Dental Asia Jan/Feb 2019

User Report DENTAL ASIA JANUARY / FEBRUARY 2019 50 Abstract A 4 7 - y e a r - o l d m a l e presented with pain in the temporomandibular joint (TMJ). He also had an aesthetic request since part of his veneer on the middle upper incisors had broken off. Fully digitalised work steps were used to remedy this issue: the Digital Smile Design protocol was applied and, following a minimally invasive preparation, monolithic veneers and crowns made of lithium disilicate ceramic were produced by means of CAD/CAM. The aim of rehabilitation was to remedy the loss of bite height as well as the associated aesthetic and jaw joint impairments. Background The digitalisation of work steps in dentistry has gained ground in recent years due to the technical advances with regards to intraoral scanners and software programs. This development has also resulted in improved communication between the dentist and dental technician. Digital Smile Design (DSD) is a digital tool for planning the aesthetic restoration of facial symmetry. It not only aids communication between specialists, but also improves the treatment results which can be expected. 1 Dynamic documentation of the smile is an important step in the 2D/3D Digital Smile Design process. The process can be fully digitalised and also supports the rehabilitation procedure. The advantages of video documentation lie in the fact that this renders documentation, the Smile Design, the analysis of the facial symmetry, treatment planning, team communication and patient education both more simple and more effective. 2 The DSD can be converted into a conventional or virtual diagnostic model to simplify the subsequent clinical treatments, e.g. CAD/CAM restoration. 3–7 The combination of the adhesive technique with light- transmissive restoratives makes preparing for minimally invasive restorative dentistry interventions simpler. Materials such as lithium-disilicate ceramic 8–11 boast similar properties to natural teeth which, in turn, enabled positive results to be achieved. 12-13 Intraoral scanners are an important tool in the digital workflow. These handy devices allow the impression quality to be checked directly and, in addition, the models can be simply transferred, cost-effectively and quickly via e-mail to the laboratory. 14 However, there is little information in the literature about the ability of intraoral scanners to produce high-quality impressions. 15–24 Computer-aided design (CAD) software is invaluable as it controls the fully automated devices which create the objects and assemblies in a virtual environment. 25 In this report, a clinical case is represented with fully digitalised work steps. Following minimally invasive preparation, the Digital Smile protocol and the monolithic veneers and crowns made from lithium- disilicate ceramic remedy the loss of bite height aswell as theassociatedaestheticand jaw joint impairments through CAD/CAM. Case presentation In 2015, a 47-year-old male presented with pain in the temporomandibular joint (TMJ). He also had an aesthetic request since part of his veneer on the middle upper incisors had broken off (Figs. 1-3). The clinical and radiographic analysis (Fig. 4) indicated a loss of bite height and tooth substance due to bruxism. Correction of Bite Height: Fully Digitalised Work Steps, Integration of the Dental Scanner, Smile Design and CAD/CAM In this report, a clinical case is represented with fully digitalised work steps. By Dr. Miguel Stanley , Dr. Ana Gomes Paz , Dr. Inês Miguel and Dr. Christian Coachman Fig. 1: Intraoral photo prior to treatment (frontal view) Fig. 2: Occlusal view of the maxilla Fig. 3: Occlusal view of the mandibular Fig. 4: Initial situation – Panoramic image (2015) Digital intraoral photos were taken from the frontal view under retraction as well as from the occlusal and lateral perspectives. More photos were also taken using a digital single-lens reflex camera (DSLR) (frontal, lateral and 45°). A diagnostic impression of both jaws was produced with an intraoral scanner (Carestream 3500). The maximum intercuspal position (MIP) was determined intraorally using the

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