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Special Issues
July/August 2021
Volume 42, Issue 1

Intraoral Scanning Plays Integral Role in Resolving Anterior Spacing

Cara A. Lund, DMD

A 46-year-old female patient presented with the chief complaint of disliking the shape, color, and spacing of her front teeth. After conducting online research, the patient was adamant she did not want veneers or traditional bonding but instead preferred Bioclear® composite restorations (Bioclear, bioclearmatrix.com) on her maxillary and mandibular anterior teeth to preserve tooth structure. An intraoral scan using the iTero Element® 2 intraoral scanner (Align Technology, Inc, itero.com) and photographs were taken. It was discussed with the patient that prior to final restorations Invisalign® clear aligner therapy (Align Technology, Inc, invisalign.com) was needed to close all mandibular spacing (eliminating the need for restorations) and partially close the maxillary spacing (improving the height-to-width ratios of the final maxillary restorations). The patient completed Invisalign treatment in 15 weeks and then whitened with Opalescence™ PF 10% whitening gel (Ultradent, ultradent.com). An intraoral scan with the iTero Element 2 scanner was taken for a pre-prosthetic lab wax-up of teeth Nos. 6 through 11. These teeth were restored with full esthetic composite veneers using the Bioclear heated composite injection overmolding technique with Filtek™ Supreme Ultra Universal Restorative White Body paste and flowable (3M Oral Care, 3m.com). No tooth structure was resected. The patient was immediately scanned for Vivera® retainers. She was thrilled with her smile transformation.

Key Takeaways

The iTero Element 2 intraoral scanner provides clinicians a formidable system for streamlining workflow, enhancing precision, and connecting more effectively with patients.

Invisalign clear aligner therapy can be utilized to rapidly close spacing and improve height-to-width ratios of final restorations; custom-fit Vivera retainers help maintain teeth alignment.

Direct composite restorations with the Bioclear method
are minimally invasive, additive, and esthetically natural looking.

About the Author

Cara A. Lund, DMD
Private Practice, Stoneham, Massachusetts

Fig 1. iTero Element 2 scanner full-arch intraoral scan taken at initial visit.

Fig 1

Fig 2. Invisalign ClinCheck showing anterior view before (left) and after (right) Invisalign clear aligner therapy.

Fig 2

Fig 3. Invisalign ClinCheck showing occlusal view before (left) and after (right) Invisalign clear aligner therapy. All mandibular spaces were closed and interproximal reduction was performed between the mandibular anterior teeth to allow further closure of maxillary spaces.

Fig 3

Fig 4. Pre-prosthetic lab wax-up of teeth Nos. 6 through 11 to be used as a template for the restorative treatment. Bioclear restorations utilizing additive dentistry (ie, no tooth structure resected) were treatment planned.

Fig 4

Fig 5. Intraoral anterior view after completion of Invisalign clear aligner therapy and whitening (Invisalign attachments on teeth).

Fig 5

Fig 6. Intraoral photograph of tooth No. 9 after injection overmolding with heated composite using the Bioclear method. Tooth No. 8 was injection overmolded and polished to 80% completion. Bioclear Black Triangle Large Pink matrices are forming an aquarium on tooth No. 9 and a shield on tooth No. 10.

Fig 6

Fig 7. Before (left) and after (right) radiographs of teeth Nos. 9 through 11, highlighting the infinity margins of Bioclear restorations.

Fig 7

Fig 8. Intraoral maxillary anterior view after completion of Bioclear composite restorations on teeth Nos. 6 through 11 and removal of Invisalign attachments by polishing.

Fig 8

Fig 9. TimeLapse technology (occlusal view) on the iTero Element highlights changes in dentition between scans. The scan in the upper right corner was taken prior to Invisalign treatment, while the comparison scan was done after the Bioclear restorations. Hovering over teeth Nos. 8 and 9 allows the patient to see the transformation of the teeth.

Fig 9

Fig 10. TimeLapse technology on the iTero Element highlights changes in dentition between scans. The first scan (right) was Fig 10. TimeLapse on the iTero from the buccal view.

Fig 10

Fig 11 and Fig 12. Extraoral view of patient’s smile before (Fig 11) and after (Fig 12) treatment

Fig 11

Fig 11 and Fig 12. Extraoral view of patient’s smile before (Fig 11) and after (Fig 12) treatment

Fig 12

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