Registering Maxillomandibular Relation to Create a Virtual Patient Integrated with a Virtual Articulator for Complex Implant Rehabilitation: A Clinical Report

A digital workflow for full-mouth rehabilitation using CAD-CAM tooth reduction template

A digital workflow is presented for multiple transfers of targeted jaw relation and restorative spaces from interim to definitive restorations in patients with severe tooth wear. Following analysis of the targeted restorative space, segmented arch stereolithographic templates were digitally created and fabricated for precise control of reduction depth. Then, the jaw relation was transferred from the initially determined stabilization splint to the temporary fixed restoration and definitive restoration by using a digital articulator. This digital approach yielded a stabilized jaw relationship and restorative spaces transferring effect throughout successive stages of occlusal reconstruction resulting in satisfactory prosthetic outcomes.

A digital technique to adjust the disc-condyle relationship based on CBCT-MRI fused 3D images

A digital workflow that can adjust the disc-condyle relationship rapidly and precisely is described. Cone beam computed tomography (CBCT), magnetic resonance imaging (MRI), and an intraoral scan at maximal intercuspal position are superimposed depending on the anatomic structure, and the disc-condyle relationship is adjusted on the fused display of the articular disc and condyle in the CBCT-MRI 3-dimensional spatial environment. An occlusal device is then directly designed and fabricated on the achieved maxillomandibular position, and the occlusal device is finely adjusted intraorally to improve function as needed. This technique can also be seamlessly integrated into the virtual environment to allow clinicians and dental laboratory technicians to design prostheses or treatment planning devices in a fully digital workflow.

Digital cross-mounting of intraoral scan casts from a virtual articulator to a mechanical articulator by using a custom transfer plate: A dental technique

With the development of digital dental technologies, a complete digital workflow without using physical casts has become possible. However, for certain clinical and dental laboratory procedures, especially in complex rehabilitation treatments, physically mounted casts in an ideal location in a mechanical articulator are still necessary for treatment planning and restoration fabrication. This technique report describes a digital approach to fabricating a custom transfer plate to cross mount intraoral scan casts from a virtual articulator to the corresponding mechanical articulator. This technique eliminates the need for conventional physical facebow transfer processes and offers a straightforward approach to integrating virtual procedures with analog workflows.

Investigation of the accuracy of dynamic condylar position: A model study

OBJECTIVES

To evaluate dynamic condylar positions by integrating mandibular movement recording data and cone-beam computed tomography (CBCT) and to investigate its accuracy via dynamic model experiments.

METHODS

A polyvinyl chloride skull model was utilized. A robot arm was used to operate the mandible to perform mouth opening, closing, protrusion, and lateral movements. A recording device, worn on the skull, was used to record the dynamic process and an optical position tracking (OPT) system was used to simultaneously trace the movements. A self-developed software module was used to evaluate the dynamic condylar position by integrating the dynamic tracing data and a virtual skull model derived from CBCT images. Errors were defined as differences between the dynamic coordinates of six landmarks around the condylar area derived from the software module (test) and OPT system (gold standard).

RESULTS

The condylar position errors were 0.76 ± 0.31, 0.55 ± 0.15, and 0.68 ± 0.23 mm for mouth opening, bilateral, and protrusion movements, respectively. Furthermore, the errors for small, moderate, and large mouth opening movements were 0.62 ± 0.19, 0.69 ± 0.29, and 0.94 ± 0.31 mm, respectively. The errors for all movements, except for large mouth opening, were significantly less than 1 mm (P < 0.05). The error was not different from 1 mm in the large mouth opening movement (P > 0.05).

CONCLUSIONS

Our developed method of achieving dynamic condylar position by integrating mandibular movement recording data and CBCT images is clinically reliable.

CLINICAL SIGNIFICANCE

This study proved the reliability of evaluating dynamic condylar position using a commercial dynamic recording instrument and CBCT images.

Maxillomandibular relationship and virtual facebow integration in complete-arch intraoral implant scan: A novel clinical technique

This clinical report introduces a novel clinical technique to create a 3D virtual patient for transferring the edentulous maxillary arch position with maxillomandibular relationship by using a facial scan device and an intraoral scanner and omitting CBCT imaging.

Recommendations for successful virtual patient-assisted esthetic implant rehabilitation: A guide for optimal function and clinical efficiency

OBJECTIVE

Complete arch implant rehabilitation necessitates meticulous treatment planning and high-level collaboration between surgical and prosthetic dental teams. Emerging virtual technologies hold considerable promise in streamlining this process. The aim of this article is to extend recommendations to clinicians venturing into the virtual patient-assisted esthetic implant rehabilitation workflow.

OVERVIEW

This article summarizes recommendations for virtual patient-assisted esthetic implant rehabilitation in the following five aspects: three-dimensional data handling and superimposition, occlusion and virtual articulator integration in creating virtual patients, streamlined face- and prosthetic-driven surgical planning, reuse of presurgical data ("Copy & Paste"), and final impression for passive fitting of final restoration. To illustrate these principles, a case with complete-mouth implant rehabilitation completed within six visits using this virtual patient workflow is presented.

CONCLUSION

The virtual patient workflow serves as an invaluable tool to perform treatment planning, enhance efficiency, and ensure predictable outcomes in esthetic complete arch implant rehabilitation.

CLINICAL SIGNIFICANCE

Virtual workflows are increasingly prevalent in esthetic implant rehabilitation. Nevertheless, these workflows necessitate a distinct set of knowledge and tools divergent from conventional dentistry practices. This article offers guidelines and recommendations for dental clinicians who are new to this field.

Virtual facebow techniques: A scoping review

STATEMENT OF PROBLEM

Although advances in technology continue to improve the acquisition of patient data and the manufacturing of different oral rehabilitations, the method of transferring clinical information to a virtual environment has not yet been consolidated in the literature.

PURPOSE

The purpose of this scoping review was to map the existing literature on different techniques of transferring information from virtual facebows for oral rehabilitation.

MATERIAL AND METHODS

This scoping review was structured using a 5-step methodology based on guidelines proposed by Arksey and O'Malley: (1) characterization of the research question, (2) identification of relevant studies, (3) selection of studies, (4) mapping of results, and (5) selection, summary and reporting of the data. The Joanna Briggs Manual for Evidence Synthesis was followed and the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The guiding question for the development of this review was, "What virtual facebow techniques are being used to transfer anatomic data to the virtual environment?"

RESULTS

A total of 1745 articles were found during the search, and 20 were included in this review. Nineteen of the included articles had positive results with the described techniques of registration and transfer of anatomic references to the virtual environment; however, 1 study indicated that the technique was negative.

CONCLUSIONS

Based on the findings, facial scanning, 2-dimensional photographs, and cone beam computed tomography are feasible methods of acquiring extraoral anatomic landmarks. The use of a device that allows the convergence of intraoral and extraoral images by superimposing data was revealed to be a promising option.

A fully digital workflow to register maxillomandibular relation using a jaw motion tracer for fixed prosthetic rehabilitation: A technical report

OBJECTIVE

This technique aimed to describe a fully digital workflow to register maxillomandibular relation for fixed prosthetic rehabilitation.

CLINICAL CONSIDERATIONS

Mandibular kinematics could be reproduced in a four-dimensional (4D) virtual patient based on the intraoral scan, facial scan, cone beam computed tomography, and jaw motion trajectory, which helped record centric relation and determine a proper occlusal vertical dimension in a virtual environment. The therapeutic position could be exported directly to the dental computer-aided design software for digital waxing design with a facial scan. The 4D virtual patient was also used to verify the functional and esthetic outcomes of provisional restorations.

CONCLUSIONS

This novel approach digitized the process of determination, delivery, and double-check of maxillomandibular relation, thus contributing to the establishment of a completely digital workflow for fixed prosthetic rehabilitation.

CLINICAL SIGNIFICANCE

Registration of maxillomandibular relation, including centric relation and occlusal vertical dimension is critical to the success of prosthetic rehabilitation. Traditional procedures are complex and time-consuming, and heavily rely on the clinical experience of dentists. A fully digital approach to creating a 4D virtual patient and registering the maxillomandibular relation is established, which guides to determine a proper occlusal vertical dimension in centric relation. Digital delivery and double-check can simplify the conventional procedure and ensure that the determined maxillomandibular relation is reliable.

A novel technique for implant-supported fixed complete rehabilitation based on a dynamic virtual patient

BACKGROUND

A digital workflow for implant-supported fixed complete prostheses (ISFCP) using photogrammetry (PG), virtual articulator (VA), and virtual facebow (VF) data remains a challenge.

METHODS

The novel ISFCP technique included four steps: (1) formation of a dynamic virtual patient, (2) integration of PG data, (3) fabrication of a diagnostic ISFCP, and (4) fabrication of a definitive ISFCP and test of the deviation.

RESULTS

Dynamic virtual patients were formed by integrating PG, VA, and VF data. The cumulative root mean square deviation between the designed data and actual definitive prosthesis was 140.4 µm.

CONCLUSIONS

The novel technique for ISFCP fabrication described in this paper can help optimise the clinical efficiency and quality of ISFCP but requires an initial learning curve.

CLINICAL SIGNIFICANCE

This technique provides a direct workflow, using PG, VA, and VF data, to fabricate ISFCP based on the provisional restoration.

Computer-Guided Osteotomy with Simultaneous Implant Placement and Immediately Loaded Full-Arch Fixed Restoration: A Case Report

Aim: This case report aims to illustrate a clinical protocol that allows for the rehabilitation of patients requiring extensive osteotomy, simultaneous implant placement, and full-arch, screwed-in prosthetics in one session. This protocol allows for the improvement of the aesthetics and functionality of the fixed implant-supported prosthesis through the preoperative planning of all surgical procedures, including osteotomy, and of the prosthesis through the application of 3D-printing technology for the creation of surgical templates and prostheses. Methods: This case report concerns a 72-year-old patient, ASA1, who, following diagnosis, the establishment of a treatment plan, and the provision of informed consent, opted for an immediate, full-arch rehabilitation of the lower arch. The digital planning stage started with the correct positioning of the fixtures. The proper bone levels were found and used to guide the creation of the provisional screwed-in prothesis. Two templates with the same supports (landmarks/pins) were then 3D-printed: a positioning template, including a slit to assist the surgeon during the osteotomy, and a surgery template to assist the surgeon during the implants’ positioning. A screwed-in prosthesis encased in resin C&B MFH (NEXTDENT®, Soesterberg, The Netherlands) was delivered. Minimal occlusal adjustments were performed. Results: In a single clinical session, through careful planning and the pre-operative 3D printing of a prosthesis, a temporary implant-supported prosthetic rehabilitation was possible in a case that required an extended osteotomy. Clinically, the correspondence between the virtual design phase and the final realization was consistent. At a functional level, the provisional prosthesis required minimal occlusal adjustments and the DVO values obtained in the immediate post-operative period were found to be comparable to those of the virtual design. By planning the final position of the bone and the implants in advance, it was possible to deliver a full-arch prothesis with proper implant emergence, occlusal vertical dimensions, and occlusal relationship. Conclusion: This fully digital protocol allows the clinician to preview and plan the osteotomy and implant surgery as well as the delivery of the temporary, immediately loaded, complete, fixed prosthesis in patients who are candidates for post-extraction surgery with the need for severe osteotomy.

Four-Dimensional Superimposition Techniques to Compose Dental Dynamic Virtual Patients: A Systematic Review

Four-dimensional virtual patient is a simulation model integrating multiple dynamic data. This study aimed to review the techniques in virtual four-dimensional dental patients. Searches up to November 2022 were performed using the PubMed, Web of Science, and Cochrane Library databases. The studies included were based on the superimposition of two or more digital information types involving at least one dynamic technique. Methodological assessment of the risk of bias was performed according to the Joanna Briggs Institute Critical Appraisal Checklist. Methods, programs, information, registration techniques, applications, outcomes, and limitations of the virtual patients were analyzed. Twenty-seven full texts were reviewed, including 17 case reports, 10 non-randomized controlled experimental studies, 75 patients, and 3 phantoms. Few studies showed a low risk of bias. Dynamic data included real-time jaw motion, simulated jaw position, and dynamic facial information. Three to five types of information were integrated to create virtual patients based on diverse superimposition methods. Thirteen studies showed acceptable dynamic techniques/models/registration accuracy, whereas 14 studies only introduced the feasibility. The superimposition of stomatognathic data from different information collection devices is feasible for creating dynamic virtual patients. Further studies should focus on analyzing the accuracy of four-dimensional virtual patients and developing a comprehensive system.

An Indirect Digital Technique to Transfer 3D Printed Casts to a Mechanical Articulator With Individual Sagittal Condylar Inclination Settings Using CBCT and Intraoral Scans

With the widespread application of digital impression techniques in prosthetic dentistry, accurate intraoral scan mounting, and virtual articulator parameters setting as per patients' anatomic structures are essential for treatment planning and restoration fabrication, especially for complex rehabilitation cases; meanwhile, marginal fit checking, occlusal adjustment, and porcelain layering of restorations are also crucial procedures in all cases in which the analog procedure to mount maxillary arches on a mechanical articulator is still required. This technique article presents an indirect digital approach that can first achieve virtual intraoral scan mounting and sagittal condylar inclination value setting of an Artex virtual articulator based on bony structures provided by a single cone beam computed tomography scan. It then facilitates the transfer of virtually mounted intraoral scans from the virtual articulator to the matched Artex mechanical articulator by relating a digitally scanned mounting plate of the Artex mechanical articulator to the virtual articulator, printing the intraoral scan and mounting plate scan assembly, and then mounting the printed casts on the mechanical articulator based on the printed mounting plate. This technique eliminates the conventional facebow transfer and protrusive bite registration procedures and offers a straightforward approach for the seamless integration of virtual environments and analog workflows into clinical practice. It aids in the design of restorations that are harmonious with the mandibular movements and reduces chairside adjustment time.

Dynamic 3D images fusion of the temporomandibular joints: A novel technique

OBJECTIVES

To demonstrate a procedure for fusing images from cone-beam computed tomography (CBCT), magnetic resonance imaging (MRI) and optical positioning tracking system to dynamically evaluate the relative motion of the temporomandibular joint (TMJ) for the diagnosis of temporomandibular disorders (TMD).

METHODS

CBCT data was collected from a patient wearing a fixation device with markers in the intercuspal position. The patient's mandibular movements were recorded using an optical positioning tracking system. The CBCT data were imported into a virtual simulation system to reproduce the mandibular movement. Five jaw positions were selected for 3D printing of the occlusal plate that the patient wore to undergo MRI. MRI scans were registered with the CBCT image for fusion and reconstruction.

RESULTS

The anatomical structures of the articular fossa, articular disc, and condyle were clearly displayed in the CBCT-MRI fused images. The spatial posture and relative position of the fossa-disc-condyle during mandibular movement could be reproduced dynamically using the 3D reconstruction model.

CONCLUSIONS

This method can visually display mandibular motion trajectories and the relative TMJ positions. Virtual reproduction provides a comprehensive understanding of the articular disc's morphology and position in different states from a 3D perspective.

CLINICAL SIGNIFICANCE

This method can be used in clinical studies of TMJ as an adjunct to the 3D dynamic diagnosis and assessment for complex patients with TMD and provide relevant data for doctors.

An overview of three-dimensional imaging devices in dentistry

OBJECTIVE

To review four types of three-dimensional imaging devices: intraoral scanners, extraoral scanners, cone-beam computed tomography (CBCT), and facial scanners, in terms of their development, technologies, advantages, disadvantages, accuracy, influencing factors, and applications in dentistry.

METHODS

PubMed (National Library of Medicine) and Google Scholar databases were searched. Additionally, the scanner manufacturers' websites were accessed to obtain relevant data. Four authors independently selected the articles, books, and websites. To exclude duplicates and scrutinize the data, they were uploaded to Mendeley Data. In total, 135 articles, two books, and 17 websites were included.

RESULTS

Research and clinical practice have shown that oral and facial scanners and CBCT can be used widely in various areas of dentistry with high accuracy.

CONCLUSION

Although further advancement of these devices is desirable, there is no doubt that digital technology represents the future of dentistry. Furthermore, the combined use of different devices may bring dentistry into a new era. These four devices will play a significant role in clinical utility with high accuracy. The combined use of these devices should be explored further.

CLINICAL SIGNIFICANCE

The four devices will play a significant role in clinical use with high accuracy. The combined use of these devices should be explored further.

Open-sleeve templates for computer-assisted implant surgery at healed or extraction sockets: An in vitro comparison to closed-sleeve guided system and free-hand approach

OBJECTIVE

A buccal opening guide provides better view and better irrigation. The aim of this study was to investigate the accuracy of this open-sleeve system.

MATERIAL AND METHODS

Thirty duplicated maxillary models, each with 6 extraction sockets and 4 healed sites, were used. Based on the same digital plan, three modalities, sCAIS with open-sleeves, closed-sleeves, and free-hand approach, were used to place implants. The global, horizontal, depth, and angular deviations between the virtual and actual implant positions were measured.

RESULTS

Both sCAIS groups exhibited better accuracy than the free-hand group in two clinical scenarios. At healed sites, the closed-sleeve group showed a significantly fewer error than the open-sleeve group in global apical (0.68 ± 0.33 vs. 0.96 ± 0.49 mm), horizontal coronal (0.28±0.15 vs. 0.44±0.25 mm), horizontal apical (0.64±0.32 vs. 0.94±0.48 mm), and angular deviations (1.83 ± 0.95 vs. 2.86 ± 1.46°). For extraction sockets, the open-sleeve group exhibited fewer deviations than the closed-sleeve group in terms of global (coronal: 0.77 ± 0.29 vs. 0.91 ±0.22 mm; apical: 1.08 ± 0.49 vs. 1.37 ±0.52 mm), and horizontal (coronal: 0.60±0.24 vs. 0.86±0.20 mm; apical: 0.95±0.50 vs. 1.32±0.51mm) deviations. However, the closed-sleeve group was more accurate in the depth control (0.26 ± 0.20 vs. 0.40 ± 0.31 mm).

CONCLUSION

In this in vitro investigation, open-sleeve sCAIS proved better accuracy than free-hand surgery for both delayed and immediate implant placement. Compared with a closed-sleeve sCAIS system, open-sleeve have the potential of providing better outcomes in extraction sockets but not in healed sites.

Digital Workflow in Implant Treatment Planning For Terminal Dentition Patients

Treatment planning for the transition of patients from terminal dentition to full-arch implant rehabilitation poses challenges. Such challenges pertain to achieving the new orientation of the occlusal and esthetic plane as well as the change of vertical dimension of occlusion (VDO), while the fixed provisionalization using a digital workflow, still tends to be considered complex and hard to perform. This article illustrates step-by-step the utilization of a digital workflow protocol in the treatment planning for rehabilitation of terminal dentition patients, simplifying the smile design and ensuring that fixed provisionalization serves both the functional and esthetic requirements. This protocol includes facially-driven, three-dimensional (3D) digital smile design and chairside mock-up restoration workflows that enable prosthetically-driven assessment prior to implant treatment planning and 3D printing of surgical templates, which can predictably reduce chairside time and adjustments at the surgical and fixed provisionalization appointment. This article is protected by copyright. All rights reserved.

Trueness and Precision of Economical Smartphone-Based Virtual Facebow Records

PURPOSE

To investigate the trueness and precision of virtual facebow records using a smartphone as a three-dimensional (3D) face scanner.

MATERIAL AND METHODS

Twenty repeated virtual facebow records were performed on two subjects using a smartphone as a 3D face scanner. For each subject, a virtual facebow was attached to his/her maxillary arch, and face scans were performed using a smartphone with a 3D scan application. The subject's maxillary arch intraoral scan was aligned to the face scan by the virtual facebow fork. This procedure was repeated 10 times for each subject. To investigate if the maxillary scan is located at the right position to the face, these virtual facebow records were superimposed to a cone-beam computed tomography (CBCT) head scan from the same subject by matching the face scan to the 3D face reconstruction from CBCT images. The location of maxillary arch in virtual facebow records was compared with its position in CBCT. The "trueness" of the proposed procedure is defined as the deviation between maxilla arch position in virtual facebow records and the CBCT images. The "precision" is defined as the deviation between each virtual facebow record. The linear deviation at left central incisor (#9), left first molar (#14), and right first molar (#3), as well as angular deviation of occlusal plane were analyzed with descriptive statistics. Differences between two objects were also explored with Mann Whitney U test.

RESULTS

The 20 virtual facebow records using the smartphone 3D scanner deviated from the CBCT measurements (trueness) by 1.14 ± 0.40 mm at #9, 1.20 ± 0.50 mm at #14, 1.12 ± 0.51 mm at the #3, and 1.48 ± 0.56° in the occlusal plane. The VFTs deviated from each other by 1.06 ± 0.50 mm at #9, 1.09 ± 0.49 mm at #14, 1.11 ± 0.58 mm at #3, and 0.81 ± 0.58° in the occlusal plane. When all sites combined, the trueness was 1.14 ± 0.40 mm, and the precision was 1.08 ± 0.52 mm. Out of eight measurements, three measurements were significantly different between subjects. Nevertheless, the mean difference was small.

CONCLUSIONS

Virtual facebow records made using smartphone-based face scan can capture the maxilla position with high trueness and precision. The deviation can be anticipated as around 1 mm in linear distance and 1° in angulation.

A digital workflow with the virtual enamel evaluation and stereolithographic template for accurate tooth preparation to conservatively manage a case of complex exogenous dental erosion

OBJECTIVE

This article describes a digital workflow using virtual enamel evaluation and a stereolithographic template for accurate tooth preparation for a complex exogenous dental erosion.

CLINICAL CONSIDERATIONS

A 22-year-old man with different degrees of defects on the labial surface in esthetic area was diagnosed as exogenous dental erosion. The residual undamaged enamel area and depth of defect were measured and analyzed accurately by creating a digital virtual patient based on the pretreatment data. According to the different conditions of residual enamel and tooth defect, the treatment plans of porcelain veneer, crown and composite resin were chosen for corresponding involved teeth. Based on the virtual wax-up and the suggested material thickness, a template for tooth preparation was designed and three-dimensional printed. This template together with a special bur indicating the reduction depth accurately guided the teeth preparation and achieved a long-term effect.

CONCLUSIONS

The virtual enamel evaluation contributes to obtaining the appropriate corresponding treatment plan objectively. The stereolithographic template effectively meets the accuracy of tooth preparation, preserving the tooth hard tissue to the greatest extent.

CLINICAL SIGNIFICANCE

The digital workflow described here may provide a quantifiable evaluation method and an accurate tooth preparation method for exogenous dental erosion.

Prosthetic articulator-based implant rehabilitation virtual patient: A technique bridging implant surgery and reconstructive dentistry

This technique report describes a fully digital workflow to create a prosthetic articulator-based implant rehabilitation (PAIR) virtual patient for complete-arch or complete-mouth implant rehabilitation. This workflow uses a custom gothic arch tracer during the cone beam computed tomography (CBCT) scan and a 3-dimensional virtual facebow when superimposing data. The PAIR virtual patient possesses reliable centric relation and vertical dimension of occlusion and is compatible with virtual articulators. Computer-aided implant planning and a digital prosthetic design can be seamlessly integrated by using this virtual patient.

Three-dimensional (3D) facially driven workflow for anterior ridge defect evaluation: a treatment concept

The esthetic rehabilitation of anterior ridge defects and the achievement of patient satisfaction has become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures which fail to meet patient expectations. The loss of hard and soft tissues in esthetic compromised zone is commonly associated with anterior ridges and affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction. A treatment planning considering esthetic parameters, prosthetic needs, and morphological defects must be conducted to improve treatment outcomes. Therefore, this study aims to propose a treatment concept for anterior ridge defects focusing on digital evaluation systems and guided by an ideal facially driven smile design project. In addition, the relevance of the papilla for the esthetic outcomes and the treatment alternatives for anterior ridge defects are also addressed.

Interdisciplinary guided dentistry, digital quality control, and the "copy-paste" concepts

OBJECTIVE

The aim of this report is to present an interdisciplinary approach with novel concepts to virtually plan and achieve esthetics and function.

CLINICAL CONSIDERATIONS

Despite the advancements in the digital workflow applied to restorative dentistry, the final outcomes are commonly not similar to initial planning. To overcome this major limitation, three concepts are proposed: guided dentistry, digital quality control and "copy-paste" dentistry. Guided dentistry consists of simulations in 3D software and also includes the manufacture of guides/appliances to assist dentists in all clinical steps. Digital quality control involves the use of intraoral scanners and 3D software to compare the real outcomes with the pre-operative simulations after every procedure. "Copy-paste" dentistry is a consequence of the previous two concepts. Using the capacity of the software to overlap files, the original project can be maintained and adapted to achieve results more comparable with the initial design. The proposed method associates facially driven treatment planning and periodontal and restorative procedures to perform the patient's dental rehabilitation.

CONCLUSION

Through a guided workflow and digital control of clinical steps, the final outcomes obtained were equivalent and closer to the initial design.

CLINICAL SIGNIFICANCE

In interdisciplinary cases, the treatment plan needs to address individual requirements and to coordinate sequential clinical stages. It is challenging to meet these demands in a conventional process. The proposed concepts engage technological resources to orientate the procedures and to provide assessment in each step. This approach enables the development of a complete and accurate functional-esthetic rehabilitation. Ultimately, the technique presented is reproducible and the results reflect the established plan.

Complete Digital Workflow for Mandibular Full-Arch Implant Rehabilitation in 3 Appointments

The aim of this clinical report is to describe a complete digital workflow protocol for mandibular full-arch implant rehabilitation from guided surgery to definitive prosthesis in only 3 appointments. This expedited protocol allows for guided implant placement with a system of stackable surgical templates and CAD/CAM prosthodontic rehabilitation using a digital workflow. At the first appointment, a guided implant placement protocol with the stackable template concept was done followed by immediate loading with a prefabricated interim prosthesis. At the same appointment, the Double Digital Scanning (DDS) technique was used for scanning, maxillomandibular relationship registration and virtual articulation. The anchor pins from guided surgery were used as fiducial markers for DDS data superimposition. At the second appointment, the prosthesis prototype was tried-in and adjustments were made. At the third appointment, the definitive monolithic zirconia full-arch prosthesis was delivered.

Esthetic treatment planning with digital animation of the smile dynamics: A technique to create a 4-dimensional virtual patient

A method is presented for obtaining a virtual 4-dimensional patient that replicates the intended esthetic treatment. The process involves facial and intraoral scanning to acquire records and software manipulation to enable a virtual waxing of the smile. Once the digital design is complete, patient information can be merged to generate an animated video of the projected rehabilitation, displaying movement and smile dynamics. This strategy provides a noninvasive and reliable diagnostic tool for predicting clinical outcomes.