Severe pathology treatment in Pre-geriatric patients: Proposal for a clinical protocol of Same-day Dentistry

Authors: Mauro Fazioni, Nicolò Surico, Rita Consolaro and Stefano Orio

Introduction

Modern restorative and prosthetic dentistry have undergone significant advances over the last five years. Dental material innovation has truly transformed clinical applications by improving restoration performance in the oral cavity. The ability to achieve ultrathin thicknesses using the current generation of hybrid composites, super-esthetic Zirconia, and reinforced glass-ceramics, to name a few, is now available to clinicians and is achievable through simpler procedures in the Dental Laboratory.

This achievement is possible thanks to digitalization procedures that guarantee highly improved design techniques and the fabrication of medical devices in the lab utilizing modern milling technologies. When applied in the lab, these tools provide manufacturing options that substantially expand the range of potential treatments. In-house methods can provide almost any manufacturing procedure, working with dry to wet ceramic composite materials, hybrids, metals, etc., in contrast to external milling centers that frequently standardize production protocols, limiting applications.

The Odontostomatology Department of IRCC Sacro Cuore Hospital in Negrar Verona has been investigating Clinical Treatment Models for Dental Disease. Development of therapies that are prepared to match the patient’s needs in the near future must occur in order to understand and recognize changes. The following are some of the important emerging fields of interest that we can highlight:

  • Applying artificial intelligence for diagnosis: pre-viewing, 3D modeling, and treatment simulation
  • Restorative approach with a Single Visit Dentistry: Materials & Methods
  • Treatment of severe pathology in Pre-geriatric patients: Day Surgery treatment
  • Teeth malocclusions and orthodontic treatments with aligners
  • Treatment of severely worn dentition: In-house Procedures
  • Clear aligner therapy: Risks and clinical strategies

The clinical and dental team needs to be able to handle this new method of addressing patient needs and diseases.

Description

Adult patients with severe or extremely severe oral diseases that impact the functions of the stomatognathic apparatus are becoming increasingly prevalent.

Unlike in the past, these patients have full social integration in society. Even at ages over 75 to 80, these patients’ dietary and lifestyle habits are comparable to those of adults, particularly in terms of their expectations. Clinically, these patients show severe signs and symptoms that are frequently seen in other systemic diseases:

  • Problems in chewing
  • Rapid-onset oral pain
  • Recurrent infections of the mouth and oral tissues
  • Deterioration of the dental system
  • Periodontal disease
  • Reduced ability to chew

Changes in one’s physical appearance are an important component of modern aging, especially for people over 65. Age-related changes in the anatomo-functional integrity of the oral cavity have an effect on more than just dental health; they also affect the progression of systemic diseases and nutrition.

Reducing the number of appointments while continuing to provide effective treatment is one of the most challenging issues to overcome. For these patients, success in pre-visualization is an essential aspect. A deficiency in dental occlusion has the same impact as inflammation from periodontal disease in changing the alveolar bone structure. Recently, materials with high levels of aesthetic and functional predictability have been introduced to the market, providing complete rehabilitation of the edentulous entire arch in a very short amount of time. The intraoral impression can be instantly accessed in the patient’s normal intercuspidation. Condylar determinants can be evaluated in real-life situations with digital axiography combined with DICOM 3D, and chewing movements can be reproduced. Full arch reconstruction with full dentures is possible using 3D modeling software in just a few minutes, with an accurate assessment of vertical dimension recovery. It becomes possible to reconstruct the integrated functional and aesthetic profile, which was initially shared with the patient using simulations.

Materials and Methods

For teeth and prosthetic bases, cross-linked PMMA from the Denture System (Ivoclar) should be used. It allows excellent outcomes with a single milling and hence extreme time optimization due to its unique Shell Geometry. Time and result optimization are made possible by the use of ultraprecise, innovative milling machines that are compatible with all commonly used milling techniques. A modern system that provides the technician and clinician with incredibly precise milling details, compatible with a Day Dentistry regimen, is the vhf R5 (vhf camfacture).

Clinical case

A 75-year-old female patient in good mental and clinical condition presents implant-retained rehabilitation in the upper arch with diffuse peri-implantitis and burning mouth syndrome. In the lower jaw, she presents complete dentures with abraded teeth and incongruence between the bases and alveolar processes (Figs. 1-13).

Fig. 1_Facial expression at the initial examination.
Fig. 2_Intraoral image: The patient reports pain and bleeding in the upper jaw with impaired stability of the lower prosthesis.
Fig. 3_ Areas of chronic inflammation of transmucosal tissue evident after removal of the maxillary prosthesis.
Fig. 4_Intra-oral scans of the maxillary and mandibular arches.
Fig. 5_Virtual removal of the maxillary prosthesis using Exocad software.
Fig. 6_Maxillary and mandibular prostheses designed with Ivotion libraries.
Fig. 7_The unique shell geometry of the Ivoclar Ivotion disc, which is compatible with the vhf R5 milling machine.
Fig: 8_Denture in the vhf CAM software module for the R5.
Fig. 9a_ vhf milling and grinding machine R5 for wet and dry machining.
Fig. 9_The Ivoclar Ivotion disc in the adapter bracket of the R5.
Fig. 10_ The simultaneous monolithic milling of the pink aesthetics and the teeth shows a high degree of morphology and surface detail at the same time.
Fig. 11_The prosthesis is inserted in the upper jaw and relined.
Fig. 12_Check-up after 4 weeks.
Fig. 13_ Detail of the morphology and texture of the anterior teeth at four weeks.

Dr Mauro Fazioni DDM, Graduate at the University of Verona 1992, 2002/2006 Since 2005 he has been a consultant in the Research and Development Department of some of the most important Digital Dentistry companies on the topics of Intraoral Scanning, Prosthetic Design Software, Guided Surgery and Machinable Materials applied in Fixed Prosthetics and Implant Prosthetics.

Since 2017 founder of MCD Consulting (Medicalcentrostyledesign Consulting) an independent company specializing in: Head & Neck digital investigations in Digital Solutions, Clinical Protocols Head & Neck reconstructions, Semiotics, Head & Neck Lab Prototype and medical device projects settings, anatomical structural design prototyping for labs, surgeon prosthodontics & companies. CAM design in and certified prototyping with milling, grinding, 3D printing technology, B2B regulatory support.

Since 2020 founder of AIOD Italian Academy of Digital Odontostomatology (www.aiod.it) an independent study group on digital applications in Odontostomatology and Maxillofacial Surgery.  He collaborates with the most important companies in the medical sector in the development of patents and hardware projects as a speaker and with publications on “one-day dentistry” and “protocols in digital dentistry”.

Since 2020 he collaborates with IRCCS Ospedale Sacro Cuore Don Calabria Negrar Verona Digital Dentistry department.

https://www.mcdconsulting.it/
https://www.aiod.it/

Nicolò Surico and Rita Consolaro are oral and facial 3D design specialists.

Dr Stefano Orio is the director of the dental center of the IRCCS Ospedale Sacro Cuore Don Calabria, a hospital in Negrar in Italy.