Course:

This course will show oral rehabilitation of a young female patient. The rehabilitation is following protocol in digital dentistry, which includes 4 phases. The first phase is treatment planning. This part of the protocol is the most demanding and involves pretreatment of the patient. In this case, professional cleaning, multiple extractions, endo treatment, and restorations were done. After that, the prosthetic planning can start, and for that, the dental technician needs proper information, like intraoral scans/impressions, photography, or face scans and some inputs from the dentist regarding materials, the patient’s wishes, etc. The digital wax-up can be done with natural libraries, or the dental technician can develop a new one for the case. In this case, the first mockup was done to evaluate possible crown lengthening of the frontal teeth. After a crown lengthening procedure, the patient should heal for 6 weeks, and then the therapy can continue. For this stage, new scans/impressions are needed, which dental technicians can scan later. The design should stay the same and not copied. The initial virtual models and models after perio surgery should be aligned in same position, and the design is simply placed on the second ones. From there, the final digital wax-up is needed.

If the design is not only additive, then the dental technician is providing 2 wax-ups: 1 noninvasive and 1 invasive. The first mockup should be noninvasive for reevaluation of the design, and for the clinician to remove part of the teeth going out through final design. Once this mockup planning phase is finished, the executing one starts. In this stage, we use the final mockup for the tooth preparation guide. After preparation of the teeth, the scans or impressions should be done and sent to the dental technician. The third phase of the protocol is manufacturing. In this stage, the dental technician evaluates the virtual models and aligns the prep models with previous ones. The design still should stay the same. The technician should provide a prototype of the restorations in PMMA material, so that the clinician can evaluate the fitting, contacts, and again, the design of the teeth. If necessary, the patient can have this prototype for provisionals to check function and phonetics. In the finalizing phase, the technician finishes ceramics and the clinician checks final try-in. The therapy ends with cementation.

The case finishes with 5 implants placed, guided and according to the treatment planning.

The standardization in fixed prosthodontics is very important. Even if an experienced dentist knows the phases, sometimes some of them are skipped, and it reflects in the final outcome for the patient.