article · Cureus
Skeletal discrepancies such as Class III mandibular prognathism can prevent the restoration of physiological anterior guidance, posing severe prosthetic challenges. A 44-year-old patient with this condition, alongside edge-to-edge and anterior crossbite relationships, underwent rehabilitation using computer-aided design and computer-aided manufacturing (CAD/CAM) tools. Treatment involved initial periodontal therapy and endodontic retreatment, followed by an occluso-prosthetic compromise featuring no anterior contacts in maximum intercuspation, bilateral posterior stability, and posterior group-function guidance. Planning utilised a mathematical virtual articulator driven by a dual physical-digital mounting protocol to ensure accurate restoration design and facially guided aesthetics. The design was verified clinically with CAD/CAM provisional restorations worn for three months prior to placing the final prostheses. A two-year follow-up confirmed the clinical feasibility of this digital approach for managing non-functional guidance under anatomical constraints.
Severe anatomical jaw discrepancies often make standard dental reconstructions impossible. By demonstrating how digital design and manufacturing tools can simulate and test unconventional bite schemes before permanent restorations are made, this work highlights alternative treatment strategies for complex patients who cannot achieve normal physiological anterior guidance.
The workflow applies to clinical prosthodontics and dental laboratory CAD/CAM software environments. Dental practitioners and laboratory technicians can employ these digital articulation and virtual planning methods to treat complex occlusal discrepancies. Because the report describes an applied and tested clinical protocol validated over a two-year patient follow-up, the technique is immediately usable with existing commercial dental CAD/CAM systems.
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Prosthetic rehabilitation of a nonfunctional anterior guidance that cannot be restored represents a major clinical challenge when skeletal discrepancies prevent the re-establishment of physiological guidance. This clinical case report describes a 44-year-old patient presenting with skeletal Class III mandibular prognathism associated with edge-to-edge and anterior crossbite occlusal relationships. The contribution of computer-aided design and computer-aided manufacturing (CAD/CAM) technology to the esthetic and functional management of this complex situation is illustrated. Following periodontal therapy and endodontic retreatment, an occluso-prosthetic compromise was established based on the absence of anterior contacts in maximum intercuspation (MI), simultaneous bilateral posterior stability, and posterior group-function guidance. Virtual treatment planning, performed using a mathematical virtual articulator driven by a dual physical-digital mounting protocol, enabled accurate restoration design and facially guided esthetic integration. The treatment plan was clinically validated using CAD/CAM-made provisional restorations and worn for three months before the fabrication of the final prostheses. The follow-up period was two years. This case demonstrates that managing non-functional guidance using CAD/CAM technology can be clinically feasible when anatomical limitations necessitate a therapeutic compromise.
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DOI: 10.7759/cureus.115473
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