Digital workflow for a direct restorative procedure using a 4D virtual articulator

The purpose of this case report was to describe a procedure for 4D virtual mounting and how to develope static and dynamic occlusion through diagnostic waxing. A 16-years-old male patient with a recent history of anterior dental trauma presented with the complaint of esthetic and function restoration. The anterior guidance within the occlusal scheme in all anterior restoration should be considered as a relevant aspect as well as esthetics. A fully digital protocol was presented using a virtual articulator through the incorporation of data from 4D optical technology. The restorative therapy was carried out in the following phases: direct digital data collection acquisition, diagnostic waxing on a virtual model, and definitive restoration. The first step was the intraoral scan of both arches before treatment. The static interocclusal record was made in maximal intercuspal position by an Intraoral scanner and the dynamic one by new measuring system "Jaw Motion Analyser Optic System" (JmA (optic System/JMA; Zebris medical, Isny Germany), which aims at a complete digital workflow for the analysis of the occlusal scheme of mutually protected articulation. The 4D concept added a missing link, brought the digital workflow, and introduced patient-specific movements with kinematic digital facebow functionality. Esthetic and function digital waxing was made (Exocad GmbH) and a waxing cast was fabricated by 3D printing in addition a silicone index was produced from it. The direct composite restoration was made intraorally. This study seems to encourage furthermore clinical trials to validate the use of this methodology.