Digital-assisted multidisciplinary treatment for complex occlusal rehabilitation: an 18-month follow-up case report.

BACKGROUND: This case report highlights the importance of standardized and fully digital sequential treatment in complex occlusal rehabilitation cases. To fully resolve the patient's dental needs, such cases often require multidisciplinary interventions including periodontal therapy, endodontic treatment, anterior esthetics, implant restoration, and prosthetic rehabilitation. A fully digital workflow (including facial scanners, intraoral scanners, jaw motion tracking systems, virtual articulators, and computer-aided design software) streamlined the complex treatment, enhancing workflow simplicity, efficiency, visibility, and precision. CASE PRESENTATION: The patient presented with decreased chewing efficiency of the upper and lower prostheses, along with unsatisfactory esthetic appearance of the anterior teeth. After physical examination and radiological assessment, this complex occlusal rehabilitation case required periodontal therapy, anterior esthetic enhancement, implant restoration, and fixed prosthetic rehabilitation. Therefore, a fully digital workflow was adopted. Full-crown prostheses were placed on teeth 13, 23, and 34; a fixed bridge encompassed positions 32 to 42, and single implant crowns were placed on teeth 35 and 36. Implant-supported fixed bridges were constructed for teeth 12 to 22 and 44 to 46, anchored by implants at teeth 12, 22, 44, and 46. All definitive prostheses were fabricated from zirconia ceramics, chosen for their durability and esthetic characteristics. Finally, restorations with satisfactory esthetic and functional characteristics were seated, preserving the tooth and its supporting structures. During treatment and follow-up, the T-scan occlusal analysis system was utilized to continuously monitor and guide the adjustment of occlusal distribution across the patient's dental arches. After 18 months, the patient remains satisfied with the definitive restorations. CONCLUSIONS: This report is intended to help dentists understand and implement standardized and fully digital workflows during the management of complex occlusal rehabilitation cases; it may also facilitate harmonious integration of esthetic and functional characteristics.

Application of digital technology in the repair of functional and aesthetic defects in patients with acid erosion and severe attrition: a case report.

Noncarious lesions, a multifactorial condition encompassing tooth attrition, abrasion, and erosion, have a surge in prevalence and required increased attention in clinical practice. These nonbacterial-associated tooth defects can compromise aesthetics, phonetics, and masticatory functions. When providing full-arch fixed occlusal rehabilitation for such cases, the treatment strategy should extend beyond by restoring dentition morphology and aesthetics. This report details a complex case of erosive dental wear addressed through a fully digital, full-arch fixed occlusal rehabilitation. A 4D virtual patient was created using multiple digital data sources, including intraoral scanning, 3D facial scanning, digital facebow registration, and mandibular movement tracing. With a comprehensive understanding of the masticatory system, various types of microinvasive prostheses were customized for each tooth, including labial veneers, buccal-occlusal veneers, occlusal veneers, overlays, inlays, and full crowns, were customized for each tooth. The reported digital workflow offered a predictable diagnostic and treatment strategy, which was facilitated by virtual visualization and comprehensive quality control throughout the process.

Complete rehabilitation of a patient with occlusal wear: a case report.

Prosthodontic management of occlusal wear problems is a demanding task on the part of the prosthodontist. Various factors such as vertical dimension of occlusion, centric relation, occlusal contact pattern, esthetics and phonetics need to be considered simultaneously for both anterior and posterior teeth during occlusal rehabilitation. This may be further complicated by existing restorations, pulpal exposure, missing teeth and tooth sensitivity. Different philosophies have been documented for rehabilitation of such cases and the choice of the treatment plan depends on the skill and experience of the clinician. This case report gives an overview of the different philosophies used for rehabilitation of such cases and a report which utilises Hobo's twin stage technique for the same.

Restoration of the dentition in a patient with a history of bruxism and amelogenesis imperfecta: A clinical report.

The report describes a 27-year-old female patient with amelogenesis imperfecta (AI) accompanied by nocturnal bruxism, who was treated with a combination of occlusal splint and full-mouth fixed prosthetic rehabilitation through follow-ups within 2 years. Soft splint protection, regular follow-up, and monitoring of carries are guaranteed to maintain a long-term curative effect.

[Application of digital technique aided occlusal rehabilitation in implant-supported fixed prosthesis of fully edentulous patients].

Objective: To evaluate the clinical outcomes of digital technique-aided occlusal rehabilitation based on implant-supported fixed prostheses (ISFP), and to provide some information for clinical application of digital technique. Methods: Retrospectively reviewed the cases which had used neuromuscular system and condylar movement tracing device to reconstruct occlusion in one or double jaw fully edentulous ISFP from January, 2013 to January, 2020. A total of 6 eligible patients were enrolled in the present study with 56 implants and 8 ISFP, including 4 male patients and 2 female patients, aged from 43 to 74 years. The clinical outcomes were evaluated in four aspects, including implant survival rate, implants success rate, marginal bone loss and the occurrence of prosthesis complications. Results: The follow-up time was (4.0±2.2) years (1-7 years). The implant survival rate was 100% (56/56) and the implant success rate was 98% (55/56), with an average missal and distal marginal bone loss of (0.04±0.11) mm/year. Veneer chipping occurred at incisal edge of 2 adjacent incisors in only one prosthesis 3 years after rehabilitation. Conclusions: Combination of digital techniques of neuromuscular system and condylar movement tracing device to assist occlusal rehabilitation based on ISFP showed a high implant success rate. The complication seldom happened. Long and stable occlusion has been observed. The clinical outcomes were favorable.

Occlusal Rehabilitation in a Patient with Oligodontia and Microdontia using Implants and Full-Ceramic Restorations: A Clinical Report.

Oligodontia is the agenesis of six or more permanent teeth, excluding the third molars. Multidisciplinary dental treatments should be performed sequentially due to the restoration requirements for good oral function, aesthetics and self-confidence of patients. In this study, we report a case using dental implants and full-ceramic prostheses to restore the absent and malformed teeth in a patient with agenesis of 18 permanent teeth and with some primary teeth retained. The dental sequential treatments began when she was 16 years old, and she wore removable partial dentures for 4 years with unsatisfying restoration outcome. When she became an adult, dental implants and full-ceramic prostheses were used to restore the absent and malformed teeth. Finally, the patient was very satisfied with the functional and aesthetic outcomes of the prosthetic treatment.

A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients

ABSTRACT Introduction: The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper's plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. Objective: This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. Methods: Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. Results: Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. Conclusion: Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.

RESUMO Introdução: A opção mais indicada para tratamento da apneia obstrutiva do sono (AOS) é o CPAP; contudo, a aderência é limitada. A Terapia com Aparelho Oral (TAO) é, frequentemente, uma opção, ou mesmo um adjuvante. A prescrição mais utilizada é o Aparelho Oral de avanço mandibular (AOm). O AOm modifica a via aérea superior, melhorando a patência do espaço aéreo. A construção do AOm se baseia no plano de oclusão para desoclusão. No presente estudo, usamos o DIORS®, um AOm diferente, baseado nos conceitos da Reabilitação Neuro-Oclusal (RNO), que utiliza o Plano de Camper como referência da desoclusão para alcançar o equilíbrio neuromuscular e estabilidade funcional. Objetivo: O presente estudo teve como objetivo principal abordar a eficácia do DIORS®, considerando-se os resultados clínicos e polissonográficos. Adicionalmente, foi avaliado, também, se o uso desse AOm é tão eficaz quanto a titulação do CPAP para tratar pacientes com AOS não aderentes ao CPAP. Métodos: Vinte pacientes foram incluídos neste estudo. Dados clínicos objetivos e subjetivos foram avaliados em um laboratório de sono usando polissonografia de noite inteira e a Escala de Sonolência de Epworth (ESE) observando-se três momentos: inicial, titulação do CPAP e usando o DIORS®. Os critérios de sucesso da TAO foram assumidos pela análise dos parâmetros respiratórios como Índice de Apneia e Hipopneia (IAH) e níveis de saturação de oxi-hemoglobina, o índice de despertar e a sonolência diurna. Resultados: Em ambas as terapias, os parâmetros respiratórios e de despertares melhoraram. Adicionalmente, uma melhora na ESE foi alcançada com o DIORS®. Conclusão: Os resultados do presente trabalho apoiam que o DIORS® é uma terapia adjuvante viável e bastante eficaz para pacientes com AOS moderada a grave não aderentes ao CPAP.

Complete oral rehabilitation in a case with severe dental fluorosis.

The authors have presented a technique of full occlusal rehabilitation in a case of severe dental fluorosis. In this technique, maxillary and mandibular anterior teeth were simultaneously prepared and restored first. This was followed by simultaneous preparation of maxillary and mandibular posterior teeth that were restored in canine guided occlusion. The technique and sequence followed here is unique and is not available in dental literature. This technique reduces number of appointments while fulfilling all objectives. Periodontal follow-up over 3 years was satisfactory. A restorative treatment protocol has been devised for fluorosis which will act as a guide for the dental practitioners.

Restoring the Lost Functional Harmony in a Mutilated Dentition using Hobo's Twin Stage Concept of Full Mouth Rehabilitation.

Reorganization of an occlusion in a mutilated dentition is the most challenging task which is ever faced by prosthodontists. An occlusal rehabilitation, though it is common, is the most complex treatment procedure which is widely practised in treating severely worn out dentitions, developmental anomalies, acquired defects, ill fitting, long span fixed partial dentures and TMJ disorders. Various factors such as vertical dimension of occlusion, centric relation, occlusal contact pattern, aesthetics and phonetics need to be considered simultaneously for both anterior and posterior teeth during occlusal rehabilitations. Different schools of thoughts have been documented for rehabilitation of such cases and the choice of the treatment plan depends on the skill and experience of the clinician. This clinical report describes the full mouth rehabilitation of a severely worn out dentition, in functional harmony with the stomatognathic system. Hobo's Twin-stage procedure was adopted to produce a definite amount of disocclusion during eccentric movements.

Complete occlusal rehabilitation of patient with radiation caries - a case report.

One of the most distressing and dramatic causes of xerostomia is radiotherapy for the cure of maxillofacial and neck carcinomas. Patient with radiotherapy induced xerostomia presents with challenges in prosthodontic management and in unique radiation caries control. This clinical report illustrates step by step execution of complex treatment planning that lead to successful outcome in 34-year-old man, who had been treated with Radical Neck Dissection (RND) and therapeutic radiotherapy for squamous cell carcinoma of tongue and due to radiation caries, was presented with chief complaint of difficulty in mastication. Rehabilitation was carried out with metal-ceramic fixed restorations and cast removable prostheses after extensive endodontic intervention. This article also discusses the maintenance strategies for radiation caries patient requiring complete occlusal reconstruction, who certainly presents with special needs in post-treatment management.

Efectividad del Equiplán en el tratamiento de la mordida profunda / Effectiveness of the Equiplan in the deep bite treatment

Introducción: la mordida profunda es una maloclusión que se caracteriza por el excesivo sobrepase de los incisivos superiores respecto a los inferiores, siendo causa directa de alteraciones funcionales en otras partes del sistema estomatognático. Varias son las opciones terapéuticas para su corrección, entre ellas, el uso del Equiplán, que ha sido empleado a lo largo de cinco décadas en la recuperación del equilibrio oclusal perdido por esta entidad. Objetivo: valorar la efectividad del Equiplán en el tratamiento de la mordida profunda. Material y Método: se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos: MEDLINE, PubMed y Scielo, con la utilización de descriptores como Equiplán, mordida profunda, rehabilitación neuroclusal. Resultados: el Equiplán mejora la sobremordida por extrusión de los dientes posteriores sin modificar notablemente la posición vertical de los incisivos, y reduce el tiempo de tratamiento en los pacientes según su biotipo facial. Conclusiones: considerando los fundamentos de la Rehabilitación Neuroclusal sobre los que se sustenta su uso, y la experiencia favorable de otros autores, se concluye que el Equiplán es efectivo en el tratamiento de la mordida profunda, al provocar cambios sustanciales del sobrepase en un período de 4 meses.

Introduction: the deep bite is a malocclusion characterized by the excessive overbite of the upper incisors related to the lowers, being the main cause of functional disorders. There are several options to treat it and the use of Equiplan is one of them. For five decades, this appliance has been proved to be effective recovering the occlusal balance. Objective: to reflect the effectiveness of the Equiplan in the deep bite treatment. Materials and Methods: reference systems such as MEDLINE, PUBMED, SCIELO were consulted. It was also made a revision of descriptors like Equiplan, deep bite, treatment, neuro-occlusal rehabilitation. Results: equiplan improves the overbite due to the extrussion of posterior teeth without remarkable changing in the vertical position of incisors, which reduces the treatment period, according to the biofacial type of the patient. Conclusions: considering the fundamentals of neuro - occlusal rehabilitation, a substantial change in the remission of the deep bite has been found in a four month period with the use of Equiplan.

Oral rehabilitation of a case of amelogenesis imperfecta with multiple periapical cysts.

Amelogenesis Imperfecta is a hereditary anomaly that affects the enamel of human teeth and is not associated with any systemic disorder of affected patients. The affected teeth are disturbed in coloration, thickness and resistance. The rehabilitation of amelogenesis imperfecta in a child must take into account the development of the child's teeth, the health of the periodontal tissues and the maxillary and mandibular growth. This article reports the endodontic and occlusal rehabilitation of a 14-year-old girl affected with autosomal recessive hypocalcified type of amelogenesis imperfecta with multiple periapical cysts.