Smile Celebration-Minimally Invasive Cosmetic Dentistry Coupled With Computer Guided Occlusal Analysis. (a Case Report)

INTRODUCTION

           The loss of teeth is matter of immense concern and their replacement by artificial substitute is important to the continuance of normal life for esthetic and functional requirements. The comprehensive concept of minimally invasive cosmetic dentistry (MICD) and its treatment protocol were introduced in 2009 with the basic aim of a clinician effecting optimum clinical therapeutic improvements in smile enhancement, while performing corrective procedures that require as little clinical intervention as possible.¹ Computer guided occlusal analysis (CGOA) was used for bilateral occlusal contact equilibration.²

^{CASE REPORT}

           A 70 year old man was reported to the Department of Prosthodontics, with the chief complaint of worn out teeth in upper arch. Complete oral examination followed by medical and dental history was recorded. On examination, healthy mucosa with well-formed ridge in upper arch, maxillary denture with worn out teeth, missing 31 and 41,mandibular anterior fixed dental prosthesis involving 32 and 42 that was fractured, with attrition of remaining teeth was seen.(Fig. 1)

OPG was advised as a part of routine investigation which revealed adequate interdental bone in lower arch with good ridge height and bone density in the upper arch. A new denture for upper arch, with ceramageonlays on the lower teeth and replacement of fractured fixed partial denture with new prosthesis was planned.

Procedure

           After thorough Oral prophylaxis, upper occlusal rims were fabricated and evaluated for parallelism. Face bow transfer(Fig. 2-3) was done and mounted on semi-adjustable articulator (Arcon) (Fig. 4-6). Centric relation records were made by bimanual manipulation (Dawson's Technique)³, this was used for the development of diagnostic waxing with which Occlusion was developed. Maxillary denture was fabricated using polymethyl methacrylate resin. Mandibular anterior teeth in relation to 32 and 42,43 were prepared. Die preparations and wax patterns were prepared, followed by investing of the wax patterns and casting of the same. Metal try in was done to check the clearance and marginal fit and PFM bridge was fired using feldspathic porcelains. The FPD was luted using Type II GIC (GC corporation, Tokyo, Japan).

           Teeth were prepared in relation to 33,34,35,36,37 and 44,45,46,47 to receive onlays(Fig. 7). Indirect ceramopolymer (Ceramage, ShofuInc, Japan) restorations were fabricated. These restorations were bonded by using Flowable composites and Bonding agents ( Beautifil Flow Plus and Beautifil bond ShofuInc, Japan).

           Post insertion of maxillary denture and Mandibular fixed prosthesis, Digital analysis of occlusion was carried out by using T-Scan III from Tekscan, USA.⁴ The forces were harmonized by Occlusal corrections as seen in the pre-treatment and post treatment Tekscan recordings , and the restorations were finished and polished intraorally by using Ceramage finishing and polishing kit and One gloss kit from ShofuInc, Japan.¹ (Fig. 8-11)

           Regular recall and maintenance advised for long term success. In addition patient was instructed on good oral hygiene habits.

DISCUSSION

           Correct diagnosis and analysis are important to identify and address the causes of the problems in the treatment plan.

           The T-Scan Computerized Occlusal Analysis System offers precision technology that analyses Occlusal contact force and time sequences in 0.003-second increments and graphically displays them in movie form. This system simplifies occlusal adjustments, as it quickly isolates excessive force concentrations and time-premature contacts, so their eradication is predictable and effective. The Occlusal force and time-sequence data are relayed to a monitor through a high definition recording sensor that measures contactvarying relative force sequentially as differing tooth contacts interact at the Occlusal surfaces. During a turbo-mode recording, the sensor records 500 sections per second, resulting in a dynamic movie of changing Occlusal forces that can be incrementally viewed in a slow-motion playback.⁶ (Table 1-4)

           This dynamic playback separates all the force variance into their contact order, while simultaneously grading their relative occlusal force, so that a clinician can observe them for diagnosis and possible treatment. In two or three dimensions, the contact timing sequence can be played forwards or backwards continuously or in 0.003-second increments, to reveal an Occlusal “movie” that describes the occlusal condition. In the 3-D playback view, the force columns change both their height and color designation. In the 2-D contour view, the colour-coded force concentration zones alter size, shape and colour as the Occlusal forces change. Warmer colours indicate forceful contacts, while darker colours indicate lower force contacts.^5,6 .

           Minimally invasive cosmetic dentistry aims to preserve healthy tooth structure. Such modalities focuses on the minimal intervention, re mineralization and prevention of teeth reduction by the use of scientific advancement where the dentist can perform the least amount of tooth structure removal and be able to restore teeth to its normal condition. The choice of restorative material used for treating the above case was Ceramage due to its properties like extra ordinary strength, elasticity, excellent finish and high resistance to plaque with the ability to reproduce natural color with life-like aesthetics.¹