Dr. Piero Venezia
• Honors Degree in Dentistry at the University of Bari, Italy (1989)
• Specialized in prosthetics at the University of Siena, Italy, and in prosthodontics at the University of Bari, Italy (2003)
• He is a lecturer of postgraduate programs at the universities of Siena, Genoa, Naples, Bari, Foggia, Catania and Rome
• Contract Professor in Dental Prosthodontics at the School of Dentistry of the University of Catania.
• He is an active member of:
DDS (Digital Dental Society) AIOP (Accademia Italiana di Odontoiatria Protesica)
IADDM (International Academy for Digital Dental Medicine)
DI&RA (Digital Implant & Restorative Academy)
• Fellow of the ITI (International Team for Implantology)
• He has authored several scientific papers in prestigious journals.
• He focuses his clinical and scientific activities on prosthetics, removable prosthetics and implant prosthetics.
introduction
introduction
Modern treatment plans often involve ultidisciplinary approaches. Digital workflows allow for easier communication between professionals (e.g., prosthetist, periodontist and orthodontist) and between clinicians and dental technicians.
Invisalign Smile Architect™ software combines orthodontics and restorative dentistry into one powerful tool. It allows professionals to foresee restorative goals with the end in mind, visualising them on each patient’s face, and make changes to the orthodontic treatment plan to achieve an optimal clinical outcome.
This new tool represents the vehicle for one of the most desired results in modern dentistry – a predictable, minimally invasive approach to the patient’s biological structures since dental elements can be positioned according to the prosthetic design. From this perspective, we increasingly speak about prosthetically guided orthodontics (PGO).
the case
the case
The patient, 39 years old, came to us with a request to improve his smile. The initial aesthetic analysis revealed:
- disproportions between the dental elements
- presence of diastema
- incorrect inclinations of the dental axes
- excessive width of the labial corridors (Fig. 1A, B).
clinical considerations
clinical considerations
Considering the needs of the patient and the initial clinical conditions, we decided to plan an integrated ortho- restorative therapy to improve the aesthetics of the smile. During the clinical observation, the patient showed a good occlusal relationship, irregular smile, non-coincidence of the midlines and evident buccal corridors.
No articular symptoms or functional problems were present. At the time of the first visit, the patient reported no issues in chewing or occlusal function so he was in occlusal equilibrium and articular balance. These clinical conditions allowed us to plan an aesthetic treatment aimed at improving and harmonising the smile, respecting the occlusal relationships of the posterior sectors and the existing occlusal balance.
The treatment included the restoration of the correct inclinations of the dental elements and space management in the first phase. A second phase proceeded to an implant prosthetic rehabilitation for aesthetic rehabilitation of the anterior sector.
treatment objectives
treatment objectives
2. Manage spaces for implant-prosthetic rehabilitation and the positioning of veneers.
3. Improve aesthetics with the replacement of the implant supported crown in position 1.1 and nine adhesive veneers.
4. Solve the patient’s aesthetic problem in the shortest time possible.
CONFIGURATION AND TREATMENT PLANNING
CONFIGURATION AND TREATMENT PLANNING
An intraoral scan was performed with the iTero™ scanner. Intraoral and extraoral images were collected via the Invisalign® Practice App. Through the Invisalign platform, the scanner allows the photos of the patient’s face to be matched with the intraoral scan in a few minutes. The result of the tooth alignment in the patient’s face can then be visualised using the Invisalign® Outcome Simulator Pro software.
Photographs and scans are uploaded to the Invisalign platform, together with the prescription for the required movements and the indications as to which teeth will be involved in the restorative phase (Fig. 2).
The clinician receives a proposed treatment plan that is fully customisable, both at the tooth alignment level and, using Smile Architect software, at the prosthetic level, where it is possible to work on the shape of the restorations (Fig. 3) and the volumes and gingival levels (Fig. 4).
The option also exists to modify the facial reference parameters (midline, incisal ridge course and interalar distance; Fig. 5). An intraoral scan was performed with the iTero™ scanner, and both intraoral and extraoral images were captured.
The achievable results of the integrated ortho-restorative therapy can also be assessed (Fig. 6).
The software allows for the evaluation of the tooth mass that should be removed with or without restorative therapy, visualising the minimally invasive approach gathered from an ideal tooth alignment (Fig. 7).
When the clinician has assessed the implementation of all required movements, they can request the production of the aligners. After the orthodontic therapy has been completed, they can proceed with restorative therapy, always using fully digital workflows (Figs. 8, 9).
STEPS IN THE RESTORATIVE PHASE
STEPS IN THE RESTORATIVE PHASE
2. Preparation of anterior teeth and digital impression on natural teeth from 1.5 to 2.5 and on implant placement in position 1.1.
3. Cementation of the veneers and delivery of implant-supported screw-retained crown on 1.1
4. Delivery of a new retainer for the upper arch.
SUMMARY OF TREATMENT WITH ALIGNERS
SUMMARY OF TREATMENT WITH ALIGNERS
• Number of aligners used: 13.
• Aligners: changed weekly.
• Treatment time: 13 weeks.
• Use of auxiliaries: none.
• Follow-up visits: the patient was seen one month after the placement of the attachments. The appointments were initially scheduled for every four weeks to monitor the progress of the treatment and check the patient’s level of cooperation.
After two follow-up visits, given the patient’s compliance, appointments were then scheduled for every six weeks.
• Urgencies during treatment: no follow-up visits were required for emergencies.
“The combination of Smile Architect™ software with Invisalign Go has enabled a minimally invasive approach to the patient’s biological structures”
clinical discussion
clinical discussion
An aesthetic smile is often requested by patients seeking dental treatment today. Many clinical options are available, and these have been enhanced by a multidisciplinary approach involving several specialists. Moreover, in this field, digital workflows enable easier communication between professionals (prosthetist and orthodontist) and between clinicians and dental technicians during the planning and management of the treatment.
The recent introduction of Invisalign Go has enabled the general dentist to
plan slight sectoral alignments for the preparation and management of aesthetic areas to be rehabilitated with restorative and prosthetic treatments.
In particular, the introduction of the Invisalign Smile Architect™ software in Invisalign Go combines orthodontics and restorative dentistry into one powerful clinical tool, improving multidisciplinary treatment planning.
The software allows the clinician to visualise the restorative objective by
adapting it to the patient’s face and make the necessary changes to the orthodontic treatment plan to integrate the two clinical approaches and achieve an optimal clinical outcome. In the clinical case described, Invisalign Go allowed for easy and
convenient management of the pre-prosthetic phase, which led to the alignment of the anterior sector and management of the spaces in the arch.
An improved alignment of the sector to be treated allows for a minimally invasive approach in the pre-prosthetic preparation, thanks to the 3D visualisation of the amount of enamel to be removed. The combination of Smile Architect™ software with
Invisalign Go has thus enabled one of the most valued results in modern dentistry: a minimally invasive approach to the patient’s biological structures because the dental elements can be positioned according to the prosthetic project.
From this perspective, we can talk more and more concretely about PGO. Within a multidisciplinary treatment plan, in this case, purely aesthetic, orthodontic programming must meet restorative and prosthetic needs. Invisalign Go allows, with very small movements and limited to the anterior sectors only, clinical results
that are foundational to the restorative phase, with a fully conservative approach and considerable advantages for diagnostics, restorations and occlusal stability for the patient.
The synergy between digital workflows and Smile Architect software enabled an optimal end-to-end result in a highly predictable manner (Fig. 11).
NOTES
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