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Special Issues
July/August 2022
Volume 43, Issue 1

Intraoral Scanner Eases Impression Taking in Zirconia-Based Treatment

Jennifer Bell, DDS

A female patient aged 57 years presented with altered passive eruption of the maxillary anterior teeth, which was diagnosed as a secondary condition to tooth erosion resulting from long-standing gastroesophageal reflux disease (GERD). Clear aligner therapy was initiated to level and align the occlusion and intrude the maxillary anterior teeth back to their original gingival position. After 18 months of poor patient compliance, improvement in tooth position was minimal and the amount of clinical overjet that was desired was not achieved. This limited the restorative armamentarium, and a decision was made to proceed with monolithic zirconia-oxide restorations. Following teeth preparation and tissue retraction, the case was impressed using an intraoral scanner (iTero® Element 2, Align Technology, Inc., itero.com). The final restorations were made of zirconium dioxide with a feldspar veneering ceramic shade 1M1 as the pressed layer on porcelain on the facials. The outcome of the case met the patient's primary concerns, achieving the lengthening and lightening of the anterior teeth that she desired. Because of the patient's continued challenges with GERD, however, she reported having difficulty with compliance related to the clear aligner therapy and whitening protocols, precluding a more ideal result. Nonetheless, the patient was pleased with her new smile and the clinician, given the challenging circumstances, was satisfied with the clinical results of the final restorations.

Key Takeaways

A key component of the zirconia-based treatment for this case was the use of an intraoral scanner for digital impressions, which allowed for clear marginal visualization, time efficiency, and a simplified impression process.

When patients present with erosive tooth wear, which may be caused by common conditions such as GERD, the erosion process must be properly identified and diagnosed before proceeding with a smile design change.

Digital impressions are an effective, predictable alternative to conventional impression techniques and may be considered as the first option for impression-taking.

About the Author

Jennifer Bell, DDS Private Practice, Holly Springs, North Carolina; Fellow, Academy of General Dentistry

Fig 1. Maximum intercuspation showing worn incisal edges and altered gingival curvature of the maxillary arch at patient’s initial presentation.

Figure 1

Fig 2. Occlusal view at initial presentation highlighting the erosive wear present on the lingual aspects of the maxillary anterior teeth, with a preserved enamel ring around the gingival margin.

Figure 2

Fig 3. Preoperative lateral view at initial presentation.

Figure 3

Fig 4. Initial orthodontic situation, showing patient’s relaxed smile with worn incisal edge display.

Figure 4

Fig 5. Final orthodontic situation, showing patient’s relaxed smile with leveling of gingival margins and incisal edges.

Figure 5

Fig 6 and Fig 7. Digital impressions offer clear marginal visualization, time efficiency, and patient comfort. With the MyiTero (Align Technology, Inc.) digital platform, the clinician can quickly assess the quality of the preparations, marginal design, marginal visualization, and clearance between arches. The software can show the margin highlighted to ensure an adequate and precise impression.

Figure 6

Fig 6 and Fig 7. Digital impressions offer clear marginal visualization, time efficiency, and patient comfort. With the MyiTero (Align Technology, Inc.) digital platform, the clinician can quickly assess the quality of the preparations, marginal design, marginal visualization, and clearance between arches. The software can show the margin highlighted to ensure an adequate and precise impression.

Figure 7

Fig 8. Scan of preparations with iTero Occlusogram activated. This feature shows occlusal clearance and occlusal contacts using a gradient feature and graphic key, which allows the clinician to quickly determine if sufficient clearance has been achieved for fabrication of restorations.

Figure 8

Fig 9. Scan from the lateral position showed overjet and overbite of teeth in relation to the preparations and the clearance needed for the final prosthesis.

Figure 9

Fig 10 and Fig 11. Final periapical radiographs of the restorations prior to delivery. The marginal integrity interproximally was evaluated to ensure adequate seating of restorations and closed margins.

Figure 10

Fig 10 and Fig 11. Final periapical radiographs of the restorations prior to delivery. The marginal integrity interproximally was evaluated to ensure adequate seating of restorations and closed margins.

Figure 11

Fig 12. Final maximum intercuspation immediately after delivery of restorations. The restorations had pressed porcelain only from above the incisal edge to the gingival margin. Monolithic zirconia oxide was used for the lingual and incisal edges of the restorations in an effort to prevent chipping.

Figure 12

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