Full-Digital Workflow In Orthodontic-Prosthodontic Treatment For Bimaxillary Protrusion

Introduction: Severe bimaxillary protrusion with open bite and TMD poses major orthodontic challenges, requiring balanced esthetics, occlusion, and function. Digital innovations enable comprehensive diagnosis and treatment, especially in multidisciplinary cases. Case description: A 25-year-old female presented with bimaxillary protrusion. Clinical examination revealed skeletal bimaxillary protrusion, 3-mm anterior open bite, and discolored resin restorations on 11, 12, 21, and 22. CBCT showed labial alveolar bone fenestration. MRI showed bilateral irreversible anterior TMJ disc displacement. The orthodontic-prosthodontic combined treatment was employed. Firstly, clear aligners were used to align and level the dentition, assisted with mini-screws for maximum anterior retraction. Following orthodontics, veneer restorations were placed on maxillary incisors. Post-treatment evaluation revealed significant improvement in patient's facial profile and frontal smile esthetics. Discussion: We integrated the patient's facial scan, CBCT, intraoral scan, and electronic axiography data to reconstruct a 4D virtual patient model. The digital workflow comprised: ①Digital orthodontic treatment simulation, enabling visualized treatment planning with precise tooth movement control to prevent worsening of alveolar bone fenestration. ② Electronic axiography, recording mandibular movements to evaluate dynamic occlusal function and TMJ stability. ③Virtual articulator, accurately transferring jaw relationships. ④Patient-centered aesthetic design with digital smile simulation. Conclusion/clinical significance: The transition from conventional 2D assessment to dynamic 4D digital evaluation represents a paradigm shift in contemporary dentistry. By integration of multimodal data, clinicians can achieve a more predictable treatment. Furthermore, digital solutions have effectively bridged the communication gap between different dental specialties and patients through visualized treatment planning and real-time data sharing.