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.
I have chronicled many of the cases scanned using my Cadent iTero scanning system. I think it has been about two years that I have been using the system with stellar results. My son Ryan practices with me and we "fight" over the scanner--it's so much fun to scan! The cost savings is best seen at the restoration delivery appointment. It is rare that we have occlusal adjustments, making the delivery visit a breeze. The front-end costs are perhaps a little less, as the die cost is about equal to that of PVS material. Now that I have had the unit, I would purchase iTero even if the cost were not recouped. It has made my life so much easier at both impression and delivery. Best of all patients love it, as there is no “goo”!
P.J.
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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.
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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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»Cadent iTero Digital Impression System
- Cadent, Inc.
iTero—powered by proprietary imaging technology—enables the dentist to take a powder-free digital scan of the patient’s teeth and bite, make any necessary adjustments in real-time, and then transmit the file via a wireless Internet connection to a Cadent-partnering laboratory for further processing. From there the digital file is transmitted to Cadent where a precision milled model is created and shipped to the laboratory within 48 hours. The laboratory may also import the iTero STL file into their lab based cad/cam milling systems for direct production of copings and full coverage cad/cam restorations. With significant benefits such as increased patient satisfaction, improved clinical outcomes, and enhanced office efficiencies, iTero is making an impression...85,000 of them and counting.
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