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Journal of Prosthetic Dentistry

Innovations in fixed prosthodontic workflows

      Abstract

      A systematic approach to treating complete mouth reconstructions is essential to achieve optimal treatment results, and current conventional methods do not always provide a fully controlled setting. The utilization of digital ecosystems allows for creating more predictable and efficient workflows in fixed prosthodontic reconstructions.

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      October 27, 2022

      Innovations in fixed prosthodontic workflows

      Faraj Edher, DDS, MSc, Dip Pros

      Summary

      The field of prosthodontics and restorative dentistry commonly deal with complex restorative reconstructions. Alongside an increasing demand for complete mouth rehabilitations because of multifactorial causative elements,
      • Lieberman A.
      • Edelhoff D.
      • Guth J.F.
      • et al.
      Oral health-related impact profile in full-mouth restored patients with two different tooth-colored restoration materials.
      • Shah P.
      • Razavi S.
      • Bartlett D.W.
      The prevalence of cervical tooth wear in patients with bruxism and other causes of wear.
      • Wetselaar P.
      • Lobbezoo F.
      The tooth wear evaluation system: a modular clinical guideline for the diagnosis and management planning of worn dentitions.
      a systematic approach is necessary to ensure appropriate diagnosis, planning, and treatment.
      • Binkley T.K.
      • Binkley C.J.
      A practical approach to full mouth rehabilitation.
      Historically, conventional methods have achieved successful treatment outcomes.
      • Binkley T.K.
      • Binkley C.J.
      A practical approach to full mouth rehabilitation.
      • Song M.Y.
      • Park J.M.
      • Park E.J.
      Full mouth rehabilitation of the patient with severely worn dentition: a case report.
      • Moslehifard E.
      • Nikzad S.
      • Geraminpanah F.
      • Mahboub F.
      Full-mouth rehabilitation of a patient with severely worn dentition and uneven occlusal plane: a clinical report.
      However, certain drawbacks have been noted with tooth-supported restorations, including extended chairside time, frequent adjustments, and extensive laboratory and patient communication in order to achieve predictable, functional, and esthetic outcomes.
      • Park J.S.
      • Lim Y.J.
      • Kim B.
      • Kim M.J.
      • Kwon H.B.
      Clinical evaluation of time efficiency and fit accuracy of lithium disilicate single crowns between conventional and digital impression.
      ,
      • Garcia P.P.
      • da Costa R.G.
      • Calgaro M.
      • Ritter A.V.
      • Correr G.M.
      • da Cunha L.F.
      • et al.
      Digital smile design and mock-up technique for esthetic treatment planning with porcelain laminate veneers.
      With the emergence of the computer-aided design and computer-aided manufacturing (CAD-CAM) technology, the use of digital technology in the field of dentistry is shifting from the present focus on diagnostic tools to treatment-implementation methods.
      • van Noort R.
      The future of dental devices is digital.
      Promising improvements have been made through the use of intraoral scanners and rapid prototyping of dental materials by additive or subtractive manufacturing. Digital dentistry has led to efficient prostheses fabrication, useful communication, and treatment archiving for potential remakes.
      • Kim S.Y.
      • Kim M.J.
      • Han J.S.
      • Yeo I.S.
      • Lim Y.J.
      • Kwon H.B.
      Accuracy of dies captured by an intraoral digital impression system using parallel confocal imaging.
      ,
      • Rekow E.D.
      Digital dentistry: the new state of the art - Is it disruptive or destructive?.
      The accuracy or digital scanning and fixed prosthesis fabrication has been investigated with reports of successful clinical treatments.
      • Park J.S.
      • Lim Y.J.
      • Kim B.
      • Kim M.J.
      • Kwon H.B.
      Clinical evaluation of time efficiency and fit accuracy of lithium disilicate single crowns between conventional and digital impression.
      ,
      • Chochlidakis K.M.
      • Papaspyridakos P.
      • Geminiani A.
      • Chen C.J.
      • Feng I.J.
      • Ercoli C.
      Digital versus conventional impressions for fixed prosthodontics: a systematic review and meta-analysis.
      ,
      • Ahlholm P.
      • Sipila K.
      • Vallittu P.
      • Jakonen M.
      • Kotiranta U.
      Digital versus conventional impressions in fixed prosthodontics: a review.
      This presentation reviews digital dentistry and proposes a systematic approach to completing complete mouth rehabilitations with an efficient and predictable digital workflow. Understanding the opportunities that arise when utilizing digital workflows allows the clinician–dental laboratory team to communicate more effectively and efficiently. The utilization of virtual smile design allows for effective communication and review of the proposed plan by the clinician while considering the patient’s feedback (Fig. 1A). The approved design is then communicated to the laboratory team to use as a base for the 3-dimensional (3D) design, while also accounting for static and dynamic functional relationships (Fig. 1B).
      Figure thumbnail gr1
      Figure 1A, Three-dimensional design overlayed with patient’s photograph for smile analysis. B, Three-dimensional design superimposed with digital diagnostic casts.
      An approved 3D design acts as the infrastructure moving forward for the prosthetic reconstruction. It allows for the fabrication of a putty matrix for indirect trial restorations, preparation guide, and matrices for chairside interim restorations (Fig. 2).
      Figure thumbnail gr2
      Figure 2A, Putty matrix fabricated based on approved 3-dimensional design utilized for indirect intraoral trial restorations. B, Three-dimensional printed crown preparation guide with palatal support. C, Polymethyl methacrylate interim matrices shells with support from palate.
      Utilizing optical scanners, the definitive impression workflow can also be simplified by taking advantage of the stitching ability of intraoral scanners. A complete arch or complete mouth scan of crown preparations can be sequenced into predictable stages to ensure accurate capture of the necessary details (Fig. 3).
      Furthermore, the superimposition of the definitive digital scan and the optical scan of the chairside interim restorations provides the dental laboratory technician with sufficient data when designing and fabricating the definitive restorations by using the CAD-CAM process (Fig. 4).
      Figure thumbnail gr4
      Figure 4Occlusal design of definitive restoration by using virtual articulator.
      Digital workflows can improve patient analysis, treatment planning, chairside time, objective treatment, and data archiving for enhanced efficiency and predictability in restorative treatment outcomes (Fig. 5).
      Figure thumbnail gr5
      Figure 5Definitive zirconia complete coverage restorations. A, Protrusive. B, Intercuspal position.

      Supplementary Data

      References

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