The gnathological positioner in the digital age – Workflow, accuracy analysis, and case report

Introduction The positioner is an orthodontic appliance traditionally used to refine occlusion and support functional settling following orthodontic treatment. Aim To present a digital workflow for the fabrication of a gnathological positioner and evaluate its clinical use in a patient case. Methods A female patient with a unilateral cleft lip and palate and agenesis of teeth 14 and 22 underwent orthodontic treatment with a multibracket appliance. Following appliance removal, fixed retainers were bonded to stabilize the anterior teeth. A gnathological positioner was manufactured in-office based on intraoral scans (TRIOS 5, 3Shape) and digital setup. The appliance was delivered the following day and worn full time for three days, then afternoons and nights for two weeks, and evenings for three months. Results The digital workflow presented reduces the manufacturing process to two working steps, 3D printing and appliance thermoforming, allowing rapid appliance delivery. Clinically, the positioner improved static and dynamic occlusal contacts according to the digital setup in the virtual articulator. Conclusions This case demonstrates the renewed relevance of the positioner in digitally supported finishing protocols.