Correct 3D treatment planning with reverse thinking and copy paste dentistry


Correct 3D treatment planning with reverse thinking and copy paste dentistry


A New revolution in Digital Dentistry.

If you Fail to Plan ...You Plan to Fail!

A 26-year-old male patient presented with a chief complaint of an unpleasant smile and teeth getting worn out faster. The patient desired to improve their smile and prevent further loss of teeth structure. 

Based on history and clinical diagnosis the patient has fluorosis and hypoplastic enamel which resulted in an unpleasant smile and tooth wear at his age was a worrisome factor. The patient had undergone a root canal in past for teeth # 31 #32. It was decided to treat the patient desires and prevent further loss of teeth wear a full mouth Rehab at new vertical dimension and full coverage

Restorations in monolithic form based on RSD 2D philosophy along with 3D natural algorithms was suggested.

Based on Initial diagnostic data like face photos, intraoral photos, phonetics video, intraoral scans - A RSD 2D smile framework was created. For 3D motivational, we used natural shapes from our database. The motivational design was 3D printed and a silicone index was made. A Bis acrylic transfer in the mouth along with a silicone index was carried out by the doctor. Good quality photo videos were repeated and a comparative study of before after was shown to the patient. A delighted patient accepted the proposal of Full mouth Rehabilitation with proposed Natural restorations monolithic restorations.

Based on RSD 2D planning gingivoplasty on tooth #12 was carried out.

A kois deprogrammer design was made at desired vertical height for deprogramming the mandible and diagnose possible TMD problems. Deprogrammer was given to the patient for over 3 weeks period to check for condylar reprogramming and after correct assessment, we received the scans at desired VD and CR.

We designed Full functional upper-lower jaws at given VD and CR keeping the approved motivational design as our foundation. There were no Facebow records or Physical mounting of models on semi-adjustable articulator required. Virtual Artex semi-adjustable articulator with mean values was programmed and used to guide the digital wax mock-up. This functional prototype at new VD and CR using copy-paste technology for form, function, and natural aesthetics were used to carry functional TEST DRIVE in the mouth. No occlusal adjustments were required in the mouth. This was tested in the patient mouth for 2 weeks.

Upper 10 and lower 10 teeth were prepared for full coverage restorations. The mock-up was used to guide through for minimal invasive preparations. Post preparation scans were sent to the design center.

Using copy-paste technique the approved functional mock-up was converted into individual monolithic restorations. The restorations were milled in Empress CAD MULTI and using 3 D staining technique more lifelike illusion on natural shapes created.

The upper-lower 20 restorations were bonded with regular bonding protocol. In the second phase, all upper-lower molars were prepared and were scanned using intraoral scans.

The design center using copy-paste technique created individual monolithic restorations in Emax.

The 3D-stained E max restorations were bonded with the regular protocol. Occlusal was checked and minor adjustments required were done.

The patient was given a splint post-treatment.