Digital Smile Design, Vast Bone Reduction with Surgical Guide and Intraoral Welding - A Case Report

Author(s): Adam Nowicki, Karolina Osypko

This case presents a whole treatment of a patient with residual dentition and poor esthetics due to the phenomenon of Godon. The planning of the treatment included conducting face scans, intraoral scans, extraoral photographs in smile and CBCT diagnostic. While the esthetics were as important to the patient as a function, Digital Smile Design was necessary to fulfill these expectations. New digital position of teeth arch dictated the position of the implants (6 in the maxilla and 4 in the mandible) and pointed to the need for bone reduction, as due to the phenomenon of Godon, the excessive bone volume would interfere with prosthetic restoration. Two triple, stacked surgical guides, for both maxilla and mandible, were designed and 3D-printed from dedicated resin. First guide was placed on residual teeth and determined the proper position of the second guide, which was pinned to the bone and served as both guide for alveolar bone reduction and as a base for the third guide for fully navigated implantation. Implants were immediately loaded after intraoral welding of titanium wire and creating a rigid frame for longterm temporary prosthetic reconstruction. After 6 months of healing, allceramic milled superstructures on a titanium anodized bar were delivered and the occlusion was checked with a dedicated electronic device. This case is unique for its fusion of DSD, guided bone reduction and immediate loading on a welded titanium frame, all planned from the very beginning due to proper diagnosis and potential of digital tools.