The 4D Digital Dentistry Workflow applied in Neuromuscular Approach
by Florin E. Constantinescu
DDS, MSc Neur Orth.
Abstract
Over the past few years, there have been notable progressions in functional and digital dentistry. Various acquisition systems, like intraoral scans, facial scans, dynamic CBCT, and tracking of free mandibular movements, have emerged, offering unprecedented levels of detail. Consequently, dentists can now gather both quality and quantity of data about their patients. Employing the neuromuscular approach alongside 4D technology enhances treatment precision and predictability by integrating physiological metrics and accommodating patient preferences and requirements.A 36-year-old female patient visited our clinic in December 2022 with complaints of chewing difficulty post-orthognathic surgery, recurrent upper retainer debonding, cavities in posterior teeth, and dissatisfaction with aesthetics (ASA-Score: I). She had no significant medical history but had a history of frequent dental visits for cavities. Orthognathic treatment was undergone to correct a Cl II subdivision 2 dentomaxillary anomaly. Radiographic examination revealed significant morphological loss in posterior teeth. Dental examination showed simple and complicated caries with no periodontal pockets. TMJ evaluation indicated normal function. Using the neuromuscular protocol, by performing sEMG of right and left Mm Master and Temporal before and after transcutaneous electrical neurostimulation (TENS), and subsequently, recording the free mandibular movements with a digital optical system we integrated all data, combining the intraoral and facial scans with the full head CBCT in the CAD software for diagnostic purpose according to our 4D evaluation protocol. Prognosis indicates that future prosthetic treatment is likely to succeed in achieving the correct mandibulo-cranial position and enhancing both function and aesthetics. The treatment plan major steps involves mandibular deprogramming, functional dynamic digital analysis, occlusal stabilization with orthotic appliance, and final prosthodontic treatment with minimal invasive crowns and veneers. The patient consented to the proposed treatment plan and academic use of clinical documentation. Digital dentistry revolutionizes diagnosis and treatment planning, offering clinicians precise tools for personalized patient care.