iTero® and iTero® Element™
Developed by Align Technologies (www.itero.com), the iTero is the first generation of this open-system scanner. The iTero Element is the newest version. Multiple restorative, implant, and orthodontic workflows are available. The incredibly accurate image is acquired by a laser confocal point and stitch method, and displayed in pseudo-color. The entire system is on a mobile cart. The system will communicate with the iOs TS150 mill for a chairside option. The new Element system has a patented dual-aperture lens system, which enhances the speed and quality of the images produced. Neither the original or the Element system provides a true color. The iTero Element is not yet available for restorative dentistry, but it is available for use in orthodontics.
The Carestream CS 3500 (www.carestreamdental.com) is a relative newcomer to the market. An open system, it uses a laser point and stitch technology for image acquisition. This system requires a point-and-click by the operator to obtain the image. The system generates a “life-like” image in pseudo-color. Once again, with this being an open system, the restorative and implant restorative options are plentiful. The system can be used for orthodontic planning, but there is no orthodontic workflow at this point in time.
CEREC (www.cereconline.com) has several scanners available, and is a closed system.Please note, being a closed system does not imply that there are fewer restorative choices. There are several restorative choices available; however, in order to use a laboratory, they must have CEREC inLab. There are several mills available that communicate with the CEREC Omnicam. The Omnicam has the most capabilities of the CEREC scanners. Powder is not used to acquire the image for this system. The scanner produces an image in pseudo-color. The image is acquired via a high-speed confocal point-and-stitch method. The system has multiple implant and restorative workflows. There are also a couple of orthodontic workflows available as well. The main disadvantages to this system are the fact that it is closed and that it is rather costly.
Incorporating Digital Scanners Into the Practice
The most important factor is the effect on the patient. The patient should always be the clinician’s top concern. The ill-received perception of a clinician’s technique could have a negative impact on that clinician’s success. Recent studies have shown that a patient would choose a digital impression technique over a conventional impression technique.15
The switch to digital impressioning should not be made to eliminate the lab bill. The dental laboratory is more capable of fabricating certain restorations. Although it may be impossible to eliminate the lab bill entirely, it can be greatly reduced. Many labs have offered incentives to practitioners that are using digital impressioning devices. A common misconception with regard to the dental lab is that all restorations must be CAD-produced. The impressions and models created from open systems make it possible for any type of restoration to be produced. Digital impressioning should strengthen the relationship with the laboratory. In addition to the reduced remakes, the laboratory will benefit from the lack of distortive potential in transporting the models. The aforementioned benefits should also lead to reduced time in seating the restoration.16
Make sure that the staff is committed to change. One of the biggest failures of incorporating technology is the resistance to learn. While there is a learning curve associated with each of these scanners and it is not an exact science, all staff members should be fully competent after completing 20 scans.
Another factor to consider is the cost of the system. When one looks at costs, one needs to look beyond the initial costs, to other factors such as monthly usage fees, software upgrades, and warranties. The least expensive and the most expensive systems each have different capabilities, and therefore will also have different fees for usage and upgrades. Cost should be weighed, but is certainly not the only factor to consider.
A great feature of any of these systems is the ability to integrate them into clinical practice with minimal up front investment. Although initially a dentist may not want to mill, it is recommended that he or she buy a scanner with milling capability. This will eliminate the need to purchase a new scanner later on if milling ever becomes desired.