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

Abstract

The virtual patient, a unique computer simulation of the patient's face, teeth, oral mucosa, and bone, provides an extraordinary mechanism for digital dental implant surgery planning and prosthetic design. However, the seamless registration of digital scans with functional information in the context of a virtual articulator remains a challenge. This report describes the treatment of a 47‐year‐old male with full‐mouth guided immediate implant placement and immediate loading of CAD/CAM interim prostheses. Utilizing a novel digital workflow, a multifactorial registration of the vertical dimension of occlusion, centric occlusion, and facebow record were completed digitally and paired within a digital articulator. Utilizing this innovative approach, a complex treatment plan and procedure was executed smoothly with a successful prosthetic outcome demonstrating good fit, occlusion, esthetics, and patient reported satisfaction.

Interdisciplinary guided dentistry, digital quality control, and the “copy‐paste” concepts

“…A contemporary clinician is expected not only to successfully perform the clinical procedures but also to generate outcomes more similar to the preliminary simulations. Accordingly, dentistry is moving into less free hand and more into guided techniques because of the increase in efficiency and predictability 1‐3 …”

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

“…[12][13][14][15] However, in terms of the dental erosion, there were few reports about the use of digital methods in its diagnosis and treatment, not mention throughout the entire process. Here, we report a case with complex exogenous dental erosion in esthetic area, which was managed by a digital treatment workflow: the residual undamaged enamel area and depth of defect were measured and analyzed accurately by creating a digital virtual patient based on the data of pretreatment intraoral scan, facial scan and cone-beam computed tomography (CBCT), 15 so as to guide the accurate treatment plan and corresponding restorative materials and types for each eroded tooth; the digital 3-dimensional printing tooth preparation template combining with the fixed depth hole preparation method was used to accurately control the tooth preparation depth and make the reduction amount consistent with the virtual design of targeted restorative space (TRS). 16,17 As a result, all the involved teeth were preserved to the greatest extent, and a long-term restorative effect was achieved.…”

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

“…The reason lies within the data acquisition procedures with IOSs and the absence of anatomic landmarks such as teeth that represents a challenge for the registration and data superimposition 6 . Recent reports illustrated approaches to overcome the challenge of registering the maxillomandibular relationship and superimposition of different Standard Tesselation Language (STL) files 6–9 . Fiducial markers attached in the soft tissues can be used to facilitate the superimposition of the generated STL files.…”