Dr. Luca Lepidi
• Graduated in Dentistry and Dental Prosthetics at the University of Rome ‘La Sapienza’ with a grade of 110/110 cum laude.
• Specialised in Dentistry Surgery at the University “Tor Vergata”.
• Advanced training in Gnathology at the State University of Milan.
• Advanced training in Implantology at the G.D’Annunzio University of Chieti.
• Master in Fixed Prosthetics at Ace Institute Fradeani.
• Lecturer Master in Oral Surgery University of Foggia.
• Teaching activities in Oral Surgery in the 5th academic year CLOPD University of Foggia.
• Member of:
the Italian Academy of Prosthetic Dentistry (AIOP).
the Italian Society of Orthodontics (SIDO).
the National Association of Italian Dentists (ANDI).
• He practices in his offices in Andria and Foggia.
introduction
introduction
Modern dentistry aims to minimise unknown factors as much as possible, and the digital workflow can contribute to achieving this aim when facing different types of clinical cases by providing realistic and accurate treatment simulations.
Using devices and software that allow us to study anatomy has become commonplace, visualising digital clinical data from intraoral scans, which are turned into virtual casts, and radiographic imaging methods (e.g. cone beam computed tomography). Moreover, recent advances in the digital field also allow us to acquire information on jaw movements, benefiting the planning and manufacturing of prostheses. In the preliminary phases of acquiring diagnostic data, our ‘static’ data acquisition begins with the intraoral scanner. Then, we can acquire ‘dynamic’ data with devices that can register jaw movements. Using an Optical Jaw Tracking System (JMA-Optic System, Zebris Medical GmbH), we can register both static (maximum intercuspation position or centric relation) and dynamic occlusion, the horizontal hinge axis, pro/retrusion and laterality movements, opening and closing movements, and much more. These values are all registered with arches mounted on an individual values virtual articulator, a software tool that can digitally reproduce the relation of the arches and simulate their movements.
Since the mounting of the casts in the virtual articulator is a prerequisite for studying and planning cases involving occlusion and used in laboratory procedures in rehabilitative dentistry such as orthodontics, prosthodontics, and implant surgery, the strategies to adopt for an accurate cast mounting in the virtual articulator are of great clinical interest. Since virtual articulators naturally evolve with advancements in technology, the question we pose is: Is the individual values virtual articulator a valid and effective tool in clinical practice?
In prosthodontics, the morphology of the prosthetic elements and occlusal plane should always be constructed after closely examining the patient’s casts positioned based on their unique jaw relation to reduce the risks of mistakes and prosthetic complications in the middle-long term.
The goals shared by patients and dentists are efficacy and efficiency,
meaning results should align with expectations with as little discomfort as possible in a reasonable period of time.
Given these premises, there is no doubt that interest in developing and applying the mounting procedure of individual values virtual articulators is increasing since they represent a simulation method that allows dentists to reproduce their patients virtually.
the case
the case
We present the clinical case of a 30-year-old patient who had a specific request: rehabilitate their deciduous
upper canines that were partially present but had already lost function and esthetics. This case has been approached with the idea of treating them with two immediate loading post-extractive implants. After illustrating the procedure to the patient and obtaining informed consent, we
developed our digital workflow and clinical execution plan and conducted the treatment in four steps:
A) Acquire diagnostic records for the digital workflow.
B) Extraction and implant surgery.
C) Digital acquisition of implant position and static and dynamic occlusion.
D) Delivery of the prosthetic elements.
“The digital procedures that involve an Optical Jaw Tracking System can represent a new opportunity in our everyday practice.”
In the introduction, we posed the question about the validity and effectiveness of a virtual articulator compared to a classic articulator. Based on our experience, the digital procedures that involve an Optical Jaw Tracking System (JMA-Optic System, Zebris Medical GmbH) that allows us to register both static and dynamic occlusion can represent a new opportunity to resolve cases needing an accurate study of the occlusal morphology in our everyday practice. The clinical advantage is, without doubt, relevant if we consider that the accuracy of this method can allow us to avoid modifying prosthetic elements produced and refined in the laboratory. Another advantage is the digital workflow, which can save patients and clinicians the time needed for planning and treatment.
conclusion
conclusion
While we know that many aspects of this methodology must be investigated and verified, the presented clinical case provides an encouraging stimulus to continue developing mandibula dynamics registration systems integrated into digital workflows.
NOTES
CARESTREAM DENTAL IMAGING
Dr. Roberto Aza chooses Carestream Dental imaging for its high quality and reliability at his dental office.