Patient presents with a minor jaw defect that was a result of tumor, trauma, or other reasons. The patient cannot exercise normal physiological functions such as chewing, swallowing and accurate pronunciation, which has caused some level of psychological distress. Due to the relation between the oral and nasal cavities and insufficient support of the remaining tissues, such patients have difficulty in taking impressions, difficulty in determining the occlusal relationship, insufficient recovery of facial soft tissues, and poor retention of the restoration during clinical treatment. The development of digital technology has undoubtedly helped the treatment of such difficult and complicated cases.
In this case, digital technologies – specifically intraoral scanning, mandibular motion track recording, facial 3D scanning, and 3D printing – were used to determine the CR position of the patient’s suitability. This was achieved with the help of an electronic facebow, and the three-dimensional DS-FSCAN facial scanning technology of Shining 3D. The 3D scans and CT data were then used to create a temporary denture, from which a secondary impression could also be made.
Under the guidance of the digital implant guide, four Anthogyr implants were inserted and sutured. The final implant-supported overdenture restoration of the maxillary edentulous jaw with jaw defect was performed three months later. Satisfactory results were obtained for the patient, and the case won the “Full Denture Implant” Award in the 2021 Anthogyr Health China 20th Anniversary Implant Talent Show.
Case information and Treatment Plan
Patient: Mrs Lai, Female, 60 years old
Chief Complaint: The patient was unable to exercise normal masticatory function after surgery 2 weeks ago and required treatment.
Present Medical History: The patient lost her maxillary teeth due to caries, periodontitis and other factors. She had a history of removable denture restoration. Due to the black plaque on the left upper posterior tooth and the limited bone wall defect of the jaw, the maxillary bone was partially removed a month ago.
Past history: Denied drug allergy history and other contraindications related to implant surgery.
Restorative premaxillofacial contours recorded by digital scanning
After clinical examination and imaging examination, the diagnosis was: partial defect of left maxilla; upper dentition loss; lower dentition defect.
• Periodontal treatment
• Upper jaw:
Option1: Prosthetic complex + maxillary partial denture restoration
Option2: Prosthetic complex + Locator implant support upper overdenture
• Inform the patient the advantages and disadvantages of each plan, and the patient chosen prosthesis + Locator implant overdenture
Making Temporary Wax rim
Preparing for restorations, taking digital impressions by intraoral scans
Print models, make temporary bases, make temporary wax rims
Making functional occlusal bite block
Extraoral DS-FSCAN facial scan, obtaining the vertical distance of the lower third of the patient’s face through facial observation
Use Zebris electronic facebow to determine the CR position for patient suitability and record the occlusal relationship and transfer to the articulator.
Data aligning, refer to surface scan data, motion trajectory, CT data to make functional occlusal wax rim.
Making surgical guides for implant surgery
Intraoral secondary functional impression taking, making radiological guide and implant guide after correct jaw trial
Four Anthogyr implants were implanted under the guidance of implant planning surgery
Second stage Implant Surgery
3 months after the operation, the patient had no obvious discomfort, and the second-stage implant surgery was performed. ISQ was used to test the osseointegration of the implant.
Obtain intraoral scan data, print 3D implant models, and make implant overdentures supported by Implant Locator
The patient’s final oral condition with Implant locator supported overdenture
Digital Verification of Facial Morphology and Functional Movement in Patients mouth wearing the implant overdenture
Comparative analysis of before and after treatment: left/before treatment, right/after treatment
In this case, the combination of digital technology (intraoral scanning, mandibular motion track recorder, facial 3D scanning, 3D printing) and intraoral functional impression taking can not only improve the accuracy of dental restorations, but also reduce the dentist’s chairside operation time.
Digital non-contact impression scanning can not only simplify the technical operation of patients with jaw defect impression taking , but also avoid the stimulation of the maxillary defect wound.
• With the full assistance of digital means, various data are accurately recorded before and after restoration, which not only realizes the contour of the patient’s maxillofacial region, but also shortens the patient’s tooth loss time and reduces the patient’s economic burden.
This case was completed by Shining 3D and the Special Clinic Department of the Stomatological Hospital of Southern Medical University. We thank Mr. Shi Yong for his support and trust.