Abstract Statement of problem Limited evidence is available for the marginal and internal fit of fixed dental restorations fabricated with digital impressions compared with those fabricated with conventional impressions. Purpose The purpose of this systematic review was to compare marginal and internal fit of fixed dental restorations fabricated with digital techniques to those fabricated using conventional impression techniques and to determine the effect of different variables on the accuracy of fit. Material and methods Medline, Cochrane, and EMBASE databases were electronically searched and enriched by hand searches. Studies evaluating the fit of fixed dental restorations fabricated with digital and conventional impression techniques were identified. Pooled data were statistically analyzed, and factors affecting the accuracy of fit were identified, and their impact on accuracy of fit outcomes were assessed. Results Dental restorations fabricated with digital impression techniques exhibited similar marginal misfit to those fabricated with conventional impression techniques (P>.05). Both marginal and internal gaps were greater for stone die casts, whereas digital dies produced restorations with the smallest gaps ( P <.05). When a digital impression was used to generate stereolithographic (SLA)/polyurethane dies, misfit values were intermediate. The fabrication technique, the type of restoration, and the impression material had no effect on misfit values ( P >.05), whereas die and restoration materials were statistically associated ( P <.05). Conclusions Although conclusions were based mainly on in vitro studies, the digital impression technique provided better marginal and internal fit of fixed restorations than conventional techniques did.