Digital Occlusal Reconstruction For Non-Reconstructable Unilateral Mandibular Defect

This case demonstrates a prosthodontic protocol integrating diagnostic dentures with digital workflows to achieve functional occlusion in a patient with a non-reconstructable unilateral mandibular defect and occlusal loss. A 70-year-old male developed a left mandibular defect for recurrent odontogenic keratocysts over 20 years. Mandibular reconstruction was contraindicated due to high recurrence risk and compromised systemic conditions. Progressive tooth loss (#33 residual root; #42,43 residual crowns) led to mandibular instability and masticatory dysfunction. Treatment began by establishing occlusal relationships based on maxillomandibular spatial relationship, followed by fabricating a diagnostic removable denture. After one year, this denture provided a reproducible occlusal relationship and improved mastication, and digital technologies documented this occlusion. Metal abutment was fabricated for #33, and #43 was prepared for a CAD/CAM crown using #42 for alignment. After crown placement, the occlusion was re-recorded, and #42 was prepared for a CAD/CAM crown using #43 for alignment. Finally, a functional mandibular impression was taken and scanned, utilizing #42 and #43 to align with the final occlusion, to fabricate the definitive mandibular removable partial denture. This innovative integration of diagnostic dentures and digital workflows addressed the unilateral mandibular defect unsuitable for reconstruction. The diagnostic denture facilitated muscle memory for a reproducible occlusal relationship, overcoming mandibular instability and occlusal loss. Digital technologies enabled precise documentation and transfer of occlusal relationships through segmented preparations and repeated matching. The successful outcome provides a strategy for occlusal reconstruction in patients with minimal remaining teeth or requiring guided denture stabilization.