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Special Issues
September 2020
Volume 41, Issue 1
Peer-Reviewed

Intraoral Scanning Key Factor in Long- Awaited Smile Restoration

Chad C. Duplantis, DDS

A patient had been in the author's practice for more than 15 years. As a child, she had numerous surgeries to repair a cleft lip and palate. Approximately 30 years ago, a metal framework with an acrylic overlay and denture teeth had been placed to restore her missing maxillary left lateral incisor. In time, a failing left central incisor and prosthesis necessitated further restoration. Implants were not considered due to concerns over graft success. Through orthodontics, the patient's midline and restorative spacing between teeth Nos. 8 and 11 were addressed. A diagnostic wax-up was then ordered, with the intent of restoring the entire maxillary arch. After review of the wax-up and considering the excellent health of her dentition, however, it was decided to restore the void and her smile conservatively. A fixed partial denture was fabricated to restore missing teeth Nos. 9 and 10. The iTero Element® 2 (Align Technology, Inc., itero.com) intraoral scanner was used for final impressions. Shade was relayed to the laboratory using a digital dental camera, and the prosthesis (Nos. 8 through 11) was fabricated using a zirconia coping with porcelain and various glazes. A direct composite resin restoration was placed on tooth No. 7. Minimal adjustments were needed at the seat appointment.

Key Takeaways

Restorative goals must align with patients' desires. Communication, both verbal and nonverbal, with the laboratory is imperative for restorative success.

Intraoral scans and photographs for both single- and multiple-unit cases allow instantaneous and effective communication. Use of the iTero Element 2 intraoral scanner can decrease production time and allow for creation of an accurate restoration.

Because "beauty is in the eye of the beholder" a successful result is not always a perfect smile. Modern technology and materials allow the fabrication of a lifelike periodontium and dentition that enables patients to regain a confident smile.

About the Author

Chad C. Duplantis, DDS
Private Practice, Fort Worth, Texas; Fellow, Academy of General Dentistry

BEFORE. Intraoral view of patient before orthodontic therapy.

BEFORE

Fig 1. Final evaluation of midline and restorative space for the final prosthesis before restorative treatment and debonding. (Orthodontics: David C. McReynolds, DDS, MS, Keller, Texas)

Figure 1

Fig 2. Postorthodontic treatment evaluation of remaining dentition. The patient was happy with the appearance of her teeth and resultant bite, thus it was opted to treat conservatively and restore teeth Nos. 7 through 11.

Figure 2

Fig 3. A digital dental camera (EyeSpecial C-III, Shofu, shofu.com) was used to relay the cervical shade utilizing the “isolate shade” feature, which deemphasizes the gingiva and background for optimal shade matching.

Figure 3

Fig 4. A mid-operative view of the preparations. The shade of the final preparations will be provided to the laboratory. Effective communication of the shade is especially important for highly translucent restorations

Figure 4

Fig 5. A monochromatic view of the final impressions using the iTero Element 2 scanner. Digital scans enabled the lab to work efficiently, eliminating guesswork on margins and occlusal clearance.

Figure 5

Fig 6. A colorized view of the final impressions using the iTero Element 2 scanner. Digital scans enabled the lab to work efficiently, eliminating guesswork on margins and occlusal clearance.

Figure 6

Fig 7. The facial view of the final restoration, fabricated using a low-translucency zirconia coping (IPS e.max® ZirCAD® LT, Ivoclar Vivadent, ivoclarvivadent.com) with feldspar veneer porcelain (VITA VM®9, VITA North America, vitanorthamerica.com) and various shades of glazes (MiYO®, Jensen Dental, jensendental.com) for staining and gingival effects. Gingival tissue was incorporated into the restoration to fill the void created from the patient’s cleft palate. Direct composite resin (Evanesce™, Clinician’s Choice, clinicianschoice.com) (not shown) was placed on the maxillary right lateral incisor. (Laboratory work: Aaron Hoffman, Sunflower Dental Studio, Topeka, Kansas)

Figure 7

Fig 8. The intaglio view of the final restoration, fabricated using a low-translucency zirconia coping (IPS e.max® ZirCAD® LT, Ivoclar Vivadent, ivoclarvivadent.com) with feldspar veneer porcelain (VITA VM®9, VITA North America, vitanorthamerica.com) and various shades of glazes (MiYO®, Jensen Dental, jensendental.com) for staining and gingival effects. Gingival tissue was incorporated into the restoration to fill the void created from the patient’s cleft palate. Direct composite resin (Evanesce™, Clinician’s Choice, clinicianschoice.com) (not shown) was placed on the maxillary right lateral incisor. (Laboratory work: Aaron Hoffman, Sunflower Dental Studio, Topeka, Kansas)

Figure 8

Fig 9. The final restoration bonded in place, lips retracted.

Figure 9

Fig 10. The final restoration bonded in place, in repose.

Figure 10

Fig 11. A postoperative scan was done using the iTero Element 2 to evaluate the final occlusion digitally and to fabricate an occlusal guard. Postoperative views of the scanned arches (as shown) using the iTero Element Occlusogram feature verified that the occlusion on the new fixed prosthesis was not excessive.

Figure 11

Fig 12. The patient happily displaying her new smile

Figure 12

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