J Korean Acad Prosthodont.  2019 Oct;57(4):495-505. 10.4047/jkap.2019.57.4.495.

Computer-aided design and manufacturing-based full mouth rehabilitation for a patient with excessive attrition and restricted vertical dimension: A case report

• Cho JH
• Yoon HI
• Yeo IS
• Han JS

• KMID: 2461159
• DOI: http://doi.org/10.4047/jkap.2019.57.4.495

Abstract

This study reported the treatment of a patient with excessive worn dentition and limited maxillo-mandibular space for restoration, utilizing the computer-aided design and computer-aided manufacturing (CAD/CAM) technology. After the thorough examination of the patient's occlusal vertical dimension (OVD), full mouth rehabilitation was planned with increase of the OVD. The patient was satisfied with the provisional restorations establishing the increased OVD. The horizontal and vertical data of the patient's jaw relation that the provisional restorations contained were transferred to the definitive metal ceramic fixed prostheses by double scanning and three-dimensional printing. After the fixed restorations were cemented to the abutments, electronic surveying and three-dimensional printing were used to fabricate metal frameworks for the patient's removable partial dentures. The mandibular definitive removable prostheses were delivered to the patient's mouth and the full mouth rehabilitation procedures were completed. The digital technologies used for this case produced fixed and removable restorations satisfactory in masticatory, phonetic and aesthetic functions to both the patient and the dental clinician.

Keyword

Full mouth rehabilitation; Computer-aided design and computer-aided manufacturing (CAD/CAM); 3-D printing; Occlusal vertical dimension; Tooth wear

MeSH Terms

Ceramics
Computer-Aided Design*
Dentition
Denture, Partial, Removable
Humans
Jaw
Mouth Rehabilitation*
Mouth*
Printing, Three-Dimensional
Prostheses and Implants
Tooth Wear
Vertical Dimension*

Figure

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  Fig. 1 Preoperative intraoral photographs and radiographic evaluation. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Panoramic radiograph, (G) Transcranial view are shown.

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  Fig. 2 Preoperative extraoral photos. (A) Occlusal plane analysis, (B, C) Vertical dimension analysis with Willis method are shown.

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  Fig. 3 Diagnostic cast analysis. (A) Excessive worn of mandibular left premolars, (B) Limited maxillo-mandibular space for restoration of left canine and premolars are shown.

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  Fig. 4 Diagnostic wax-up. (A) Right lateral view, (B) Frontal view, (C) Left lateral view are shown.

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  Fig. 5 Intraoral photographs and eccentric guidance of provisional restoration. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Group function at right side, (F) Mandibular occlusal view, (G) Group function at left side are shown.

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  Fig. 6 Definitive impression taking and master cast. (A, B) Impression body, (C, D) Master cast, (E) Master cast mounted are shown.

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  Fig. 7 Virtual master cast. (A) Superimposition of scanned separate dies and second die, (B) Superimposition of provisional cast and master cast using double scanning are shown.

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  Fig. 8 Metal coping fabricated by 3D printing. (A) Frontal view, (B) Maxillary occlusal view, (C) Mandibular occlusal view are shown.

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  Fig. 9 Intraoral photographs and eccentric guidance of definitive fixed restoration. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Group function at right side, (F) Mandibular occlusal view, (G) Group function at left side are shown.

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  Fig. 10 Removable partial denture (RPD) fabrication procedures. (A) Electronic surveying of master cast, (B) Block out with respect to selected insertion path, (C) RPD framework was designed in CAD software, (D) Metal framework, (E) Occlusal reduction and retention hole formation, (F) RPD with metal occlusion are shown.

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  Fig. 11 Postoperative intraoral photographs and radiographic evaluation. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Group function at right side, (F) Mandibular occlusal view, (G) Group function at left side, (H) Panoramic radiograph, (I) Transcranial view are shown.

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