Cadent iTero Digital Impression Case Study: Full-Arch Fixed Provisional Bridge

Cadent iTero Digital Impression Case Study: Full-Arch Fixed Provisional Bridge

The following case is a great example of where optical scanning is perhaps the only reasonable impression technique. This 80-year-old patient presented for treatment of a compromised dentition consisting of several remaining maxillary teeth over a mandibular arch with a bilateral distal extension removable partial denture and six remaining mandibular teeth (Figures 1, 2, and 3 show the pre-operative condition).

The patient has a biopsy-confirmed diagnosis of pemphigoid, a rare disease that is characterized by bulbous lesions of the oral mucosa as well as other areas of the body.



A significant feature of pemphigoid is termed a positive "Nikolsky's" sign. This is evidenced by loss of epithelium occasioned by rubbing apparently unaffected oral mucosa/gingiva. One can only imagine the difficulty in manipulating the tissue for a full-arch impression with the pressure of retraction cord, injection material, and PVS material. Simply blowing air on the tissue causes it to raise and separate, as prevesicular edema disrupts the dermal-epithelial junction.

The treatment plan called for a full-arch provisional fixed bridge to span the remaining maxillary teeth. Given the patient's oral condition, medical history, age, and financial constraints, this treatment plan seemed most reasonable. The primary challenge would be tissue management, given the pemphigoid condition.

The iTero scans (Figures 4,5,6) were used to create working dies (Figure 7) and ultimately fabricate a full arch provisional restoration (Figure 8, 9, 10). The actual scan required no dusting powder and was virtually bloodless! This is phenomenal, as any dentist who has seen this disease can attest. Simple finger pressure opens to blisters and even the simplest pressure causes bleeding. It was only with the iTero system that I was able to capture the information necessary to produce the virtual image and create the full-arch dies to fabricate the prosthesis. This further validates the "open" platform of iTero, allowing practitioners to use any restorative solution. And the patient was ecstatic with her new smile (Figures 11 and 12).


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