Development of a Novel Restorative Digital Workflow for Patients with Bulimia Nervosa, Report of a Case

Background: To determine whether a novel restorative digital workflow is feasible for patients with bulimia nervosa. Methods: This new dental technique was designed and implemented individually for a 32-year-old bulimia nervosa patient, who suffered from the disease over 20 years. The dental treatment was planned virtually by inputting individual parameters from the preliminary diagnostic to develop a novel therapeutic approach, which is a detachable “sample-denture”. The digital workflow was supported by a virtual articulator and a four steps technique. Step 1: only one single impression and bite registration is needed from the first appointment to the restoration. Step 2: determination of a new adequate vertical dimension is supported by a cephalometric analysis and a ‘soft tissue prediction' technique. Step 3: removable sample dentures support a ‘gradual' non-invasive introduction to the aesthetic and functional changes. Step 4: non-prep crowns as long-term provisional's are allowing the fixation of the new full mouth restoration in only one appointment. Results: A harmonious length-to-width ratio of the front teeth of the upper jaw, improvement of stable lip support, harmonization of the smile-line as well as occlusion contacts, natural tooth anatomy, tooth colour, gummy smile reduction, aesthetic smile, improved articulation and better formation of sounds was achieved. Lateral teleradiograph analysis after verticalization indicated a change of 3.0° for the lower height of the face, intermaxillary relation increased with 1.8°. After treatment chewing difficulties, toothache and tooth sensitivity (hot, cold, sour and sweet) disappeared. The patient stopped vomiting, smoking, and changed eating, physical activity and social behavior. Conclusions: This is the first dental restorative digital workflow for patients with bulimia nervosa. The minimally invasive technique had impact on dental, lifestyle, nutrition and psychological aspects. A dental restorative digital workflow can help to preserve dental health and to strengthen the compliance of psychotherapeutic treatment with dental psycho-education.