A Digital Approach to a Full Mouth Rehabilitation

As well as being the director and co-founder of iDD, I also work full-time as a dentist in Wellington.?

Here’s one of many clinical cases he’s completed, completely digital and done in-house utilizing 3D printing.

Full Mouth Rehabilitation Workflow

As with all these cases we start with intraoral scans using 3Shape TRIOS 5 intraoral scanner, diagnostic scans, and face scans using RAYFace and MODJAW .?

A complete digital wax-up and trial smile was then 3D printed and tested in the mouth. Digital smile design is a key in our practice to ensure we provide our patients with the best possible results.

After everything is confirmed, we start with the lower teeth first in FMR.

Full Mouth Rehabilitation Workflow - Lower Arch?

Why lowers? Well in the words of Dr Mike Brumm:

1) The length of the lower incisors is the prime determinant for the vertical dimension of occlusion which is altered in almost every full-mouth case

2) The position and shape of the lower incisal edges dictate esthetics, phonetics, and function

I have done multiple FMR cases and used to start with the upper arch first, but this was a lot better in my experience.

So we start with the preps. These are then scanned and then 3D printed temps are made.

One of my favorite uses of 3D printing is the temporization of these big cases.

Printing all these temps took 20 min and about 20-30 min processing time. Keep that in mind which is overlooked in all the hype of printing.

Once these were printed, they were then luted into place. The temps were splinted for ease of cementation and removal.

The printed temps stayed in the mouth for around 1 month to let everything heal (as we also did some laser gingivectomy to improve gum line positions).

The beauty of 3D printed temps is the tissue response! Far better than any direct method or bis-acryl/luxatemp. It made the final cementation process straightforward as the tissues were so healthy.

Zirconia discs were milled for the final restorations using Amann Girrbach and bonded into place.

I was very happy with the final result of the lower arch. We then moved to the upper arch.

Full Mouth Rehabilitation Workflow - Upper Arch?

The upper arch consisted of a large number of composite build-ups and severe erosion of the palatal surfaces of the teeth.

Everything was deconstructed and rebuilt. The patient was also missing 25 so this required careful planning and CAD to ensure an aesthetic outcome.

All preps were guided by the functional wax-up which was designed in exocad and transferred to the mouth.

After preparing the teeth, 3D printed temps using NextDent by 3D Systems were inserted which meant a perfect fit void of any overhangs.?

Upon removing the temps when the final zirconia restorations were ready, the gingival tissue was very healthy. Facilitating easy bonding. My favorite use of 3D printing in dentistry.

The preps were scanned and the finals were designed by Marjorie Andrade , our resident CAD designer and dental technician at our iDD Lab.

It just shows how applicable and innovative utilizing digital technology is to make dentistry predictable and improve patient outcomes.

And this was all possible due to our amazing team at iDD and iDD Lab.

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This article was written by Dr Ahmad Al-Hassiny on October 24, 2023.