Advertorial: An Indispensable Intraoral Scanner That Goes Beyond Digital Impressions

I remember it like it was yesterday—but it was 15 years ago. I was walking the exhibit floor of the American Dental Association meeting, when I came across a very small booth with a very intriguing device. The company was Cadent, and the device was named iTero.

It was a digital impression system, but unlike the other systems at the time, it didn’t come with a mill. There was finally a company for doctors who wanted digital impressions but didn’t want to use a mill. I did my research, and before long, I owned a device. A few years later, we upgraded by purchasing the iTero Element® system.

After all this time using their products, I was ecstatic when Align Technology—the company that purchased Cadent in 2011—reached out to Dental Products Report® to have me test-drive their new iTero Element 5D Plus imaging system.

First Look

I love watching devices evolve, and the iTero Element line of scanners is no exception. The intraoral scanner has taken the advantages of the original iTero Element scanner and improved upon them. The stand is more stable and more esthetic, the wheelbase has been expanded, and the length of the wheel arms have extended slightly, which greatly increases stability. The scanner has also been given light and dark accents, giving it much more of a space-aged look.

The unit was shipped to us disassembled, and my trusty assistant and ‘fix-it gal’ Nicky had it assembled and ready to roll in less than a lunch break. When she first turned the unit on, we were asked to connect to our secure Wi-Fi and to input our account information. Because we were existing iTero customers, all our previous cases and settings were downloaded from the Cloud, and within moments, we were ready to roll. It was easy and impressive.

In the Clinic

We were blown away. The screen resolution is stunning, the details are easily and clearly identified, the scans are gorgeous, and the processing power is downright impressive. We always position the iTero so the patient can see the monitor while the scan is taking place, and the speed with which the data appears on the screen is phenomenal. When I started with digital impressions in the late 1990s, the operator was taking photos with the device by tapping a foot pedal, and when enough images had been acquired, the system’s software would assemble those images into a 3D digital representation.

Watching the iTero Element 5D Plus imaging system scan the mouth is akin to watching water flow over an object. The system takes thousands of images per second,and combined with the processing power of the device, the scan appears smoothly and precisely. Patients are practically hypnotized by the experience. The color depth allows for easy margin discernment, and the resolution allows the user to enlarge the image on the screen with no loss of detail.

Another clinical feature that bears mentioning is the efficiency and the time savings it brings. In the past, when moving our iTero from operatory to operatory, it was necessary to power the scanner down, wheel it in, plug it in, then go through the boot sequence. Although it wasn’t a tremendous weakness, it did impede clinical progress on many occasions. Being a 3-doctor practice, there are times when the scanner is in use by another clinical team while the second team waits for the unit. The power down and power up steps simply added time to the process, but now that problem is history. The iTero Element 5D Plus imaging system comes with a built-in battery, which means when one team is done, the unit can be unplugged and moved to where it is needed next without fussing with the “power problem.” Now the unit is wheeled in, plugged in, and working on the next case in a matter of seconds. This has saved time and, more importantly, frustration for clinical personnel.

Clinical Results

The clinical results have been phenomenal. The cases we have performed with the help of the iTero Element 5D Plus imaging system have been accurate and the prosthetics require minimal chair time to seat. One of the best things about iTero scans is the time they save: the system is fast and accurate on the front end, which leads to incredible accuracy on the back end. In the old days of analog impressions, when a case went to place with no adjustments, it was a high five moment. Now, when adjustments are necessary, we evaluate what happened on the front end to make that happen. Our expectations are now that cases fit with minimal to no adjustments.

It’s also a tremendous advantage of the device that our lab receives the case within minutes. If need be, we can discuss the case with the lab almost as soon as it is done. It also means, for cases that are done model-less, the lab can begin to design the case practically before the patient has left our office.

The scans have also been used to create restorations with our Axsys Versamill 5x400 mill. Having a mill is not a requirement to have the iTero experience in your office, but if you do own a mill or are considering purchasing one, your iTero scanner will provide incredibly accurate data for your design process.

Intraoral Camera

The iTero Element 5D Plus imaging system is a terrific intraoral scanner, but it does much more. In addition to scanning, the system can take beautiful intraoral images. This saves time and boosts efficiency when it comes to documentation. Do you need to have photos of your preparation to send to third-party payers? No need to stop and pick up your operatory intraoral camera—you can take those photos directly with the iTero.

Occlusogram

We’ve all had the experience of saying to a patient something along the lines of, “Your teeth are showing signs of excessive wear.” only to be met by the response, “No they aren’t.”

These situations are much easier to deal with due to iTero’s Occlusogram feature. Instead of telling a patient they brux, you can show them. In my office, we scan and discuss what we see before we mention the problem. This makes the acceptance easier.

Humans are visual creatures. More than 85% of what we discern about our environment comes through our eyes, and the iTero Occlusogram plays to that advantage. It shows the teeth with a colored “weather radar” appearance that clearly identifies the patient’s wear patterns. It is a tremendous educational tool and a great adjunct to our office philosophy o “Focus, Educate, Relationships.”

TimeLapse Technology

Have you ever monitored a patient for several years and wished you could show them how the condition of their dentition changed? iTero’s TimeLapse feature puts this magic at your fingertips. If you scan a patient multiple times at different appointments, the iTero Element 5D Plus imaging system can combine those scans and create a video to show the changes that have occurred over time.

This is a powerful tool that can provide years of data in the span of a few seconds, which greatly increases patient understanding. Because the iTero Element 5D Plus scans so quickly and is easy to use, we have incorporated scanning every new patient to the practice. This is helping us to build a baseline of patient data. Our goal is to incorporate a digital scan into our normal 6-month hygiene visits to allow us to monitor every patient easily and efficiently.

Near Infrared Imaging

Another benefit built into the iTero Element 5D Plus imaging system is the implementation of near infrared imaging (NIRI) to aid in the detection of caries above the gingiva. Infrared is outside of the visual spectrum, and this harmless wavelength penetrates tooth structure, allowing the device to operate as an accurate and powerful transillumination device for identification of caries above the gingiva. After completing the scan, the operator can tap an icon on the screen and see the scan through the eyes of NIRI imaging.

Viewing the dentition through NIRI is another data gathering tool for the doctor to help render a clinical decision. Combining things, such as NIRI, with the data acquired through digital radiographs, can add accuracy to a clinical situation that otherwise might have been difficult to diagnose with a high degree of certainty. NIRI is also nonionizing, meaning that it can be used on pregnant patients and young children without any concern regarding radiation.

Whether used as a diagnostic scan in hygiene or reviewing scans taken for routine prosthetic cases, NIRI is a feature that is accurate, always on, and simple to use. During my test drive, I encountered areas of decay that I otherwise would not have identified.

Efficiency

With the iTero Element 5D Plus imaging system, full mouth scan takes just minutes, and the learning curve is short. Even our study models are now done digitally, and the models are created using our 3D printer. Gone are the days where study models were taken in alginate, then poured immediately to minimize distortion. Cases are stored in the cloud and can be reprinted easily, if needed.

As I mentioned previously, the seating of cases is tremendously easier than before. Single unit cases—which are most of the cases seated in the average general dental practice—are frequently accomplished in 10 minutes. We normally block 30 minutes for a single unit seat, but it is rare if it takes longer than 10 minutes.

Allow me to let you in on a secret: Patients hate impressions. However, they are fascinated and impressed with the iTero Element 5D Plus imaging system, and they talk about it to their friends and relatives. One of the unseen benefits of the system is that the technology markets itself. We get referrals based on digital impressions and our overall use of technology to improve patient outcomes.

Wrapping Up

I’ve been an iTero client for well over a decade, and for good reasons. However, I’m not just impressed with the iTero Element 5D Plus imaging system simply because of that fact. I’m impressed because the system is capable of so many things! I also feel that, as a long-term client, I have a better appreciation for how much their systems have improved.

Caries detection with NIRI, occlusal analysis, time-lapse videos, intraoral photography, and digital impressions are all wrapped up in a highly esthetic and highly mobile high-tech package. I know a lot of you that have not yet made the jump to digital are weighing your options. The lack of trade shows for over a year hasn’t helped. However, if you are looking to make a purchase in the near future, and you saw an iTero unit a few years ago, you owe it to yourself to take a close look at the iTero Element 5D Plus imaging system.

Suffice it to say if you haven’t seen iTero lately, you haven’t seen iTero.

Oh…one other detail I should tell you. There is a time limit to my test drives and there always comes that point in the process when the product must be sent back to the company that was gracious enough to allow me to have time to evaluate it.

This time was a bit different. I was so impressed with the iTero Element 5D Plus imaging system that I called the company and had them start the paperwork so I could have one of my own. In just a couple of months, the technology had become indispensable to my practice. The iTero Element 5D imaging system is an impressive device. I’m so impressed that I cannot do without it. I think you will feel the same way.