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Digitally guided technique for crown lengthening in an amelogenesis imperfecta patient

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Digitally guided technique for crown lengthening in an amelogenesis imperfecta patient: A Fabrication Technique.

Elena Chachik, DDS

Farhad Vahidi, DMD, MSD, FACP

Paul Zhivago, DDS

 

Introduction.

Amelogenesis imperfecta is a rare congenital disorder that presents with abnormal enamel formation due to malfunction of the enamel proteins. It is very important to recognize the problem and to provide adequate treatment for the affected patients to improve esthetics, masticatory function and overall quality of life. Management of these patients requires a multidisciplinary approach including involvement of the prosthodontist, periodontist, endodontist and orthodontist. Effective communication between specialists is essential for a good result and long-term prognosis. Digital technologies help to improve communication among specialists resulting in more precise and accurate reproduction of the initial treatment plan.

Patient Presentation.

A 15-year-old female patient with amelogenesis imperfecta presented to NYU Jonathan and Maxine Ferencz Advanced Education Program in Prosthodontics. The treatment plan included crown lengthening and gingival recontouring, endodontic and orthodontic treatments. After completion of the diagnostic wax up, it was very important to accurately transfer that information to the periodontist. The existing dental softwares are not designed to create guides for more complex cases such as that of our patient. The ZBrush digital sculpting and painting software was used to fabricate a 3D-printed surgical guide for the crown lengthening procedure.  It is an open software that is widely used for CGI in movies, games and animations.

Fabrication Technique.

Diagnostic casts articulated at the desired vertical dimension of occlusion were scanned with the 3Shape E3 desktop scanner. Models were printed for a diagnostic wax-up. The diagnostic wax-up that included alteration of the soft tissue level was completed on the printed models according to presurgical clinical analysis. New models with the diagnostic wax-up were scanned and the obtained STL files were transferred to Pixologic's ZBrush Software. Files of the diagnostic casts and wax-up were superimposed on each other. The desired gingival margins, together with clinical crowns, were marked and subtracted from the diagnostic casts. The data was transferred to SprintRay's MoonRay S 3D printer to fabricate a surgical guide. The 3D printed surgical templates were tried in the patient’s mouth and used to guide a more precise crown lengthening procedure.

Conclusion.

The ZBrush software was shown to be a viable option as a communication tool with the surgical team. Even though this program is not designed for dentistry, it can be adopted to create precise and cost-effective surgical guides for complicated cases.

References:

Anca Jivanescu, Antonio Miglionico, Simona Ioana Hategan. Alternative prosthodontic‐based treatment of a patient with hypocalcified type Amelogenesis Imperfecta. Clin Case Rep. 2017 Jul; 5(7): 1093–1097, doi:  10.1002/ccr3.1005

Chiung-Fen Chen, Jan CC Hu, Maria Regina Estrella. Treatment considerations for patient with Amelogenesis Imperfecta: a review. Braz Dent Sci. 2013; 16(4): 7–18, doi:  10.14295/bds.2013.v16i4.904

Jaafar Abduo,Karl M. Lyons. Interdisciplinary interface between fixed prosthodontics and periodontics. Periodontology 2000; 74(1): 40-62

Jiayue Yin, Dan Liu, Yuehua Huang, Lin Wu and Xiaolin Tang. CAD/CAM techniques help in the rebuilding of ideal marginal gingiva contours of anterior maxillary teeth. The Journal of the American Dental Association 2017; 148(11): 834-839.

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