Fogorvosi Szemle (Dec 2023)
Comprehensive dental care for Autism Spectrum Disorder (ASD) patient
Abstract
Today’s modern digital dentistry aims at predictable outcomes, made possible by facially driven treatment planning, prototype fabrication, copy-paste and continuous digital quality control. Furthermore, due to the comprehensive nature of dentistry, a satisfactory end result is obtained by considering functional, aesthetic, gnathological and periodontal aspects. In this case, we present the prosthodontic rehabilitation of a patient with Autism Spectrum Disorder (ASD), using bite-elevation and fabrication of monolithic zirconia and porcelain-fused-to-metal bridges using a combination of conventional and digital workflows. The patient is a 41-year-old female with ASD and severe mental retardation. Dysgnathia, malocclusion and deep overbite were observed. Following professional oral hygiene treatment and restorative dental procedures, a two-dimensional digital smile design (3Shape Smile Design, Copenhagen, Denmark) and digital wax-up were prepared. The virtual designs were 3D printed (NextDent, 3D Systems, Rock Hill, USA) and used to create self-curing acrylic (Structur 2 SC A2, VOCO) mock-ups. The gothic arch tracing method was used to determine the centric relation position and a digital jaw movement analysis was performed with a digital facebow (Zebris for Cermaill, Aman Girrbach, Austria). Based on the increased occlusal vertical dimension long-term temporary polymethyl methacrylate restorations were fabricated. After 3 months of provisional period the functional temporary prostheses were copied with a copy-paste technique using an intraoral scanner (3Shape Trios 3 Pod, Copenhagen, Denmark) to provide the design of the final prostheses. In this case, we made a lower and upper pre-preparation scan and registered the intercuspidal position. In the next step, upper and lower digital precision-situational impressions were taken. The pre-prep and prep scans were aligned in 3Shape design software (3Shape Design Studio), where the final restorations were then designed. To record and mount the proper maxillo-mandibular relationship of the casts, a silicon bite registration was used before the veneering process of the lower metal frameworks The final restorations were cemented with resin-modified glass ionomer cement (GC Fuji Plus, GC Corp., Tokyo, Japan). If the steps of the modern digital workflow are carefully followed, necessarily supplemented by analogue steps, a predictable end result is achieved that is both functionally and aesthetically satisfying the patient.
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