Page 12 - DP Vol 19 No 2 HR_Neat

Multidisciplinary section

iNTERDiSCiPLiNARY APPROACH BASED FULL MOUTH

REHABiLiTATiON WiTH PRE-ALiGNMENT FOLLOWED

BY STAGED DiGiTALLY DESiGNED TEMPORARiES AND

FULL CONTOUR ZiRCONiA CROWNS

Shravan Chawla, Rahul Kakodkar, Neeraj Kolge

ABSTRACT
Young male patient (40 years) presented with deep
vertical bite, crowded, worn-out dentition with
constricted arches and loss of vertical dimension.
After a thorough discussion with the patient
treatment provided was staged. Pre-treatment with
aligners to expand arches and reduce crowding,
followed by staged CAD CAM designed and milled
temporaries to raise the bite, establish and test the
new envelope of function and vertical dimension.
The temporaries were changed to full contour
zirconia in a phased manner to maintain the stable
anterior and posterior established vertical dimension
and functional dynamic. 1
Fig 1: Full Face Pre
CASE REPORT – PREOPERATiVE
PRESENTATiON
A young healthy energetic male (40 years) presented
with severely crowded and worn lower anterior
and posterior dentition with constricted arches and
loss of vertical dimension due to a deep bite. Pre-
operative records for diagnostics were made and sent
to the Laboratory (Precision Dental Studio, Mumbai)
After thorough evaluation we decided to do pre
alignment to reduce crowding and expand the arches
to help reduce the amount of tooth structure reduced
during preparation followed by staged occlusal
rehabilitation. Medical history revealed nothing
significant. 1

STAGE i - PRE-ALiGNMENT
After the initial analysis, an Orthopantomogram and
Lateral Cephalometry radiographs were advised.
Intraoral scans (3Shape Trios) were made along
with photos and occlusal bite records (Virtual,
Ivoclar) and sent to the lab. The case was loaded onto
the Aligner software by Precision Align, Precision
Dental Studio Ltd, Mumbai. The software used was 3
Shape. The primary aim of the pre-alignment phase
was to expand the arches, reduce lower anterior
crowding and open the anterior deep bite as much
as possible prior to preparing the teeth as part of
occlusal rehab. This helps limit the amount of healthy
tooth structure reduced during preparation in phase
2. A treatment plan and a 3D Simulation video was
generated with attachment guidance report.
IPR and attachments were placed on the teeth as
provided by the company and the patient was given
a total of 22 Upper and Lower Aligners to be worn Fig 2: Intraoral Pre
12 Dental Practice i March-April 2023 i Vol 19 No 2