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Braz Dent Sci 2024 Jan/Mar; (1): e4099
Pereira TC et al.
Is scanning under rubber dam isolation a feasible approach for the execution of indirect restorations?
Pereira TC et al. Is scanning under rubber dam isolation a feasible approach for
the execution of indirect restorations?
INTRODUCTION
The Cad-Cam (Computer Aided Design/
Computer Aided Manufacturing) technology
has enabled the scanning and generation of a
three-dimensional digital representation of a
tooth’s preparation. This digital image can be
utilized for the purpose of designing and producing
a dental restoration. Within prosthodontics,
intra-oral scanning has streamlined the impression
process by reducing the number of steps involved.
This advancement enhances precision, shortens
treatment duration, and ultimately results in a
superior t of the restoration when compared
to traditional impressions [1-4]. In addition, the
scanning procedure still demands the hability
of the operator, but it requests less than the
conventional impression. Consequently, it has
been reported that patients prefer digital scans
because they are more comfortable and less
time-consuming [5-9].
It is crucial, during scanning, that the
operative eld remains as dry as possible. This
is because the camera captures images where
light interacts with the surface, potentially
capturing the same image that is visible to the
naked eye. Therefore, the preparation margins
must be visible, requiring the application of
techniques to displace gingival tissues and keep
them free from saliva, gingival uid, and blood.
The presence of these uids leads to errors due
to the difference in refractive index of light in a
liquid medium [10,11].
Rubber dam isolation offers several benets
for both the patient and the clinician [12,13].
The rubber dam can enhance the visual field
for the clinician as it eliminates the necessity to
constantly reposition the cheek, lips, and tongue,
thus facilitating work in the targeted area.
Additionally, it effectively manages moisture and
blood [13,14].
Due to its benets, the integration of a chairside
CAD/CAM system for creating restorations along
with the use of a rubber dam has evolved into a
standard procedure [15,16]. The most signicant
benet of this suggested approach lies in its ability
to conduct scanning within a clean and dry setting.
Additionally, this method can save time as it
enables the clinician to promptly conduct a precise
digital scan of the prepared area right after
tooth preparation, without requiring additional
materials like displacement cord or hemostatic
agents [13].
Furthermore, creating an impression after
the removal of the rubber dam can be time-
consuming and complex, as there is a chance
that the prepared nish line, even if it is located
above the gingival margin, might become
obscured by blood or saliva. This can disrupt
or prolong the procedure [13]. Thus, the aim
of the study was to report the aplicability of
intraoral scanning while rubber dam isolation
is in place.
CLINICAL REPORT
A 50-year-old female patient visited the
Institute of Science and Technology of São Jose
dos Campos, from São Paulo State University
necessitating restorative procedures for teeth
35 and 37 (Figure 1). The tooth 35 had a
history of previously performed endodontic
treatment, with a direct composite resin
restoration which developed secondary caries
and margin maladaptation. The tooth presented
buccal, mesial and palatal remaining faces.
The patient reported food accumulation in
the interproximal region and tearing of dental
oss during its use. Tooth 37 had a history of
restorative treatment with a silver amalgam
alloy, presenting clinical signs of enamel
cracks and mistting edges of the restoration
in relation to the tooth substrate. Remaining
faces presented was buccal, distal, and palatal.
The antagonist had sound teeth 24, 25, and 27,
with tooth 26 as a ceramic crown.
The patient’s occlusion and esthetic demands
were evaluated, and the Shofu Block HC Hard -
ceramic based restorative block for milling (Shofu,
Japan) was selected as the restorative material
(Figure 2). It is composed by Zirconium silicate,
UDMA, Urethane diacrylate, micro fumed silica
and pigments. An A3 – HT block was selected.
Figure 1 - Preoperative condition, labial view.