Immediate-load provisionals: milled PMMA or 3D-printed?

How does a milled provisional differ from a printed one?

A milled provisional is cut from a PMMA disc that was polymerized at the factory; a printed one is built layer by layer from a light-cured resin and finishes polymerizing in post-cure. Both can come from the same CAD design and seat on the same multi-unit abutments. What changes is the material and the process.

With a printed part, the result depends on the resin, its orientation on the build plate, layer thickness and post-cure. So “printed resin” is not one material: each resin has its own indications for use, and studies test one or two at a time.

On the bench, the gap shows up in flexural strength. The meta-analysis by Valenti and colleagues (The Journal of Prosthetic Dentistry, 2024) pooled 76 in vitro studies of prosthetic materials. Milled parts had higher flexural strength than printed ones, including after aging. Hardness, roughness, marginal discrepancy, fracture load and internal fit did not differ between the two processes.

What did the head-to-head clinical trial show?

In the randomized crossover trial by Vasquez-Ramos and colleagues (Journal of Prosthodontics, 2026), milled PMMA full-arch provisionals had mechanical complications in 10% of cases and printed resin ones in 45%. Each of the 20 edentulous patients wore both, for three months each, in random order; the printed material was a ceramic-filled hybrid resin.

Most complications with the printed resin were minor and fixed chairside with composite. Two were major, the kind that means removing and replacing the prosthesis, and were recorded at the three-month visit; milled PMMA had only minor ones. Passive fit, checked with the Sheffield test, and color stability did not differ, and both provisionals improved patient-reported quality of life.

The trial has limits that matter if you do immediate loading. The implants were already osseointegrated, follow-up was three months and only one printed resin was tested. The printed prostheses were polished chairside with a simplified protocol, while the milled ones got the lab’s polish.

Can a printed provisional handle immediate loading?

Printed provisionals have been used for full-arch immediate loading, but the data come from small studies with no comparison group. Pozzi and colleagues (Journal of Esthetic and Restorative Dentistry, 2026) delivered 24 monolithic printed screw-retained provisionals on the day of surgery in 19 patients. All had a passive fit, and there were no mechanical complications at six months.

For milled PMMA, Garza and colleagues (Materials, 2025) followed 72 immediate-load provisionals for three months, and none was lost. The prostheses were designed without cantilevers and with centric-only contacts, and patients kept to a soft diet early on.

None of these studies compared the two materials in the week after surgery. Ioannidis and colleagues (Clinical Oral Implants Research, 2023) looked for clinical studies comparing printed and milled implant-supported prostheses in partially edentulous patients and found none; the 2026 trial came after that review.

Do all printed resins behave the same?

No. Printed resin is a family of materials, and a study’s result holds for the resin and process it tested. Bender and colleagues (Journal of Prosthodontics, 2025) made 180 specimens, picked up on two multi-unit abutments, in three materials: a printed resin, milled PMMA and injection-molded PMMA. Combined with the technique known as smart denture conversion, the printed resin had the highest mean fracture strength in the study.

The 2026 clinical trial points the other way, with a different resin and in the mouth. Both can be true: resin choice, orientation and post-cure change the outcome, and there isn’t enough clinical data yet to say which printed resin will last a full provisional phase.

How long does a full-arch provisional last?

Studies have followed full-arch provisionals for three months to a year, and none has followed a printed one past six months. The longest data are for milled PMMA: Makarov, Pompa and Papi (International Journal of Implant Dentistry, 2021) milled provisionals before guided surgery, and all 10 patients went a year in function without a fracture.

If your plan includes a long provisional phase, such as testing tooth position, vertical dimension and phonetics before zirconia, milled PMMA has the most data behind it. With a printed resin, check the manufacturer’s indications for use before you plan that phase. Full-arch zirconia, titanium bar or PMMA shows where PMMA fits on the way to the final.

What should you ask the lab for?

On the Rx for a full-arch provisional, state the material, how long it needs to stay in and what it is meant to test. Also include:

• the surgery date, agreed in advance, for an immediate load;
• implant brand and platform, plus the brand, cuff height and angle of each multi-unit abutment;
• whether the provisional will be the reference for the final, and what you want to test with it;
• the design you want during osseointegration, such as a short or no cantilever and centric-only contacts.

At Smile Digital Lab, our PMMA full-arch bridge is milled from a disc. For immediate loading, the route for your case (a milled provisional, converting the patient’s current denture, or a prosthesis made before surgery) is agreed when the case is opened, along with the date. Immediate loading: what the lab needs lists what to send at each stage. Our immediate-load prosthesis and PMMA full-arch bridge pages show how each is made.