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14 multidisciplinary section DENTAL TECHNOLOGY, JANUARY-MARCH 2023

INTERDISCIPLINARY APPROACH BASED FULL MOUTH

REHABILITATION WITH PRE-ALIGNMENT FOLLOWED BY

STAGED DIGITALLY DESIGNED TEMPORARIES AND FULL

CONTOUR ZIRCONIA CROWNS

DR. SHRAVAN CHAWLA, RAHUL KAKODKAR, DR. NEERAJ KOLGE

AbstrAct
Young male patient (40 years) presented with
deep vertical bite, crowded, worn-out dentition
with constricted arches and loss of vertical dimen-
sion. After a thorough discussion with the patient
treatment provided was staged. Pre-treatment
with aligners to expand arches and reduce crowd-
ing, 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 verti-
cal dimension and functional dynamic. 1

cAsE rEPOrt – PrEOPErAtIVE PrEsENtAtION FIG 1: Full Face Pre
A young healthy energetic male (40 years) pre-
sented 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 evalua-
tion 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 rehabilita-
tion. Medical history revealed nothing signifi-
cant. 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 arch-
es, 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 treat-
ment plan and a 3D Simulation video was gener- FIG 2: Intraoral Pre
ated with attachment guidance report.
IPR and attachments were placed on the teeth
as provided by the company and the patient was SCHEU Biostar. The patient was called for recalls every month to check tracking of teeth
given a total of 22 Upper and Lower Aligners to be and fit of aligners. The desired outcome was achieved within 40 weeks. The post align-
worn for a period of 2 weeks each for 18-20 hours ment FIGs show considerable expansion and sufficient reduction in crowding of lower
a day as per aligner company protocol. The sheets anterior teeth. Following this the attachments were removed and removable retainers
used were CA PRO PLUS and were printed in given to be worn daily as we proceeded with planned occlusal rehabilitation. 3