PMC9593108_01
(A-E) Initial intraoral pictures and X-rays of the patient provided during the primary virtual consultation
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F1
The first visit was in fact a virtual one, the patient, providing preliminary photos and some X-rays (Figure 1A,1B,1C,1D,1E; Figure 2), considering that her chief complaint was severe headache resistant to all common painkillers.
Initial panoramic X-ray
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F2
The first visit was in fact a virtual one, the patient, providing preliminary photos and some X-rays (Figure 1A,1B,1C,1D,1E; Figure 2), considering that her chief complaint was severe headache resistant to all common painkillers.
CBCT scan: (A) Lateral view upper right quadrant; (B) Axial view of the upper right quadrant; (C) 24-section showing an important bony defect after apicectomy; (D) Right and (E) left important mandibular bone resorption. CBCT: Cone-beam computed tomography
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F3
The full cone-beam computed tomography (CBCT) taken to establish the possible teeth to be saved through endodontic treatment was useful also for the primary evaluation of the bone loss (Figure 3A,3B,3C,3D,3E).
Initial extraoral aspect in frontal and lateral views
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F4
Intraoral aspect: (A) Lateral occlusion right; (B) Frontal occlusion; (C) Lateral occlusion left; (D) Occlusal view of the upper arch; (E) Occlusal view of the lower arch
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F5
Huge VD loss and failed prosthetic treatment both on upper and lower arches, the severely grinded upper incisors, lower anterior teeth consumed and tilted inwards (the ceramic was absent on the zirconia restorations) and worn partial denture could be observed (Figure 5A,5B,5C,5D,5E).
Initial lateral teleradiography overlayed with Sassouni measurements
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F6
View of the tongue compensation
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F7
Having the patient assume a relaxed position, the rest position showed important tongue compensation (Figure 7).
(A) Initial position; (B) Myocentric occlusal registration; (C) View of the lower denture with the applied layer of light cure composite base plate Individo Lux (Voco GmbH, Germany) and the occlusion A-silicone Occlufast (Zhermack SpA, Italy)
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F8
Myotronics K7 Evaluation System analysis was proposed to the patient for establishing a correct starting point for the future full mouth rehabilitation. Moreover, the upper central crowns were removed, and a layer of light cure base plate was applied over the lower denture (Figure 8, A and B). Noting the deep bite, the lower denture was transformed by adding a layer of light cure denture base material (Figure 8C), which was intended to have a reduced quantity of bite registration silicone while transferring the myocentric position and starting the CMS and sEMG registration (Myotronics, Inc., Kent, WA, USA) (Figure 9).
(A) Patient with Myotronics K7 system mounted; (B) Initial myocentric occlusal registration on sagittal and frontal trajectory
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F9
Noting the deep bite, the lower denture was transformed by adding a layer of light cure denture base material (Figure 8C), which was intended to have a reduced quantity of bite registration silicone while transferring the myocentric position and starting the CMS and sEMG registration (Myotronics, Inc., Kent, WA, USA) (Figure 9).
Face-bow transfer Artex (Amann Girrbach AG, Austria)
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F10
(A-C) The 2-full arch milled fiber reinforced composite structures Trilor  (Bioloren Srl, Italy) with acrylic resin injected teeth
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F11
Control EMG showing overall muscular relaxation: (A) Before TENS; (B) After TENS. EMG: Electromyography; TENS: Transcutaneous electrical nerve stimulation
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F12
The control CMS and sEMG were performed showing a stable result (Figures 12 and 13).
(A) Initial CMS after provisional installation; (B) Control after six months showing the stable result. CMS: Computerized mandibular scanner
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F13
The control CMS and sEMG were performed showing a stable result (Figures 12 and 13).
Panoramic X-ray after current treatment phase
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F14
Lateral teleradiography, TMJ and panoramic X-rays were also performed to evaluate current status (Figure 14).
Smile of the patient after (first row) and before (second row) treatment
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F15
Compared to the initial situation, the new prosthesis was delivered at a VD higher with 7 mm (Figures 15 and 16).