UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
CASE REPORT DOI: https://doi.org/10.4322/bds.2024.e4099
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Braz Dent Sci 2024 Jan/Mar; (27): e4099
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Is scanning under rubber dam isolation a feasible approach for the
execution of indirect restorations?
O escaneamento sob isolamento absoluto é uma técnica viável para execução de restaurações indiretas?
Tatiana Cursino PEREIRA1 , Ana Paula de ALMEIDA-GOMES1 , Talita Suelen de QUEIROZ1 , Claudio MOREIRA2 ,
Renata Marques de Melo MARINHO1 , Alexandre Luiz Souto BORGES1 ,
Marco Antonio BOTTINO1 , Guilherme de Siqueira Ferreira Anzaloni SAAVEDRA1
1 - Instituto de Ciência e Tecnologia, Universidade Estadual Paulista, Departamento de Materiais Odontológicos e Prótese Dentária, São
José dos Campos, SP, Brazil
2 - Sao Paulo State University, Operative Dentistry, São José dos Campos, SP, Brazil
How to cite: Pereira TC, Almeida-Gomes AP, Queiroz TS, Moreira C, Marinho RMM, Borges ALS et al. Is scanning under rubber dam isolation
a feasible approach for the execution of indirect restorations? Braz Dent Sci. 2024;27(1):e4099. https://doi.org/10.4322/bds.2024.e4099
ABSTRACT
Objective: The aim of the study was to report the aplicability of intraoral scanning while rubber dam isolation is in
place. Material and Methods: Female patient, 50 years old, required restorative procedures on teeth 35 and 37. An
intraoral scan was initially performed on both arches. Isolation was carried out from 33 to 37, tooth preparation and
immediate dentin sealing were carried out. A new scan with the rubber dam in place was performed and a CAD/CAM
lithium disilicate hybrid block was digitally designed, milled, crystallized and cemented under the tooth surface with
the rubber dam still in position. After completing this stage, the rubber dam was removed, the occlusion was veried,
presenting excellent aesthetic and functional results. Results: The absolute isolation process used in the present study
works as an excellent device for gingival retraction. Conclusion: The absolute isolation can be recommended in clinical
activities of intraoral scanning favoring the quality of the nal result of treatments.
KEYWORDS
CAD/CAM; Denture precision attachment; Digital technology; Mouth rehabilitation; Rubber dams.
RESUMO
Objetivo: O objetivo do estudo foi relatar a aplicabilidade do escaneamento intraoral sob isolamento absoluto. Material
e Métodos: Paciente do sexo feminino, 50 anos, necessitou de procedimentos restauradores nos dentes 35 e 37.
Uma varredura intraoral foi inicialmente realizada em ambos os arcos. O isolamento absoluto foi feito de 33 a 37,
permitindo a realização do preparo dentário e selamento imediato da dentina. Um novo escaneamento com o dique de
borracha colocado foi realizado e um bloco híbrido de dissilicato de lítio CAD/CAM foi projetado digitalmente, fresado,
cristalizado e cimentado sob a superfície dentária ainda com o dique de borracha em posição. Após a nalização dessa
etapa, o dique de borracha foi removido, a oclusão foi vericada apresentando ótimos resultados estéticos e funcionais.
Resultados: O isolamento absoluto utilizado no presente estudo funciona como um excelente dispositivo para retração
gengival. Conclusão: O isolamento absoluto pode ser recomendado em atividades clínicas de escaneamento intraoral
favorecendo a qualidade do resultado nal dos tratamentos.
PALAVRAS-CHAVES
CAD-CAM; Encaixe de precisão intracoronário; Tecnologia digital; Reabilitação bucal; Diques de borracha.
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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.
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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?
This material was chosen due to the excellent
mechanical and optical properties provided by
the material, interesting for partial restorations
of posterior teeth. The HT block was chosen
considering the thickness of the onlay and the
possilibity of staining the restorations.
An intraoral scan (CS 3600, Carestream)
was initially conducted on both arches and a
buccal bite registration was completed without a
rubber dam (Figures 3, 4). Rubber dam isolation
was provided from 33 to 37 with a Nictone latex
rubberdam - medium thickness and 6x6 inches for
proper sealing, extended isolation in the hemi-arch,
color contrast and brightness for scanning and
visualization of the area to be worked on, tissue
retraction, patient comfort, and maintenance of
operative times. A Hu Friedy W3 clamp (Wingless
master clamp for molars) was utilized.
Both dental preparations were performed for
adhesive indirect onlay restorations, preserving
most of the initial geometry of the preparations
after the removal of the old restorations (Figure 5).
Spherical burs 1012 and 1014 were used for removal
of the old restorations. Conical burs 2135 and
2135F performed the preparation and renement
of the remaining structure. Prophylaxis was made
with Robinson brush and pumice stone solution
with distilled water followed by sandblasting with
aluminum oxide (Al2O3) for 10s on each wall.
Acid etching (37%, Condac 37 FGM) for 30s
on enamel. Primer was vigorous applicated on all
dentin walls with FL Bond II - Shofu - a two-bottle
self-etch adhesive, air spray for volatilization and
application of adhesive on dentin and enamel was
conducted. The removal of its excess was made with
an endodontic suction, subsequently light-cured for
20 seconds on each wall. A thin layer of Beautil
Flow Plus F00 - Shofu resin was applied in dentin
areas, and light-cured for 40 seconds on each wall.
An application of Beautil II LS resin mass - color
A3 for partial cavity reconstruction was performed
and nally nishing, and resin polishing procedures
were undertaken (Figure 6).
A new intraoral scan with the rubber dam in
place was made (Figures 7, 8) and the image was
automatically interposed in the previous image of
the teeth without the rubber dam. A CAD/CAM
hybrid lithium disilicate block was digitally
designed (DentalPlan, Exocad) and milled
(CEREC MC XL, Dentsply Sirona). The restoration
was sintered (Programat CS2, Ivoclar Vivadent)
following the manufacturer’s recommendation.
Figure 2 - Shofu Block HC Hard - ceramic based restorative block
for milling (Shofu, Japan) selected as the restorative material.
Figure 3 - Preoperative intraoral scans with no dental dam, occlusal view.
Figure 4 - Preoperative intraoral scans with no dental dam, labial view.
Figure 5 - Dental preparation under rubber dam isolation, labial view.