In the rehabilitation of a patient with loss of vertical dimension, repositioning of the condyle may be crucial to avoid loading on the retrodiscal area of the temporomandibular joint (TMJ). However, establishing a new position of the condyle within the glenoid cavity is not a simple procedure, and several indications exist in the literature. Digital techniques and 3D visualization using cone beam computed tomography (CBCT) can help. In this clinical case, the procedure for the repositioning of the condyle is described on the basis of the restoration of the normal widths of the intra-articular spaces using a recently introduced software (Avantis3D). After the end of the rehabilitation with the splint, a second examination confirmed the accuracy of the repositioning with this full digital procedure which represents, in selected cases, a useful choice.

Purpose: To compare the aspect of the reproduction accuracy in studied methods of determination of the (CR) of jaws using the digital research methods. The methods used were bilateral manipulation by P.E. Dawson, frontal deprogrammer, leaf gauge, and intraoral device for recording of Gothic arch angle. Methods: To determine the reproduction accuracy of the centric relation of jaws, we examined 5 patients with intact dentition in a prosthetic dentistry clinic (first class in Angle’s system). For each method, 20 registrations of the centric jaw relation were carried out by one operator. The breaks between definitions were 30 minutes. A total of 400 CR recording operations were carried out (400 records of CR). In order to study the reproducibility of CR determination methods, 200 recorded mandible positions were analyzed by means of an analog-to-digital method (a macro kit Canon 650D, Canon 60 mm macro IS USM f2.8, Canon macro ring MR-14 EX and the computer program Adobe Photoshop) to assess the first occlusal contact obtained in the CR of jaws, while the other 200 were analyzed by means of a digital method (the computer program Avantis for 3D modeling, Prime as a laboratory 3D scanner (DOF), and Trios as an intraoral scanner (3Shape)) to assess the spatial position of the mandible in the CR. Statistical analysis was carried out using STATISTICA-10. In all statistical analysis procedures, the critical significance level p was assumed to be 0.05. Results: In the study of the data by means of the computer program Avanti 3D, the reproducibility of the mandible position in the CR reached 0.119 ± 0.012 mm for frontal deprogrammer, 0.225 ± 0.028, p ≤ 0.05 for bilateral manipulation by Dawson P.E., 0.207 ± 0.02, p ≤ 0.05 for leaf gauge, and 0.120 ± 0,013, p ≤ 0.05 using an intraoral device for recording the Gothic arch angle. The analog-to-digital method showed an identical tendency for reproduction of the mandible position. Conclusions: The digital analysis we made using the Avantis 3D program showed, with high confidence, that the maximum reproducibility of the CR position was reached by using our own design frontal deprogrammer and the device for recording Gothic arch angle.

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In complex dental treatments, a preliminary virtual plan (VP) can minimise the probability of errors and increase the predictability of the achieved result. Digital technologies and artificial intelligence open more opportunities for such planning, as they can be applied at the early stages of clinical examination to develop a simultaneous VP of all stages of treatment. The present clinical case describes a one-stage entire VP combining all the stages of treatment: gnathological, orthodontic, and prosthetic rehabilitation, until the final result. This approach avoids the accumulation errors associated with multistage VP, in which one stage of planning follows the end of a previous stage. One-step VP also allows demonstrating to the patients the expected results of the restoration, which increases their motivation to initiate the treatment.

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