Digital workflow with intraoral scanning and CAD/CAM PMMA crowns in a non-cooperative pediatric patient with early childhood caries: a case report

Early childhood caries can cause extensive coronal destruction in preschool children, often requiring complex rehabilitation at an age when cooperation is limited. This case report describes a behavior-adapted digital workflow used to complete full-mouth rehabilitation in a four-year-old boy with severe early childhood caries and very limited cooperation. Clinical and radiographic assessment showed advanced multi-tooth carious involvement, with marked destruction of the maxillary anterior segment. Differential diagnostic reasoning supported severe early childhood caries as the most consistent diagnosis. Because conventional impression-taking was not tolerated, a two-step intraoral scanning workflow was used to support treatment planning and definitive anterior rehabilitation. Management included disease control, caregiver education, sealants, restorative procedures, pulpectomies where indicated, post-and-core reconstruction, and full-coverage restorations. In the maxillary anterior segment, biologic posts were used for severely destroyed primary incisors, followed by computer-aided design and computer-aided manufacturing fabrication of polymethyl methacrylate crowns. The crowns were tried in, adjusted, and cemented under controlled isolation. No pain or immediate complications were observed. At the six-month follow-up, the restorations remained intact, gingival tissues were healthy, occlusion was clinically acceptable, and periapical findings were unremarkable, with no radiographic signs suggestive of pathological resorption. This case suggests that intraoral scanning and digital restorative workflows may provide a practical pathway for completing definitive rehabilitation in selected non-cooperative pediatric patients, provided that disease control, isolation, fit verification, cementation quality, and structured follow-up are maintained.