Use of Digital Articulator in Implant Supported Prosthetics. A Case Report

A case report is presented to demonstrate advantages of a new fully digital approach, from planning through to execution to immediate loading implant-prosthetic rehabilitation. Until now, the function of the diagnostic wax-up has not been assessable and the functionalization of the finished product, be it either a provisional or a definitive, has been entrusted entirely to the ability of the technician.

A female patient, unaffected by systemic disease and cranio-cervico-mandibular muscular pain, required removal of hopeless residual teeth of the upper arch and substitution with immediately loaded implants using guided surgery. A fully digital technique was performed using specific software to record individual condylar (axiography) movements and mastication cycles and to correlate these with initial intra-oral scans in order to create a virtual 3D individual value articulator. Seven implants were placed using guided surgery and the prosthetic rehabilitation was successfully performed as planned.

The use of guided surgery guarantees atraumaticity and procedure predictability as documented in recent literature. However, in this case, for the first time, using the digital axiograph and digital articulator, it was possible to record the axiography of condylar movements in order to 'functionalize' the diagnostic wax-up prior to its insertion into guided surgery software. This clinical case suggests how the software's compatibility with intra-oral scan files, diagnostic wax-up, facial scans, CBCT and, in the near future, electromyography of mastication muscles permits the clinician to work on a virtual patient and analyze all critical aesthetic and functional parameters prior to guided surgery.