Orthodontics for the Restorative Dentist

Utilizing Digital Dentistry and Invisalign^® therapy to plan and restore a difficult case- (whereas avoiding surgical intervention)

Case Overview

Kyle, a male in his mid 40’s introduced to our GP workplace. He was lacking some posterior enamel bilaterally and had an anterior crossbite, compounding a posterior open chew on the proper aspect. On condition that Kyle was solely biting along with his entrance enamel, he was discovering it troublesome to chew and was on the lookout for an esthetic enchancment.

 

Analysis

Previous to assembly with me, Kyle met with Dr. Zachary Mursic, a prosthodontist colleague of mine who felt the posterior occlusion might be addressed with a crown and bridge. The problem can be restoring the anterior enamel whereas in crossbite with out vital tooth discount and endodontic therapy.

Dr. Mursic reported that when he first met the affected person, Kyle talked about that he had visited different dentists and specialists and was informed the one answer for treating his case was jaw surgical procedure, adopted by intensive restorations. This was one thing he had wrestled with for years as he had been given just one possibility of surgical intervention. Nobody supplied him any various to correcting his occlusion. This was sufficient motivation for each Dr. Mursic and myself to discover a higher answer.

Defining the digital restorative therapy plan

Per normal apply, Dr. Mursic’s workplace scanned the affected person with and we carried out a diagnostic analysis over Zoom. Upon evaluation of the scan, we rapidly realized that jaw surgical procedure would have had little or no profit for this affected person because it failed to deal with the a number of edentulous websites and the numerous prosthetic reconstruction that might be required even after jaw surgical procedure. By correctly establishing the VDO (vertical dimension of occlusion) and designing FPDs (fastened bridges) to each exchange the lacking dentition and re-establish a correct posterior occlusal aircraft we have been in a position to digitally reconstruct his mouth earlier than even beginning the orthodontics. The one subject remaining was the anterior crossbite.

Our hope was that the anterior crossbite might be corrected with Invisalign clear aligner remedy in an affordable period of time, permitting the prosthodontics to proceed as deliberate. Utilizing the ClinCheck^® digital orthodontic therapy planning software program it was decided that utilizing anterior mandibular IPR allowed enough space for the mandibular incisors to be retracted. As well as, the maxillary higher proper phase was pushed buccal creating an area distal to tooth #1.3. Though there have been posterior enamel lacking, the remaining enamel 1.6/1.4 supplied sufficient anchorage to permit for the anterior buccal motion. All of this was achieved with roughly 20 trays and 6 months of pre-restorative orthodontic therapy. (Figures 2a-b) This was a much-preferred possibility for the affected person in comparison with jaw surgical procedure.

Whereas this gave the impression to be a difficult orthodontic case, digital orthodontics introduced a simplified answer. Anterior crossbites might be corrected with clear aligner remedy because the trays permit for separation of the anterior enamel. The crossbite might be corrected with out the necessity for auxiliary home equipment or posterior composite build-up to open the occlusion of the anterior enamel. As well as, restoration of the anterior enamel additionally decreased the fine-tuning that’s generally wanted in typical orthodontic therapy.

The prosthodontic portion of the work was additionally deliberate digitally and scanned after tooth preparation utilizing Align Expertise’s iTero Component 2 intraoral scanner together with exocad therapy planning software program used for therapy mock-up and design of bridges (Figures 3a-b)

The ultimate outcomes are each totally purposeful and esthetically pleasing. (Figures 4a-d)

The consequence

With this technique, the proper posterior open chew was prosthodontically corrected with minimal occlusal tooth discount thereby being much less invasive and damaging to the enamel. Had surgical procedure been completed to shut the posterior open chew, vital tooth discount would have been required.

This mixed orthodontic restorative answer was much less invasive throughout. Leveraging the Align Digital Platform together with the iTero intraoral scanner and the ClinCheck therapy planning software program allowed for an correct Orthodontic analysis and aided within the Prosthodontic therapy plan and visualisation. It additionally made therapy planning and communication simpler between a number of suppliers, the affected person, and the dental laboratory.

In abstract, as a substitute of erupting the posterior segments surgically, to carry them nearer collectively, minimal discount onlays have been positioned on the posterior enamel in addition to FPD’s, and the anterior crossbite was addressed with Invisalign clear aligner remedy. Ultimately, the affected person determined to forgo any anterior restorations in the meanwhile. Digital dentistry contributed to a superb end in a comparatively quick period of time all of the whereas being much less invasive than different potential therapy options. This really exceeded the affected person’s expectations. Digital dentistry has arrived and there’s no going again!

 

The opinions expressed on this publication are these of the authors and will not replicate these of Align Expertise, Inc. An honorarium was paid by Align Expertise in reference to this publication.

 

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