Comprehensive dental care for Autism Spectrum Disorder (ASD) patient

Abstract

Today’s modern digital dentistry aims at predictable outcomes, made possible by facially driven treatment planning, prototype
fabrication, copy-paste and continuous digital quality control. Furthermore, due to the comprehensive nature of
dentistry, a satisfactory end result is obtained by considering functional, aesthetic, gnathological and periodontal aspects.
In this case, we present the prosthodontic rehabilitation of a patient with Autism Spectrum Disorder (ASD), using bite-elevation
and fabrication of monolithic zirconia and porcelain-fused-to-metal bridges using a combination of conventional
and digital workflows.
The patient is a 41-year-old female with ASD and severe mental retardation. Dysgnathia, malocclusion and deep
overbite were observed. Following professional oral hygiene treatment and restorative dental procedures, a two-dimensional
digital smile design (3Shape Smile Design, Copenhagen, Denmark) and digital wax-up were prepared. The virtual
designs were 3D printed (NextDent, 3D Systems, Rock Hill, USA) and used to create self-curing acrylic (Structur 2 SC A2,
VOCO) mock-ups. The gothic arch tracing method was used to determine the centric relation position and a digital jaw
movement analysis was performed with a digital facebow (Zebris for Cermaill, Aman Girrbach, Austria). Based on the
increased occlusal vertical dimension long-term temporary polymethyl methacrylate restorations were fabricated. After
3 months of provisional period the functional temporary prostheses were copied with a copy-paste technique using an
intraoral scanner (3Shape Trios 3 Pod, Copenhagen, Denmark) to provide the design of the final prostheses. In this
case, we made a lower and upper pre-preparation scan and registered the intercuspidal position. In the next step, upper
and lower digital precision-situational impressions were taken. The pre-prep and prep scans were aligned in 3Shape design
software (3Shape Design Studio), where the final restorations were then designed. To record and mount the proper
maxillo-mandibular relationship of the casts, a silicon bite registration was used before the veneering process of the
lower metal frameworks The final restorations were cemented with resin-modified glass ionomer cement (GC Fuji Plus,
GC Corp., Tokyo, Japan).
If the steps of the modern digital workflow are carefully followed, necessarily supplemented by analogue steps, a predictable
end result is achieved that is both functionally and aesthetically satisfying the patient.