Digital Impression For Indirect Restoration

A clinical case by our Community member Dr. Sinan Ghishan

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Digital impression is acquiring a major role in clinical dentistry. The high precision and trueness of intraoral scanners allow us to make indirect restorations more accurate, and less stressful.

styleitaliano style italiano intraoral picture showing crown on upper second premolar

Fig.1
The patient was complaining of food impaction and bad smell while flossing in the upper right quadrant.

styleitaliano style italiano xray showing infiltration under crown restoration

Fig.2
Upon x-ray examination, tooth 15 appeared to have recurrent caries.

styleitaliano style italiano abutment after removal of old crown

Fig.3
The old crown was quite easily removed, due to its poor fit, compensated by a thick layer of cement. Recurrent caries was observed at the distal margin.

styleitaliano style italiano prepared abutment with retraction cord

Fig.4
Caries and old cement were removed, and, after verifying that infiltration didn’t penetrate the abutment more deeply than expected from the x-ray (by both probing and caries detection), we decided to proceed to modify the preparation. A retraction 00 cord was used to retract the gingiva, and the distal margin was kept wide for better contouring of the subgingival restoration.

Video.1
In less than a minute, a digital impression was taken (Helios 600, Eighteeth).
Despite its depth, it was easy to precisely scan the distal margin of the prepared tooth and the undercuts of the adjacent teeth

Helios 600 Eighteeth Styleitaliano Style italiano banner intraoral scanner
Helios 600 Eighteeth Styleitaliano Style italiano banner intraoral scanner
styleitaliano style italiano zirconia crown un printed model

Fig.5
A monolithic zirconia crown was fabricated, together with the printed model to double check the contact area.

styleitaliano style italiano final crown restoration on upper second premolar

Fig.6
Final restoration is in place with perfect marginal seal.

styleitaliano style italiano xray check of crown marginal fit

Fig.7
Post-cementation x-ray shows precise margins and absence of excess cement.

Conclusions

Intraoral scanners allow for time saving, increase in accuracy and the reduction of manual errors, especially in challenging cases. All of these advantages may, altogether, contribute to cost reduction and workflow improvement.

Bibliography

1. Hasanzade M, Aminikhah M, Afrashtehfar KI, Alikhasi M. Marginal and internal adaptation of single crowns and fixed dental prostheses by using digital and conventional workflows: A systematic review and meta-analysis. J Prosthet Dent. 2021 Sep;126(3):360-368.
2. Chochlidakis KM, Papaspyridakos P, Geminiani A, Chen CJ, Feng IJ, Ercoli C. Digital versus conventional impressions for fixed prosthodontics: A systematic review and meta-analysis. J Prosthet Dent. 2016 Aug;116(2):184-190.e12.
3. Memari Y, Mohajerfar M, Armin A, Kamalian F, Rezayani V, Beyabanaki E. Marginal Adaptation of CAD/CAM All-Ceramic Crowns Made by Different Impression Methods: A Literature Review. J Prosthodont. 2019 Feb;28(2):e536-e544

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