Real jaw movements and face morphing on the digital patient: Production of functional restorations in only two chairside appointments

The latest technologies and software innovations in terms of patient data acquisition permit the production of functionalised and aesthetic restorations in considerably shorter times. Through a mock-up demo case, this article describes a workflow based on Zirkonzahn patient diagnostic tools and design automations, allowing for the manufacture of precise, individual dental prostheses in only two chairside appointments. A comparison between the produced demo mock-up and the natural teeth is also displayed to show the mock-up's high level of customisation and naturalness achieved with the workflow.

First chairside appointment

During the first appointment with the patient, the practitioner records the patient's data and oral situation by taking 2D pictures of the face as well as digital impressions through the intraoral scanner.

After the visit, the dentist sends the recorded data to the dental technician, who creates a virtual patient folder in the archive software, saving and storing all patient information for future usage. Based on the 2D pictures and intraoral scans, the dental technician designs a first set-up by means of the Smile Creator module included in the Zirkonzahn.Modellier software, in order to create a preview of the potential new smile.

With the Smile Creator, the dental technician can design the tooth setup based on the natural teeth of the patient; alternatively, the virtual libraries of natural tooth sets available in the software can be used. In addition, the dental technician can apply different tooth sizes, display the teeth in a real tooth colour, as well as integrate different reference lines into the 2D pictures for better tooth alignment (e.g. the smile line). The completed setup can then be exported as a 2D or 3D file and saved in the software for future designs.

Second chairside appointment

During the second appointment, the dentist and the dental technician show the digital smile preview to the patient. If the patient is satisfied with the aesthetic result, the dentist continues the treatment according to the restoration type. This demo case for the creation of a mock-up shows the workflow generally used for treating complex cases on implants. In such situations, the dentist employs the following patient diagnostic tools:

• The PlaneSystem® (MDT Udo Plaster), which records patient's occlusal plane and oral situation in Natural Head Position;
• The PlaneAnalyser II, which detects the patient's real mandibular movements for a detailed and customised functionalisation of the prosthetics; and
• The Face Hunter 3D facial scanner, for a photorealistic digitalisation of the patient's face physiognomy.

Such technologies permit the 1:1 reproduction of a patient's physiognomy and oral situation into the virtual world with no loss of precious information. In this way, the techno-clinical team can continue the workflow with no need for further chairside appointments to perform functional and aesthetics checks.

This is possible thanks to the integration of the recorded information into the Zirkonzahn.Modifier design software. Indeed, by means of a specific software function ("Real Movement"), the dental technician can display with accuracy all mandibular movements recorded with the PlaneAnalyser II (opening, closing, protrusion, retrusion and laterotrusive movements) achieving an optimal functionalisation of the design. Subsequently, with another function ("Face Morphing"), the functional movements can be associated with the patient physiognomy in order to simulate several face expression (e.g. smiling) and evaluate the restoration in terms of aesthetics. Movements can also be imported into the virtual articulator, which is adjusted automatically in relation to the case, for a possible switch to the analogue workflow with milled or printed models.

At this point, the dental technician sends to the dentist a PDF file including all information concerning the design as well as the software-generated functional movements. After the dentist's final approval, the dental technician proceeds with the manufacture of the prosthetics.

Delivery to the patient

The patient goes to the dental practice to receive the restoration. No functional or aesthetic changes have to be applied, since all checks were performed on the digital patient by means of the Real Movement and Face Morphing functions.