CAD/CAM: Applications for transitional bonding to restore occlusal vertical dimension

Fully digital workflow of occlusal reconstruction treatment in a patient with congenital dentition defects

OBJECTIVE

Occlusal reconstruction is a critical intervention for patients with dental hard tissue defects, temporomandibular joint (TMJ) disorders, and jaw position abnormalities. Clinical efficiency and outcomes of these procedures have improved with advances in digital technologies. This case report aims to illustrate a comprehensive digital workflow for occlusal reconstruction in a patient with congenital dentition defects, emphasizing the application of digital technologies to enhance treatment outcomes.

CLINICAL CONSIDERATIONS

A 28-year-old woman with previously installed porcelain-fused-to-metal bridge restorations presented with a fractured prosthesis and TMJ symptoms. A multidisciplinary approach was adopted involving the use of digital facebow, intraoral scanners, digital smile design, and CAD/CAM technologies. The process included the extraction of defective restorations, temporary restorations to refine jaw position, and final permanent restorations. The digital workflow facilitated precise diagnostics and treatment, culminating in the successful installation of permanent restorations. Regular follow-ups at one- and three-months post-treatment confirmed stable occlusal function and high patient satisfaction.

CONCLUSIONS

This case report showcases the potential of multiple digital technologies to streamline complex dental treatments and achieve high-quality results.

CLINICAL SIGNIFICANCE

The integration of digital technologies in occlusal reconstruction treatments offers significant benefits in terms of precision, patient comfort, and esthetic outcomes.

Accuracy of the intaglio surface of 3D-printed hybrid resin-ceramic crowns, veneers and table-tops: An in vitro study

OBJECTIVES

The present study aims to examine the influence of the build angle on the accuracy (trueness and precision) of 3D printed crowns, table-tops and veneers with a hybrid resin-ceramic material.

METHODS

One crown, on table-top and one veneer were printed in five different build angles (0°, 30°, 45°, 60°, 90°) (n = 50) with the digital light processing (DLP) system (Varseo XS, Bego) using hybrid resin (Varseo Smile Crownplus A3, Bego). All printed restorations were scanned using the laboratory scanner (D2000, 3Shape) and matched onto the initial reference design in metrology software (Geomagic Control X, 3D Systems). The root mean square error (RMSE) was calculated between the scanned and reference data. The data was statistically analyzed using the Tukey multiple comparison test and Wilcoxon multiple comparison test.

RESULTS

The crown group showed higher trueness at 30° (0.021 ± 0.002) and 45° (0.020 ± 0.002), and table-tops at 0° (0.015 ± 0.001) and 30° (0.014 ± 0.001) (p < 0.0001). Veneers demonstrated higher trueness at 30° (0.016 ± 0.002) (p < 0.0001). All three restoration types demonstrated the lowest trueness at a 90° build angle and portrayed deviations along the z axis. The veneer and table-top groups showed the lowest precision at 90° (veneers: 0.021 ± 0.008; table-tops: 0.013 ± 0.003). The crown group portrayed the lowest precision at 45° (0.017 ± 0.005) (p < 0.0001).

CONCLUSION

The build angle of DLP-printed hybrid resin-ceramic restorations influences their accuracy.

CLINICAL SIGNIFICANCE

Considering the build angle is important to achieve a better accuracy of 3D-printed resin-ceramic hybrid restorations. This may help predict or avoid the interference points between a restoration and a die and minimize the clinical adjustments.

Managing the transition to a complex full mouth rehabilitation utilizing injectable composite

OBJECTIVE

This article describes the use of flowable injectable composite resins to facilitate transitional treatment of a complex complete mouth rehabilitation.

CLINICAL CONSIDERATIONS

Some patients require urgent and complex complete mouth rehabilitations that are time and cost intensive. Financial considerations can prevent some patients from pursuing treatment. This can result in the oral conditions worsening over time and compromising the long-term prognosis of the teeth.

CONCLUSIONS

Injectable composite resins can be used as a transitional bonding material for complex cases using an injection molding technique utilizing clear indices obtained from a diagnostic waxing. This allows for a full mouth rehabilitation to be performed in a single appointment, producing instant results.

CLINICAL SIGNIFICANCE

Transitioning with injectable composite as demonstrated in this case will immediately stabilize an otherwise deteriorating situation in a cost-effective way and allows patients to address the realities of financial or time constraints when transitioning to more durable porcelain restorations over a period of years.

Reclaiming the Smile: Full Mouth Rehabilitation of a Generalized Attrition Patient Using the Hobo Twin-Stage Technique

This clinical report details the successful rehabilitation of a 63-year-old male patient with severe tooth wear, a reduced vertical dimension of occlusion, and esthetic concerns. The Hobo twin-stage procedure addressed these issues while improving the patient's oral health and quality of life. After ensuring adequate oral hygiene, the treatment began with scaling and root planning, followed by diagnostic impressions. An occlusal splint was fabricated, followed by a diagnostic wax-up and tooth preparation. Full-arch impressions of prepared teeth were made using the addition of silicon elastomeric impression material, and chairside provisional crowns were fabricated. The working casts were mounted on a semi-adjustable articulator, and the metal copings were tried on before being built up in porcelain. The patient achieved successful outcomes and expressed satisfaction with the treatment. The Hobo twin-stage technique and porcelain-fused-to-metal crowns can be viable approaches for restoring the teeth's form and function while enhancing the patient's oral health and esthetics. However, regular follow-up appointments and good oral hygiene maintenance are essential for the long-term success of the treatment.

CAD/CAM: Applications for transitional bonding to restore occlusal vertical dimension

OBJECTIVE

Explore the best technique for achieving stable and comfortable occlusion. This is critical for long-term oral health and the foundation of durable esthetic, restorative, periodontal, and prosthodontic treatments.

CLINICAL CONSIDERATIONS

Various techniques and therapies have been proposed for establishing, determining, and restoring ideal centric relation (CR) and vertical dimension of occlusion (VDO) in patients who require restorations and/or full-mouth rehabilitation. An interim prosthesis phase can help establish and stabilize an enhanced esthetics and/or functional outcome for a limited period of time before the definitive dental restorations are placed. Transitional direct composite bonding and its additive nature have provided clinicians and patients with advantages when establishing a physiologic CR and VDO in interim restorations. However, it is time consuming, tedious, and challenging chairside. The author has been using additive CAD/CAM designed and milled restorations for over 10 years to make transitional bonding more efficient, manageable, and predictable.

CONCLUSION

Transitional bonded prostheses are significantly important to providing patients with an interim therapy to determine if the proposed esthetic outcome and occlusal scheme will function as expected, or if adjustments are needed prior to the delivery of the definitive long-term restorations. CR and VDO are essential for establishing a functional and healthy occlusion, ideal restoration proportions and smile design, and treatment planning esthetic and prosthodontic restorations for long-term durability.

CLINICAL SIGNIFICANCE

This article reviews CR, VDO, and the characteristics of a CAD/CAM transitional bonding technique in reversing the signs and symptoms of a compromised dentition and reestablishing an ideal esthetic and functional occlusal outcome. Transitional bonded prostheses are significantly important to providing patients with an interim therapy to determine if the proposed esthetic outcome and occlusal scheme will function as expected, or if adjustments are needed prior to the delivery of the definitive long term restorations.