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CAD/CAM - international magazine of digital dentistry

| case report digital planning 26 CAD/CAM 2 2016 Digital planning for full mouth reconstruction Author: Dr Ara Nazarian, USA With greater public awareness about cosmetic dental reconstructions, dentists are often chal- lenged with greater demands from the patient. This increased demand for aesthetic restorative treatment challenges the dentist, the laboratory technician and dental manufacturers to develop techniques and materials to satisfy the discerning patient. Utilisingdigitalplanning,modernmaterials and effective techniques, the restorative team can succeed in restoring a smile to proper form, func- tion, and health. The case presented in this article demonstrates the significance of a systematic ap- proach to planning, preparation and material se- lection in full mouth reconstruction of a patient’s dentition. Case presentation A man in his late 30s was referred to my practice by hisdentalproviderbecausehewasdissatisfiedwith theappearanceofhissmile.Thepatientcommented that he felt that his existing teeth and restorations were unattractive because of recurrent decay, wear and colour (Figs. 1 & 2). Most importantly, he men- tioned that he was suffering from tension head- aches, grinding and a limited range of function. Initial diagnostic evaluation at the first appoint- ment consisted of a series of digital images with studycasts,acentricrelationbiterecord,afacebow transfer and a full mouth set of X-rays. In the maxillary arch, the patient had several teeth that had worn composite restorations as well as abfractions with cervical decay. Tooth #5 had an existing crown on an implant. In the lower arch, several existing composite resto- rations had wear as well as decay on the facial cer- vical areas. Although there were no restorations present in the anterior mandibular teeth, there was severe wear in the incisal edges due to possible grinding, parafunction and end-to-end bite. Planning After reviewing the clinical findings as well as the mounted models, the patient was diagnosed with a restricted envelope of function and decreased ver- tical dimension from continuous wear. To develop a treatmentplananddetermineiftheverticaldimen- sion could be increased, a diagnostic 3-D White Wax-Up (Arrowhead Dental Lab) was fabricated (Fig. 3). With this service, the dental provider also receives a Preparation Guide as well as a Tempo- risation Fabrication Template (Fig. 4). The vertical dimensionwasincreasedby1.5mm.Basedoninfor- mation gathered from the initial consult and digital images, it was determined that the maxillary cen- trals could be lengthened by 1.3 mm to improve the aesthetics. The canines would also be lengthened to restore canine guidance in lateral excursions. In regards to his lower anterior teeth, the goal was to correct the length to width ratio and create a less worn appearance. As a result of the information gathered from the diagnostic wax-up, it was determined that aesthetics and function could be enhanced by restor- ing the entire dentition. Since tooth#31wasalreadymissing and tooth #2 already had a root canal, core and crown restoration, it was decided to Fig. 1: Preoperative retracted view biting. Fig. 2: Preoperative retracted view open. Fig. 2Fig. 1 22016

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