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ePaper created 2018-05-16, 11:45:19 | version 1.38.0
Fig. 10 Fig. 11a Fig. 11b Fig. 15a Fig. 12 Fig. 13 Fig. 14 Fig. 15b Fig. 10 Upon cementation of the onlay restorations. The increase in the VDO was designed according to the functional and esthetic needs while maintaining the musculoskeletally stable position. Fig. 11 Final preparations of the anterior teeth for veneers on teeth #11, 12 and 13 and crowns on #21, 22 and 23. Minimally invasive preparations were per- formed and scanned intraorally for CAD/CAM fabrication of provisional and final restorations. Fig. 12 PMMA (Telio CAD, Ivoclar Vivadent) provisional restorations fabricated by CAD/CAM milling fabrica- tion method. The fit of the provisionals was excellent and no adjustments were needed intraorally. Fig. 13 Final IPS e.max lithium disilicate restoration cemented. The VDO was increased according to functional esthetic and prosthetic needs. At the same time, the new muscu- loskeletally stable position established initially was maintained and the patient no longer functioned in the pseudo Class III relationship he initially presented with. Fig. 14 Palatal view of the cemented final restorations Figs. 15a & b Lateral views of the cemented final restorations. The emergence profile is another important factor that needs to be taken into consideration for esthetic longevity and the health of the periodontal tissue. Conclusion Defining the treatment position prior to any extensive dental therapy, such as full- arch prosthetic rehabilitation or ortho- dontics, is essential. A healthy, stable maximum intercuspation is not always present. Skeletal abnormalities, dental malocclusions, missing posterior teeth and severe wear of the dentition are some of the etiological factors for patients pre- senting with an unfavorable bite. If the clinician does not recognize the former and diagnose this clinical situation, he or she might choose to maintain the occlu- sal relationship that the patient presents with. After all, it is what the patient is used to, and in many cases, it is also functional. According to the adaptive capabilities of the stomatognathic system, acquired malocclusion might result after comple- tion of the treatment. This is a very unfortunate situation for the patient and the treating dentist. The patient might complain of temporomandibular pain and dysfunction due to the orthopedic insta- bility. Owing to pain symptoms, it is im- possible for the clinician to redefine the occlusion, and at this point, no dental treatment can correct the malocclusion. Therefore, before any dental treatment, a stable, reproducible treatment position needs to be defined, registered and main- tained. This is called the musculoskeletal- ly stable position, and it ensures the 3-D stabilization of the mandible against the maxilla. allow the practitioner to guide the jaw during registration. The difference in the position of the mandible against the maxilla between the initial maximum inter cuspation that the patient present- ed with and the new treatment position of the musculoskeletally stable position demonstrated the importance of defin- ing and restoring the case in this new position (Fig. 8). This would ensure the stability of the occlusion, and effortless function, during treatment, but also most importantly after cementation. Is digital dentistry an option? Digitalization of dentistry is advancing rapidly. The advantages are significant, such as the standardization of working steps, increase in material quality through CAD/CAM and reproducible restorations. As a result, the final restorations are eas- ily, more quickly and predictably pro- duced, providing at the same time an excellent fit. The potential is enormous in a case like the one presented here, where the increase in VDO, along with the brux- ing parafunctional forces applied, re- quired the maximum making use of and benefiting of restorative materials. IPS e.max CAD lithium disilicate blocks were the material of choice. Intraoral scanning was performed with TRIOS 3 (3Shape), and the restorations were manufactured through CAD/CAM (Fig. 9). IPS e.max monolithic onlay restorations were cemented on the posterior teeth to in- crease the VDO (Fig. 10). In the anterior area, teeth #11, 12 and 13 were restored with veneers and teeth #21, 22 and 23 with ceramic crowns owing to pre-existing resin restorations that decreased the amount of ena mel available for final cementation (Figs. 11–15b). 80 — issue 2018 Clinical Mentoring Article