Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM)-Assisted Prosthetic Rehabilitation When Physiologic Anterior Guidance Cannot Be Re-established in a Skeletal Class III Patient: A Clinical Case Report.

Prosthetic rehabilitation of a nonfunctional anterior guidance that cannot be restored represents a major clinical challenge when skeletal discrepancies prevent the re-establishment of physiological guidance. This clinical case report describes a 44-year-old patient presenting with skeletal Class III mandibular prognathism associated with edge-to-edge and anterior crossbite occlusal relationships. The contribution of computer-aided design and computer-aided manufacturing (CAD/CAM) technology to the esthetic and functional management of this complex situation is illustrated. Following periodontal therapy and endodontic retreatment, an occluso-prosthetic compromise was established based on the absence of anterior contacts in maximum intercuspation (MI), simultaneous bilateral posterior stability, and posterior group-function guidance. Virtual treatment planning, performed using a mathematical virtual articulator driven by a dual physical-digital mounting protocol, enabled accurate restoration design and facially guided esthetic integration. The treatment plan was clinically validated using CAD/CAM-made provisional restorations and worn for three months before the fabrication of the final prostheses. The follow-up period was two years. This case demonstrates that managing non-functional guidance using CAD/CAM technology can be clinically feasible when anatomical limitations necessitate a therapeutic compromise.