson JP. Management of temporomandibular disorders and occlusion.8 th ed. Missouri, Elsevier, 2020.p.102-131. Berntsen C, Kleven M, Heian M, Hjortsjo C. Clinical comparison of conventional and additive manufactured stabilization splints. Acta Biomater Odontol Scand.2018; 4(1):81–89. https://doi.org/10.1080/23337931.2018.1497491 Mühlemann S, Kraus RD, Hämmerle CHF,Thoma DS. Is the use of digital technologies for the fabrication of implant- supported reconstructions more efficient and/or more effective than conventional techniques: A systematic review. Clin Oral Impl Res. 2018;29:184–195. https://doi.org/10.1111/clr.13300 Oliveria NRC, Pigozzo MN, Sesma N, Lagana DC. Clinical efficiency and patient preference of digital and conventional workflow for single implant crowns using immediate and regular digital impression: A meta-analysis. Clin Oral Impl Res.2020;31:669-686. https://doi.org/10.1111/clr.13604 Palma-Fernandes MJ, Ruiz-Marrara J, Campos-Muller MF, Melchior MO, Côrte-Real ISG, Mazzi-Chaves JF, Magri LV. Teaching Occlusal Splints in the Digital Age: Comparing Student Experiences with Conventional and CAD/CAM Workflows. J Dent Educ. 2025;0:1–10. https://doi.org/10.1002/jdd.70045 Hatamleh MM, Saleh SA, Radwan OI, Shamma HRA. Adoption and challenges of digital dentistry among dentists and dental technicians: A cross-sectional study J. Prosthodont. 2025;34:913–917. https://doi.org/10.1111/jopr.70043 Shin YJ, Mohan M, Kyaw Moe MM, Curtis J, Kim C, Sohn W, Lee DH. Perceptions of benefits, barriers, and educational strategies for digital dentistry in Southeast Asia: a multi-country cross-sectional pilot survey. Community Dent Health. 2025. https://doi.org/10.1177/0265539X251400878 Hall MA, Karawia I, Mahmoud AZ, Mohamed OS. Knowledge, awareness, and perception of digital dentistry among Egyptian dentists: a cross-sectional study. BMC Oral Health. 2023;23:963. https://doi.org/10.1186/s12903-023-03698-1 Whittle T, Walsh L, Tennant M. The digital workflow in dentistry: adoption and challenges. Journal of Orofacial and Health Sciences. 2025; 6(2): 244-251. https://doi.org/10.15713/ins.johs.2025.244 Sun X, Feng Y, Jiao Y, Liu W. Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement. J Dent. 2024;141:104826. https://doi.org/10.1016/j.jdent.2024.104826 Herpel C, Kykal J, Rues S, Schwindling FS, Rammelsberg P, Eberhard L. Thermo-flexible resin for the 3D printing of occlusal splints: a randomized pilot trial. J Dent. 2023;133:104514. https://doi.org/10.1016/j.jdent.2023.104514 Qin H, Liu Y, Miao H, et al. Comparative efficacy of digital 3D-printed and conventional stable occlusal splints in the treatment of temporomandibular disorders. J Oral Rehabil. 2025;52:1699–1706. https://doi.org/10.1111/joor.14032 Şimunović L, Čimić S, Meštrović S. Three-dimensionally printed splints in dentistry: a comprehensive review. Dent J. 2025;13(7):312. https://doi.org/10.3390/dj13070312 Nassani LM, Bencharit S, Schumacher F, et al. The impact of technology teaching in the dental predoctoral curriculum on students’ perception of digital dentistry. Dent J (Basel). 2024;12(3):75. https://doi.org/10.3390/dj12030075 Schnitzler C, Bohnet-Joschko S. Technology readiness drives digital adoption in dentistry: Insights from a cross-sectional study. Healthcare. 2025;13(10):1155. https://doi.org/10.3390/healthcare13101155 Acharya A, Chodankar RN, Patil R, Patil AG. Assessment of knowledge, awareness, and practices toward the use of 3D printing in dentistry among dental practitioners and dental technicians: a cross-sectional study. J Oral Biol Craniofac Res. 2023;13:253–258. https://doi.org/10.1016/j.jobcr.2022.12.007 Zhu F, Yu H, Wang Z, Lu X, Meng X, Nie R. Knowledge, attitude, and practice regarding digital dental technologies among dentists in Jiangsu Province. Healthcare. 2025;13(3):234. https://doi.org/10.3390/healthcare13030234 Additional Declarations No competing interests reported. Supplementary Files ingilizceanketceviri.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9558087","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":636024509,"identity":"7e829146-b6d9-48f4-ab23-8e6bcbeb70ea","order_by":0,"name":"Hakan Cetiner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYBACAwY2KIsZRFQwMPCBeWy4NCBp4QFrOcMgwQbTwkNQC4hgbCNCizn7scTPBQx2cvbsvAcfV86zq2NjP/6A4UPZYQZ76QNYtVj2pB2WnsGQbMzDzJdseHZbsgQbT44B44xzhxl4+BKwO+xAeoM0D8OBxB5mHjPJxm3MQIflMDDztgG14HCZwfnnzb+BWuqBWsx/Ns6pl2Djf/6A+S8+LTfSjoFsSeAB2sLY2HBYgk0iwYCZEa+WZ2nWPAbJhj2HeYwlG44dl2yTeGNwsOdcOg/PGVwOSzO+zVNhJ8/ef8bwY0NNNT8/f/rDBz/KrOXYe7BrgWpE4x9gwB0to2AUjIJRMAqIAABiNEzIUpWnfwAAAABJRU5ErkJggg==","orcid":"","institution":"Atlas University","correspondingAuthor":true,"prefix":"","firstName":"Hakan","middleName":"","lastName":"Cetiner","suffix":""},{"id":636024510,"identity":"90423e31-57e2-4ad3-a6ee-533cebe0ea4f","order_by":1,"name":"Erkin Ozcan","email":"","orcid":"","institution":"Atlas University","correspondingAuthor":false,"prefix":"","firstName":"Erkin","middleName":"","lastName":"Ozcan","suffix":""},{"id":636024513,"identity":"43aaa5f7-63eb-40c2-a0e8-175f8efccb40","order_by":2,"name":"Elif Pak-Tunc","email":"","orcid":"","institution":"Istanbul University","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"","lastName":"Pak-Tunc","suffix":""},{"id":636024515,"identity":"a110fe36-25cb-4b34-91a8-414d78e2b86d","order_by":3,"name":"Beril Bayraktar","email":"","orcid":"","institution":"Atlas University","correspondingAuthor":false,"prefix":"","firstName":"Beril","middleName":"","lastName":"Bayraktar","suffix":""}],"badges":[],"createdAt":"2026-04-28 20:23:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9558087/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9558087/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108796666,"identity":"8421e28f-2211-4dcb-b7e0-6f2a935fc77d","added_by":"auto","created_at":"2026-05-08 13:31:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":397446,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9558087/v1/5c948498-8d68-490a-abca-28ed3ff2f673.pdf"},{"id":108796625,"identity":"6024f801-a588-49a1-9df6-1dfde9bd34eb","added_by":"auto","created_at":"2026-05-08 13:31:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20578,"visible":true,"origin":"","legend":"","description":"","filename":"ingilizceanketceviri.docx","url":"https://assets-eu.researchsquare.com/files/rs-9558087/v1/26381b3f063bc01a8869ecfd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions, experiences, and adoption barriers regarding digital occlusal devices among dental professionals in Turkey: a cross-sectional survey of dentists and dental technicians","fulltext":[{"header":"Background","content":"\u003cp\u003eTemporomandibular disorders (TMD) are a very prevalent condition that, according to some investigators, are present in considerable amount of adolescents and adults (1). TMDs have been recognized as non-dentogenic pain in the orofacial region with a prevalence of 20\u0026ndash;50% among the adult population. The multifactorial etiology of TMD requires an interdisciplinary treatment but the recommended initial dental intervention is a reversible treatment with occlusal devices relieving tensions and pain in 50\u0026ndash;80% of the patients. Occlusal devices with individualized occlusal surfaces are considered the gold standard regarding their risk-benefit ratio (2). Creating an ideal occlusion through an occlusal device therapy with resulting harmonization and relaxation of the masticatory system leads to a reorganization of intramuscular and intraarticular functional patterns and pain relief of the strained muscle groups (1\u0026ndash;3).\u003c/p\u003e \u003cp\u003eIn recent years, the digital production of occlusal devices alongside conventional fabrication techniques has started to gain momentum. Digital dentistry altered the traditional workflows by introduction of digital dental technology such as intraoral scanners, advanced fabrication processes involving computer-aided design and manufacturing (CAD/CAM) technologies and 3D printing (4). Intraoral scanners facilitate the collection of precise digital records and specially programmed software makes it possible to extensively analyse the case and virtually design the prosthetic structures in the treatment planning phase. Several studies state that digital dental procedure has improved the time effciency of laboratory fabrication process and clinical procedures when compared to conventional dental techniques (5,6).\u003c/p\u003e \u003cp\u003eAmong the clinical applications of these technologies, digitally fabricated occlusal devices have been an alternative to conventionally produced devices. The digital workflow for the fabrication of stabilization devices includes computerized optical impressions of the upper and lower jaw, a digital bite registration, a computer-aided design (CAD), and a computer-aided manufacturing (CAM). The CAM process can either be performed by subtractive techniques such as milling of polymer blocks or additive techniques such as line-stereolithography, digital light processing, or material jetting (7,8)\u003c/p\u003e \u003cp\u003eAlthough digital technologies for fabricating occlusal devices offer significant advantages, users\u0026rsquo; knowledge and technical proficiency are very important and highly affect their integration into routine dental practice. However, evidence regarding the real-world acceptance, perceived clinical value, and adoption barriers of this technology among dental professionals remains limited. The primary aim of the present study was therefore to investigate the perceptions, clinical experiences, and adoption barriers related to digital occlusal device technology among dental professionals in Turkey, with a specific focus on comparing the perspectives of dentists and dental technicians. The secondary objectives were: (1) to determine whether formal training in digital device technology is associated with higher self-reported digital competency; (2) to identify the predominant barriers to adoption from the professionals' own perspectives; and (3) to explore whether years of experience, workplace setting, or professional specialisation influences attitudes towards digital devices. By simultaneously capturing both the clinical and the laboratory viewpoint within a single study, this research addresses a gap in the literature where these two professional groups are rarely examined together. The hypothesis of the study is that dentists and dental technicians differ significantly in their cost perceptions and perceived access difficulties, and also show broad consensus regarding clinical efficacy, production speed advantages, and the future potential of digital device technology.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, participants and sampling\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional, web-based survey design to evaluate the perceptions, experiences, and adoption barriers related to digital occlusal device technology among dental professionals in Turkey.\u003c/p\u003e \u003cp\u003eParticipants were recruited through a non-probability, purposive sampling strategy via professional dental networks, university department mailing lists, and social media platforms (LinkedIn, WhatsApp groups, and Instagram dental professional communities). The inclusion criteria were (i) licensed dentists actively practising in Turkey or (ii) certified dental technicians working in dental laboratories or clinical settings. No minimum experience threshold was required for inclusion. Participation was voluntary and anonymous; no incentives were provided.\u003c/p\u003e \u003cp\u003eThe online questionnaire was administered via Google Forms between September 2025 and April 2026. A total of 250 valid responses were obtained: 127 dentists (50.8%) and 123 dental technicians (49.2%). The survey was closed upon reaching the predetermined sample size. No personally identifiable information was collected.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki. The research protocol was approved by the Institutional Review Board of İstanbul Atlas University (E-22686390-050.99-66537). All methods were carried out in accordance with relevant guidelines and regulations. All participants provided informed digital consent before completing the questionnaire.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eQuestionnaire comprised 43 items organised into five thematic sections: (1) demographic and professional background (profession, age, sex, geographic location, educational level, years of experience, and workplace type); (2) digital technology competency and prior training (self-reported digital competency on a 5-point Likert scale, and prior digital device training); (3) profession-specific items for dentists (clinical usage frequency, indications, efficacy perceptions, and cost assessment) and for dental technicians (production process evaluation, material preferences, precision assessment, and time savings); (4) shared items for all participants addressing production speed, cost, durability, clinical fit, patient satisfaction, learning curve, long-term outcomes, and future outlook; and (5) three open-ended questions exploring areas for improvement, cost-reduction strategies, and barriers to adoption.\u003c/p\u003e \u003cp\u003eThe questionnaire was developed specifically for this study. The instrument was originally developed in Turkish and reviewed by two academic specialists in prosthodontics for face and content validity prior to distribution. No formal psychometric validation (e.g., Cronbach\u0026rsquo;s alpha) was performed, as the majority of items were single-response categorical or ordinal questions rather than multi-item scales. An English-language version of the questionnaire is provided as Additional file 1.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll analyses were performed using Python (version 3.12; SciPy library, version 1.13). Descriptive statistics were reported as frequencies and percentages for categorical variables, and as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median with interquartile range (IQR) for continuous and ordinal variables.\u003c/p\u003e \u003cp\u003eBetween-group differences for categorical variables were assessed using the chi-square test (χ\u0026sup2;) of independence. For ordinal variables (e.g., digital competency scores), the Mann\u0026ndash;Whitney U test was applied for two-group comparisons (dentists vs. dental technicians; trained vs. untrained), and the Kruskal\u0026ndash;Wallis H test was used for comparisons across three or more independent groups (e.g., age categories, years of experience). Post-hoc pairwise comparisons following significant Kruskal\u0026ndash;Wallis results were conducted using Dunn's test with Bonferroni correction where applicable. A significance level of α\u0026thinsp;=\u0026thinsp;0.05 was adopted for all tests.\u003c/p\u003e \u003cp\u003eResponses to the three open-ended questions (areas for improvement, cost-reduction steps, and barriers to adoption) were analysed using thematic content analysis. Responses were first segmented into comma-separated thematic units; two independent researchers then classified all themes into categories based on semantic patterns. Inter-rater agreement was assessed using Cohen's kappa (κ), and discrepancies were resolved through discussion until consensus was reached. Because multiple themes could be identified within a single response, the sum of theme frequencies exceeds the total number of respondents. Open-ended findings were interpreted in an integrated manner alongside the quantitative results from closed-ended items (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of statistical tests applied\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e Comparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eApplicable To\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOutcome Variable Type\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBetween-group differences (dentists vs. technicians)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChi-square (χ\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCategorical (nominal/ordinal)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigital competency score comparison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOrdinal (1\u0026ndash;5 scale)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffect of training on competency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOrdinal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of experience vs. competency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKruskal\u0026ndash;Wallis H\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEach group separately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOrdinal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group vs. competency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKruskal\u0026ndash;Wallis H\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOrdinal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen-ended responses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThematic content analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the existing literature and clinical rationale, the following primary hypotheses were formulated prior to analysis:\u003c/p\u003e \u003cp\u003eH1: Dentists and dental technicians differ significantly in their perception of digital device cost.\u003c/p\u003e \u003cp\u003eH2: The two professional groups differ in their perceived difficulty of accessing digital dental technology.\u003c/p\u003e \u003cp\u003eH3: Professionals who have received formal digital device training report higher digital competency scores than untrained counterparts.\u003c/p\u003e \u003cp\u003eH4: Years of clinical experience among dentists is associated with self-reported digital competency.\u003c/p\u003e \u003cp\u003eH5: No statistically significant between-group differences exist in perceived production speed, clinical fit, patient satisfaction, durability, or expectations for future adoption \u0026mdash; indicating broad consensus across professions.\u003c/p\u003e \u003cp\u003eSecondary exploratory analyses examined the influence of age, sex, workplace type (for dentists), laboratory type (for dental technicians), and professional specialisation on technology adoption and competency outcomes. These analyses were not hypothesis-driven and results are interpreted with appropriate caution.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 250 dental professionals completed the survey: 127 dentists (50.8%) and 123 dental technicians (49.2%). The majority were male (52.8%), aged between 20 and 40 years (68%), and based in Istanbul (48.6%). Most dentists worked in private clinics (41.3%) or university settings (35.7%), with prosthodontics being the most represented specialisation (43.3%). Among technicians, 70.7% worked in private laboratories. Mean self-reported digital competency was 3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 on a 5-point scale, with 70.3% of respondents reporting prior experience with digital devices and only 48.4% having received formal training in this technology (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;250)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDentists (n\u0026thinsp;=\u0026thinsp;127)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDental Technicians (n\u0026thinsp;=\u0026thinsp;123)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e132 (52.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118 (47.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;51 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior experience with digital device\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived digital device training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121 (48.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigital competency score (1\u0026ndash;5), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.44 \u0026plusmn; \u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.33 \u0026plusmn; \u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003e\u0026mdash;: Data not separately reported for sub-groups in this variable.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCost Perception (H1)\u003c/h2\u003e \u003cp\u003eA statistically significant difference was identified between dentists and dental technicians in their perception of digital device cost (χ\u0026sup2; = 13.79, p\u0026thinsp;=\u0026thinsp;0.001). Dentists were more likely to rate the cost as high (60.6%) compared to technicians (37.4%), while technicians more frequently selected \u0026ldquo;moderate\u0026rdquo; (52.0% vs. 33.1%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBetween-group differences in perceptions and attitudes toward digital occlusal splints among dentists and dental technicians (N\u0026thinsp;=\u0026thinsp;250).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDentists (n\u0026thinsp;=\u0026thinsp;127)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eH1: Cost Perception of Digital Splints\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (60.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (37.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 13.79, df\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (33.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (52.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eH2: Difficulty Accessing Digital Technology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (difficulty reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (35.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 3.94, df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.047*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (74.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eH3: Effect of Formal Training on Digital Competency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrained (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMann\u0026ndash;Whitney U\u0026thinsp;=\u0026thinsp;9041.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.026*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUntrained (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eH4: Years of Experience vs. Competency (Dentists only)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKruskal\u0026ndash;Wallis H\u0026thinsp;=\u0026thinsp;10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.018*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;20 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eH5: Consensus Findings (No Significant Between-Group Differences)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigital production faster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (78.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (76.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 0.62, df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient satisfaction increased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (76.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (69.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 0.00, df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.954\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill become more widespread\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (89.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 1.36, df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill replace conventional methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (71.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (73.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 1.25, df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore education needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (92.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 0.03, df\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical fit superior to conventional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (62.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 2.50, df\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDurability: moderate to high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (85.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; = 1.41, df\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eSD\u003c/b\u003e\u0026thinsp;=\u0026thinsp;standard deviation; \u003cb\u003edf\u003c/b\u003e\u0026thinsp;=\u0026thinsp;degrees of freedom; \u0026mdash; = not applicable to this group. \u003cb\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/b\u003e Dentists: n\u0026thinsp;=\u0026thinsp;127; Dental Technicians: n\u0026thinsp;=\u0026thinsp;123; Total: N\u0026thinsp;=\u0026thinsp;250.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAccess Difficulty (H2)\u003c/h3\u003e\n\u003cp\u003eDentists reported greater difficulty in accessing digital dental technology compared to technicians (χ\u0026sup2; = 3.94, p\u0026thinsp;=\u0026thinsp;0.047) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eTraining and Digital Competency (H3)\u003c/h3\u003e\n\u003cp\u003eProfessionals who had received formal digital device training reported significantly higher self-assessed digital competency scores (mean 3.57) compared to those without training (mean 3.21; Mann\u0026ndash;Whitney U\u0026thinsp;=\u0026thinsp;9041.5, p\u0026thinsp;=\u0026thinsp;0.026) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eExperience and Competency (H4)\u003c/h2\u003e \u003cp\u003eAmong dentists, years of clinical experience was significantly associated with self-reported digital competency (Kruskal\u0026ndash;Wallis H\u0026thinsp;=\u0026thinsp;10.02, p\u0026thinsp;=\u0026thinsp;0.018). Practitioners in the 6\u0026ndash;20-year experience range reported the highest competency scores, while those with over 20 years showed a relative decline. The result was non-significant among dental technicians (p\u0026thinsp;=\u0026thinsp;0.214) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eConsensus Findings (H5)\u003c/h2\u003e \u003cp\u003eNo statistically significant between-group differences were found for perceived production speed (p\u0026thinsp;=\u0026thinsp;0.432), clinical fit (p\u0026thinsp;=\u0026thinsp;0.286), patient satisfaction (p\u0026thinsp;=\u0026thinsp;0.954), durability (p\u0026thinsp;=\u0026thinsp;0.494), learning curve (p\u0026thinsp;=\u0026thinsp;0.843), or future adoption expectations (p\u0026thinsp;=\u0026thinsp;0.243\u0026ndash;0.263). Across both groups, 78.5% agreed that digital production is faster than conventional methods, 76.8% reported increased patient satisfaction, and 89.5% believed digital devices would become more widespread in the future (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFindings from open-ended questions\u003c/h2\u003e \u003cp\u003eTheme frequencies and findings for each question are presented below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAreas for Improvement (n\u0026thinsp;=\u0026thinsp;247)\u003c/h2\u003e \u003cp\u003eAnalysis of participants' responses regarding areas needing improvement revealed two dominant themes: cost reduction (59.5%; n\u0026thinsp;=\u0026thinsp;147) and training and awareness for clinicians and technicians (54.7%; n\u0026thinsp;=\u0026thinsp;135). Increasing widespread adoption ranked third (47.8%; n\u0026thinsp;=\u0026thinsp;118), while improving durability (17.4%; n\u0026thinsp;=\u0026thinsp;43) and ease of production (15.4%; n\u0026thinsp;=\u0026thinsp;38) were cited less frequently (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThematic frequency analysis of areas requiring improvement in digital occlusal splint technology (Open-ended Question 1; n\u0026thinsp;=\u0026thinsp;247).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% of respondents*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCost reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e59.5%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining and awareness for clinicians and technicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreasing widespread adoption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproving durability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSimplifying the production process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproving ease of use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrengthening technical support services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpanding training programmes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003e*Percentages exceed 100% as respondents could select multiple themes. Total respondents: n\u0026thinsp;=\u0026thinsp;247.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSteps to Reduce Costs (n\u0026thinsp;=\u0026thinsp;244)\u003c/h2\u003e \u003cp\u003eProposals for reducing digital device costs were spread across a wide range of strategies. The most frequently suggested step was provision of free or affordable training programmes (39.3%; n\u0026thinsp;=\u0026thinsp;96), followed by use of more affordable materials (35.2%; n\u0026thinsp;=\u0026thinsp;86), streamlining the production process (31.6%; n\u0026thinsp;=\u0026thinsp;77), and expanding batch production methods (29.1%; n\u0026thinsp;=\u0026thinsp;71). Government-backed incentive programmes (8.6%; n\u0026thinsp;=\u0026thinsp;21) and reduction of material import taxes (8.6%; n\u0026thinsp;=\u0026thinsp;21) were highlighted as policy-level solutions (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProposed steps for reducing digital occlusal splint costs as identified by survey respondents (Open-ended Question 2; n\u0026thinsp;=\u0026thinsp;244).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProposed Step\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% of respondents*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvision of free or affordable training for clinicians and technicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e39.3%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of more affordable materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStreamlining the production process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpansion of batch production methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReducing production costs through adoption of new technologies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment-backed incentive programmes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduction of material import taxes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreasing domestic production capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdopting more competitive pricing policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003e*Percentages exceed 100% as respondents could select multiple themes. Total respondents: n\u0026thinsp;=\u0026thinsp;244.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eBarriers to Adoption (n\u0026thinsp;=\u0026thinsp;190)\u003c/h2\u003e \u003cp\u003eA total of 190 responses regarding the primary reasons for non-adoption of digital device technology were categorised using keyword-based thematic coding. High cost was identified by a clear margin as the predominant barrier to adoption (61.1%; n\u0026thinsp;=\u0026thinsp;116), followed by insufficient infrastructure and equipment (36.3%; n\u0026thinsp;=\u0026thinsp;69) and lack of training and knowledge (29.5%; n\u0026thinsp;=\u0026thinsp;56). Adherence to traditional methods and resistance to change were cited by 13.2% (n\u0026thinsp;=\u0026thinsp;25) of respondents, while shortage of qualified technicians accounted for 7.9% (n\u0026thinsp;=\u0026thinsp;15). Notably, the rate of cost-related non-adoption was nearly identical across both professional groups (61% among dentists and 61% among dental technicians), indicating that the cost barrier affects both groups equally. Infrastructure and equipment deficiency emerged as a comparatively more pronounced barrier among dentists (38%) than technicians (34%) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBarriers to adoption of digital occlusal splint technology, stratified by professional group (Open-ended Question 3; n\u0026thinsp;=\u0026thinsp;190).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarrier Theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% Total*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDentists (n\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDental Technicians (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh cost\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e61.1%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62 (60.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54 (61.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient infrastructure / equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39 (38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of training / knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27 (30.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence to traditional methods / resistance to change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShortage of qualified technicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistrust of digital technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e*Percentages exceed 100% as respondents could identify multiple barriers. Keyword-based thematic coding applied. Total respondents: n\u0026thinsp;=\u0026thinsp;190 (102 dentists, 88 dental technicians).\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eIntegrated Interpretation with Quantitative Findings\u003c/h2\u003e \u003cp\u003eThe open-ended findings form a coherent and consistent whole with the results obtained from quantitative analyses. The statistically significant difference in cost perception between the two groups identified in the closed-ended items (χ\u0026sup2;=13.79; p\u0026thinsp;=\u0026thinsp;0.001) is corroborated by the 61% recurrence of the cost theme in open-ended responses across both groups. Similarly, the significant effect of training on competency (p\u0026thinsp;=\u0026thinsp;0.026) aligns with training and awareness emerging as the second most frequently cited theme (54.7%) in the areas-for-improvement question.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a cross-sectional comparison of dentists and dental technicians regarding digital occlusal device perceptions in Turkey. The hypothesis of the study was that dentists and dental technicians differ significantly in their cost perceptions and perceived access difficulties, and also show broad consensus regarding clinical efficacy, production speed advantages, and the future potential of digital device technology. The principal finding showed that the two groups share broad consensus on clinical outcomes while diverging significantly on cost. According to the results of the study, the hypothesis was accepted.\u003c/p\u003e \u003cp\u003eFrom a technology adoption perspective, the results of this study suggests that the primary barrier to wider digital occlusal device use in Turkey is not clinical scepticism but economic constraint. This finding supports H1. A likely explanation for the differential in the present study is that dentists view cost from the patient-billing and treatment-planning perspective, whereas technicians evaluate it against production inputs and laboratory overhead. This interpretation is supported by the qualitative data, in which cost-related concerns recurred at equal rates (61%) across both groups in open-ended responses, suggesting that although the magnitude of the barrier differs, its structural origin is shared. These results correspond to the findings of the Jordanian cross-sectional study by Hatamleh et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], in which cost was the leading adoption barrier and dentists and technicians diverged in their economic assessments of digital workflows. Results also shows similarity with the findings of Shin et al. that shows the pattern documented in Southeast Asia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It implies that efforts to improve adoption should focus on cost-reduction policies, subsidised training, and scalable production models rather than on changing clinical attitudes, which appear already favourable. Also, Hall et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] reported that high equipment cost was the dominant barrier to digital adoption among Egyptian dentists, a finding mirrored in Pakistan and Malaysia, where cost was cited by 54.5% and 47.2% of professionals respectively [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The comparatively high rate in the present Turkish sample (61.1% of non-adopters) situates Turkey alongside higher-barrier regional contexts. The open-ended responses further illuminate the structural character of this barrier: participants proposed not only market mechanisms such as more affordable materials or batch production but also state-level interventions like government incentive programmes, import tax reductions. This finding supports the recommendations of Shin et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] that tailored, country-specific educational and financial strategies are needed to promote adoption.\u003c/p\u003e \u003cp\u003eIn this study, dentists reported greater difficulty in accessing digital dental technology compared to technicians. In the open-ended data, infrastructure and equipment deficiency emerged as a barrier among 38% of dentists versus 34% of technicians, reinforcing the statistically observed pattern. This result partially supports H2. Dentists reported difficulty in accessing digital dental technology may be the result of infrastructure gaps and equipment costs that disproportionately affect clinical rather than laboratory settings and may reflect the higher capital investment required for chairside digital workflows (intraoral scanners, digital articulation systems) compared to laboratory-based CAD/CAM units, which are increasingly accessible through shared or outsourced production models.\u003c/p\u003e \u003cp\u003eThe high consensus on clinical outcomes observed in the present study. Particularly the 62% rated clinical fit as superior to conventional methods and the 76.8% observed improved patient satisfaction and these are well supported by the current experimental literature. Sun et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] demonstrated that fully digital device workflows based on individual mandibular movement recording produced clinically accurate, well-fitting devices while reducing chairside time. Herpel et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] found in a randomised pilot trial that 3D-printed and milled devices produced comparable patient satisfaction scores after three months of use. Qin et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] similarly reported that digitally fabricated devices were non-inferior to conventional ones in pain relief and craniomandibular index scores in TMD patients, while significantly reducing production time. The comprehensive review by Şimunović et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] confirmed that 3D-printed devices meet ISO mechanical standards. These convergent findings provide a strong evidence-based foundation for the favourable perceptions observed in this study population.\u003c/p\u003e \u003cp\u003eA significant association between formal digital device training and self-reported competency (p\u0026thinsp;=\u0026thinsp;0.026) was found and the result confirmed H3. This finding gains added weight in the context of the open-ended data, where 54.7% of respondents identified training and awareness programmes as the most important area for improvement, and 39.3% proposed free or subsidised training as the most effective cost-reduction measure. The result aligns with Nassani et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], who found that structured CAD/CAM exercises in predoctoral curricula significantly increased students\u0026rsquo; confidence and adoption intentions. It also resonates with the technology readiness framework employed by Schnitzler et al.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], in which innovativeness and optimism, that are both trainable dimensions, were positive predictors of digital equipment use. Acharya et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], comparing dental practitioners and technicians on 3D printing knowledge, similarly found that formal training was the strongest single predictor of self-reported practice. Zhu et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] also reported structured educational exposure as a key predictor of technology engagement and suggested that informal on-the-job exposure is widespread but insufficient to develop full competency.These findings suggest that investment in formal, structured training represents a high-leverage intervention for expanding digital occlusal device adoption in Turkey.\u003c/p\u003e \u003cp\u003eYears of clinical experience among dentists was significantly associated with self-reported digital competency supporting H4 and showed the highest competency scores in the 6\u0026ndash;20-year experience while those with over 20 years showed a relative decline. This inverted U-shaped pattern is explained by Schnitzler et al. study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], in which mid-career professionals exhibit the greatest adoption readiness, whereas very senior practitioners may be less motivated to integrate new digital workflows. The non-significant result among dental technicians (p\u0026thinsp;=\u0026thinsp;0.214) may reflect the more standardised, protocol-driven nature of laboratory-based digital tasks, which can be acquired independently of career stage through targeted technical training.\u003c/p\u003e \u003cp\u003eA key strength of this study is the simultaneous inclusion of both dentists and dental technicians which is a rare design in the existing literature. Hatamleh et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] is one of the few exceptions, having surveyed both groups, though with a substantially smaller sample (n\u0026thinsp;=\u0026thinsp;90). The present study\u0026rsquo;s design enabled the direct comparison that revealed cost perception as the key divergence point, while simultaneously confirming clinical consensus. This finding has practical implications for the clinic\u0026ndash;laboratory interface: it suggests that digital device adoption programmes must be co-designed with both stakeholder groups, addressing the distinct cost concerns of each rather than applying a single strategy.\u003c/p\u003e \u003cp\u003eNo statistically significant between-group differences in perceptions and attitudes toward digital occlusal devices among dentists and dental technicians were found and this result fully confirms H5. These results correlate with the report of Şimunović et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], which concluded that 3D-printed occlusal devices are clinically non-inferior to conventional ones and offer advantages in patient-reported comfort and production efficiency. The finding that both dentists and technicians converge on clinical outcomes, despite diverging on cost, suggests that perceived barriers to adoption are primarily economic and structural rather than clinical or technical in nature.\u003c/p\u003e \u003cp\u003eFindings from open-ended questions suggest that confidence in the clinical potential of the technology is high, but that structural improvements in accessibility and human resource capacity are still needed. Addressing the cost barrier requires not only market-driven mechanisms but also investment in training and public policy instruments. The quantitative findings reflect not only statistical significance, but also the real-world experiences of practitioners in the field.\u003c/p\u003e \u003cp\u003eSeveral limitations of this study should be acknowledged. The use of purposive sampling and online recruitment may have introduced selection bias, potentially over-representing professionals with pre-existing interest in digital technologies. 48.6% of participants were based in Istanbul, limiting the geographic representativeness of the findings for smaller cities and rural areas of Turkey, where digital infrastructure may be less developed. All measures were self-reported, and the digital competency scale used was not formally validated. The cross-sectional design precludes causal inference; specifically, it is not possible to determine whether training improves competency or whether more competent practitioners are more likely to seek training. Future longitudinal studies and randomised educational interventions are warranted to address this directionality question. Also the questionnaire did not distinguish between milled (subtractive) and 3D-printed (additive) digital device fabrication methods, which differ in cost, accuracy, and material properties [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis cross-sectional survey of 250 Turkish dental professionals demonstrated that dentists and dental technicians share strong consensus regarding the clinical efficacy, production speed, patient comfort, and future potential of digital occlusal device technology, while diverging significantly in their cost perceptions. High cost and insufficient training were identified as the predominant barriers to adoption by both groups. Formal digital device training was significantly associated with higher self-reported competency, and years of clinical experience was a significant predictor of digital competency among dentists. The dual-profession design of this study provides a more complete picture of the clinic\u0026ndash;laboratory ecosystem than single-group surveys and reveals that adoption strategies must address economic and educational barriers simultaneously. These findings support the development of subsidised training programmes, curriculum reform in dental education, and public policy measures to reduce equipment and material costs, as coordinated priorities for expanding digital device integration in dental practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTMD: Temporomandibular disorder; CAD/CAM: Computer-aided design/computer-aided manufacturing; SD: Standard deviation; IQR: Interquartile range; χ²: Chi-square statistic; H: Kruskal–Wallis H statistic; U: Mann–Whitney U statistic; κ: Cohen’s kappa; ISO: International Organization for Standardization; IRB: Institutional Review Board.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. The research protocol was approved by the Institutional Review Board of Istanbul Atlas University (E-22686390-050.99-66537). All participants provided informed digital consent before completing the questionnaire.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003ch2\u003eAuthors’ contributions\u003c/h2\u003e\n\u003cp\u003eHC conceived and designed the study. EO collected the data. EPT performed the statistical analysis. BB drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlonso-Royo R, Sanchez-Torrelo CM, Ibanez-Vera AJ, Zagalaz-Anula N, Castellote-Caballero Y, Obrero-Gaitan E, Rodriguez-Almagro D, Lomas-Vega R. Validity and reliability of the Helkimo Clinical Dysfunction Index for the diagnosis of temporomandibular disorders. Diagnostics.2021;11(3):472. https://doi.org/10.3390/diagnostics11030472\u003c/li\u003e\n\u003cli\u003ePatzelt SBM, Kr\u0026uuml;gel M, Wesemann C, Pieralli S, Nold J, Spies BC, Vach K, Kohal RF. In vitro time efficiency, fit and wear of conventionally-versus digitally-fabricated occlusal splints.Materials.2022;15(3):1085. https://doi.org/10.3390/ma15031085\u003c/li\u003e\n\u003cli\u003eOkeson JP. Management of temporomandibular disorders and occlusion.8\u003csup\u003eth\u003c/sup\u003e ed. Missouri, Elsevier, 2020.p.102-131. \u003c/li\u003e\n\u003cli\u003eBerntsen C, Kleven M, Heian M, Hjortsjo C.\u2028 Clinical comparison of conventional and additive manufactured stabilization splints. Acta Biomater Odontol Scand.2018; 4(1):81\u0026ndash;89. https://doi.org/10.1080/23337931.2018.1497491\u003c/li\u003e\n\u003cli\u003eM\u0026uuml;hlemann S, Kraus RD, H\u0026auml;mmerle CHF,Thoma DS. Is the use of digital technologies for the fabrication of implant- supported reconstructions more efficient and/or more effective than conventional techniques: A systematic review. Clin Oral Impl Res. 2018;29:184\u0026ndash;195. https://doi.org/10.1111/clr.13300\u003c/li\u003e\n\u003cli\u003eOliveria NRC, Pigozzo MN, Sesma N, Lagana DC. Clinical efficiency and patient preference of digital and conventional workflow for single implant crowns using immediate and regular digital impression: A meta-analysis. Clin Oral Impl Res.2020;31:669-686. https://doi.org/10.1111/clr.13604\u003c/li\u003e\n\u003cli\u003ePalma-Fernandes MJ, Ruiz-Marrara J, Campos-Muller MF, Melchior MO, C\u0026ocirc;rte-Real ISG, Mazzi-Chaves JF, Magri LV. Teaching Occlusal Splints in the Digital Age: Comparing Student Experiences with Conventional and CAD/CAM Workflows. J Dent Educ. 2025;0:1\u0026ndash;10. https://doi.org/10.1002/jdd.70045\u003c/li\u003e\n\u003cli\u003eHatamleh MM, Saleh SA, Radwan OI, Shamma HRA. Adoption and challenges of digital dentistry among dentists and dental technicians: A cross-sectional study J. Prosthodont. 2025;34:913\u0026ndash;917. https://doi.org/10.1111/jopr.70043\u003c/li\u003e\n\u003cli\u003eShin YJ, Mohan M, Kyaw Moe MM, Curtis J, Kim C, Sohn W, Lee DH. Perceptions of benefits, barriers, and educational strategies for digital dentistry in Southeast Asia: a multi-country cross-sectional pilot survey. Community Dent Health. 2025. https://doi.org/10.1177/0265539X251400878\u003c/li\u003e\n\u003cli\u003eHall MA, Karawia I, Mahmoud AZ, Mohamed OS. Knowledge, awareness, and perception of digital dentistry among Egyptian dentists: a cross-sectional study. BMC Oral Health. 2023;23:963. https://doi.org/10.1186/s12903-023-03698-1\u003c/li\u003e\n\u003cli\u003eWhittle T, Walsh L, Tennant M. The digital workflow in dentistry: adoption and challenges. Journal of Orofacial and Health Sciences. 2025; 6(2): 244-251. https://doi.org/10.15713/ins.johs.2025.244\u003c/li\u003e\n\u003cli\u003eSun X, Feng Y, Jiao Y, Liu W. Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement. J Dent. 2024;141:104826. https://doi.org/10.1016/j.jdent.2024.104826\u003c/li\u003e\n\u003cli\u003eHerpel C, Kykal J, Rues S, Schwindling FS, Rammelsberg P, Eberhard L. Thermo-flexible resin for the 3D printing of occlusal splints: a randomized pilot trial. J Dent. 2023;133:104514. https://doi.org/10.1016/j.jdent.2023.104514\u003c/li\u003e\n\u003cli\u003eQin H, Liu Y, Miao H, et al. Comparative efficacy of digital 3D-printed and conventional stable occlusal splints in the treatment of temporomandibular disorders. J Oral Rehabil. 2025;52:1699\u0026ndash;1706. https://doi.org/10.1111/joor.14032\u003c/li\u003e\n\u003cli\u003eŞimunović L, Čimić S, Me\u0026scaron;trović S. Three-dimensionally printed splints in dentistry: a comprehensive review. Dent J. 2025;13(7):312. https://doi.org/10.3390/dj13070312\u003c/li\u003e\n\u003cli\u003eNassani LM, Bencharit S, Schumacher F, et al. The impact of technology teaching in the dental predoctoral curriculum on students\u0026rsquo; perception of digital dentistry. Dent J (Basel). 2024;12(3):75. https://doi.org/10.3390/dj12030075\u003c/li\u003e\n\u003cli\u003eSchnitzler C, Bohnet-Joschko S. Technology readiness drives digital adoption in dentistry: Insights from a cross-sectional study. Healthcare. 2025;13(10):1155. https://doi.org/10.3390/healthcare13101155\u003c/li\u003e\n\u003cli\u003eAcharya A, Chodankar RN, Patil R, Patil AG. Assessment of knowledge, awareness, and practices toward the use of 3D printing in dentistry among dental practitioners and dental technicians: a cross-sectional study. J Oral Biol Craniofac Res. 2023;13:253\u0026ndash;258. https://doi.org/10.1016/j.jobcr.2022.12.007\u003c/li\u003e\n\u003cli\u003eZhu F, Yu H, Wang Z, Lu X, Meng X, Nie R. Knowledge, attitude, and practice regarding digital dental technologies among dentists in Jiangsu Province. Healthcare. 2025;13(3):234. https://doi.org/10.3390/healthcare13030234\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Digital occlusal device, CAD/CAM dentistry, Dental professionals, Cross-sectional survey, Turkey, Temporomandibular disorders, Prosthodontics","lastPublishedDoi":"10.21203/rs.3.rs-9558087/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9558087/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Digitally fabricated occlusal devices are increasingly recognised as a viable alternative to their conventionally produced counterparts. However, real-world acceptance and adoption barriers among dental professionals remain poorly characterised. Evidence simultaneously capturing the perspectives of both dentists and dental technicians is notably lacking. The objective of this study is to investigate perceptions, clinical experiences, and adoption barriers related to digital occlusal device technology among dental professionals in Turkey, and to compare the perspectives of dentists and dental technicians.\u003c/p\u003e\n\u003cp\u003eMethods: A cross-sectional, web-based survey was conducted between September 2025 and April 2026 among, dental professionals in Turkey. In total, 250 valid questionnaires involving 127 dentists and 123 dental technicians were obtained. The 43-item questionnaire covered demographics, digital competency, technology experiences, and three open-ended questions analysed by thematic content analysis. Between-group comparisons were performed using the chi-square test, Mann–Whitney U test, and Kruskal–Wallis H test (α = 0.05).\u003c/p\u003e\n\u003cp\u003eResults: A statistically significant difference was found between dentists and technicians in cost perception with dentists more frequently rating costs as high (60.6% and 37.4%). Dentists also reported greater difficulty accessing digital technology. Professionals who had received formal digital device training reported significantly higher digital competency scores than untrained counterparts (means 3.57 and 3.21; p = 0.026). Among dentists, years of experience was significantly associated with competency. In contrast, no significant between-group differences were observed for perceived production speed, clinical fit, patient satisfaction, durability, or future adoption expectations. Notably, 78.5% of all participants agreed that digital production is faster, 76.8% reported improved patient satisfaction, and 89.5% expected digital devices to become more widespread. Qualitative analysis identified high cost (61.1%), infrastructure deficiency (36.3%), and lack of training (29.5%) as the leading barriers to adoption.\u003c/p\u003e\n\u003cp\u003eConclusions: Turkish dental professionals demonstrate broad consensus regarding the clinical value and future potential of digital occlusal devices, while diverging significantly on cost perception and access. The primary barriers to adoption are economic and structural rather than clinical. Formal training was the strongest modifiable predictor of digital competency. Investment in affordable, curriculum-integrated education and supportive cost-reduction policies are recommended to accelerate digital device adoption.\u003c/p\u003e","manuscriptTitle":"Perceptions, experiences, and adoption barriers regarding digital occlusal devices among dental professionals in Turkey: a cross-sectional survey of dentists and dental technicians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-08 13:30:50","doi":"10.21203/rs.3.rs-9558087/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c2df5cd-85d2-4363-8ede-fa83b5f87453","owner":[],"postedDate":"May 8th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvited","content":"","date":"2026-05-07T08:26:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-06T11:12:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-05-06T09:14:07+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T13:30:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-08 13:30:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9558087","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9558087","identity":"rs-9558087","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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