33-year-old female patient sought for the dentist complaining about the shape and color of her anterior teeth. The patient also reported muscle pain in the temporalis and masseter region and reported that she has a habit of grinding her teeth. During the clinical examination and with the aid of intra and extra oral photographs (PRIMMA 1 and 2), the presence of generalized dental wear, loss of posterior stability and absence of incisive and canine decocclusion guides was found, in addition to loss of Vertical Dimension of Occlusion (VDO).
Thus, the planning was to reestablish the patient’s VDO through diagnostic waxing and mock-up of bis-acrylic resin in 24 elements (16,15,14,13,12,11,21,22,23,24,25,26,36 , 35,34,33,32,31,41,42,43,44,45, and 46) for esthetic approval and functional test for the new VDO, in which the patient uses the mock-up for 1 to 2 months to check that there is no muscle discomfort or pain in the new position.
Metric techniques (Willis bite gauge) and esthetic tests were used to define the patient’s VDO. The patient was deprogrammed with an interocclusal device (JIG) in acrylic resin that also helped in positioning the mandible in a Centric Relation and in restoring the patient’s VDO (PRIMMA 3 and 4).
The patient’s intraoral scanning was performed using the intraoral scanner. The following were scanned: maxilla, mandible and bite record in the new VDO defined with the JIG. This scan generated stl files that were sent to the laboratory, transferred to the Ceramill Mind software and placed in a virtual articulator. The patient’s initial photos were sent to perform the 2D / 3D overlay with the virtual models and to assist in the diagnostic waxing. This diagnostic wax-up was sent to the dentist for approval (overlay) and after this step, 3D models were printed on resin for making the mock-up walls.
To perform the esthetic and functional mock-up in the upper and lower arches, the PrimmaArt bis-acryl resin (FGM) was chosen. The bis-acryl resin was taken inside the wall of the mock-ups and positioned in my mouth, waiting for the material setting time. After removing the excesses, the mock-up was shown to the patient who approved it (Primma 5 to 8).