The Reinvention of Digital Scanning

Jul 01, 2009 No Comments by

When the digital dental scanner was introduced in 1987, a paradigm shift was created in the way dental impressions could be made. But it was 20 years later when scanner hardware and software fulfilled the potential desired by dentists everywhere. In 2007, digital impression companies produced, a more user-friendly system that produced a significant increase in the accuracy demanded by dental professionals worldwide.

Dr.  Johnny Øverby, of Tromsø, Norway, was the first dentist in Norway to use digital impressions, a technology that replaces more conventional and less-effective methods of impression making. “Intraoral scanners give us the technology to create a digital file directly from a patient’s mouth,” said Dr. Øverby. “This results in improved accuracy of the dental model and a better fit of the final prosthesis.”

“Since its introduction two years ago, iTero has been embraced by the dental community as a pioneering product in the era of digital dentistry,” said Terry Gunning, chief executive officer of Cadent. “With the introduction of our next generation system, we have built on the outstanding performance of the original product and continued the legacy of continuous innovation and superior customer service for which Cadent has become known.”

Prior to iTero, first-generation digital impression systems were hindered by their narrow application to only a small fraction of common restorative procedures. They also carried a capital-intensive price. iTero broke new ground both clinically and economically with technology that can be used for all restorative options and with a lab-based solution that has significantly improved quality and service.

“The new iTero system introduces novel functionality that significantly improves scanning time and offers users additional flexibility in designing superior-fitting prosthetics,” added Gunning. “These enhancements allow our customers to complete the scanning process more quickly, accurately, and efficiently.”

The added features and benefits in the software update include the following:

  • 50% reduction in overall digital capture and scan time
  • 50% faster real-time display of 3-D digital model
  • Expanded shade library to include vita 3-D master
  • Background color options in both solid colors and gradients for added depth of 3-D models
  • Modified foot pedal design for increased stability during scanning

Process

At the dental offices of ABA Tannlegene, Dr. Øverby can quickly capture digital images of the patient’s teeth and bite using the handheld iTero laser scanner. The scanner captures the 3-D geometry of the tooth preparation area. Real-time assistance is provided by a laboratory script and audible voice prompts.

The digital model is magnified and displayed while the patient is still in the chair. This enhanced visualization and real-time analytical tools enable Dr. Øverby to zoom in on individual teeth or look at the patient’s full bite and properly diagnose needed procedures. He can then make adjustments if needed before completing the scanning process. This, in turn, reduces the potential for compromised work or unnecessary additional patient appointments. The complete process takes less than five minutes of Dr. Øverby’s time.

Once the dentist approves the image, the file is sent electronically to a Cadent-partnering dental laboratory, which reviews the digital file and sends it electronically to Cadent’s manufacturing facility in New Jersey for milling into the physical model. Cadent models are unique in that one model is used for both the working and solid model. Cadent returns the physical model to the dental laboratory, which delivers the final prosthesis—a beautiful, precise-fitting restoration—to the dentist. All of this is completed within standard service times. The process dramatically increases the level of communication between the lab technician and dentist.

Benefits of the iTero system are simple: “Patients no longer have to bite on the impression tray and experience the choking and bad taste that accompanied it,” said Dr. Øverby. “Dentists and patients also like that the system is more accurate than before, which results in dentists making fewer mistakes.”

With a putty impression, the final fit of a patient’s crown or bridge is related to the quality of the impression, which is sometimes not a perfect match. If the model is not precise, the process starts all over.

Unlike some veteran dentists, Dr. Øverby is not afraid of new technology. He has been practicing dentistry for 30 years but began using the iTero system just last December. “It just makes sense,” he said. “Digital technology has given me better quality, accuracy, and turnaround time for my lab work. I save lots of time and have practically no remakes.”

Digital impression technology has made a significant improvement in Dr. Øverby’s practice. “People are very impressed, and the response has been tremendous,” he said. “Since we’re the first in Norway to use it, the local newspaper came to interview some of the patients and take photographs on the first day we tested it.”

Although Dr. Øverby has used the Cadent system for just six months, all preps in his offices are now going through this system. “It’s just fabulous,” he said. “Our practice is growing, and we will soon use a massive advertisement for the system.

Prognosis

While iTero was not the first digital impression system to market, it has several advantages over the leader.

  • It is a completely open system, which means it connects to any open CAD/CAM system
  • It takes a digital impression that can be used to fabricate any type of fixed restoration, like a traditional polyvinylsiloxane impression material.
  • The operator—the dentist or the assistant—can take the impression easier than with other systems. The possibility of error due to air bubbles, tearing of impression material, tray movement, insufficient impression material, and other issues inherent with conventional impressions is eliminated.
  • iTero does not require the application of powder to the teeth necessary with other systems. The powder is expensive, can be messy, and has shown to be the number-one cause of distortion in the digital impression.

“Prior to last year, I had never used a digital impression system,” said Dr. Øverby. “Many of my colleagues have had negative experiences with CEREC, and I was afraid that it would be difficult to get started with iTero. But I quickly discovered that the iTero system is very user-friendly, easy to operate, and easy to get started with.”

A basic understanding of computers is necessary for the iTero system, but Cadent offers training to get a dental office up and running in about two days. In addition, follow-up training and Cadent Customer Support are available when needed.

The entire iTero system sits on a single, compact, unobtrusive cart. It is approximately 29 inches tall, 26 inches wide, and less than 16 inches in depth. It weighs 187 pounds. Records are backed up on a secure server at Cadent, providing access by the dentist should the iTero system suffer damage.

The significant advantages of digital impressions will make intraoral digital scanning standard procedure in most dental offices within the next few years. Digital scanning has proven to increase overall impression efficiency while reducing remakes and returns. Laboratory products become more consistent and require less chair time at insertion, giving the patient a positive experience.

By the Numbers

Cadent claims some very impressive customer satisfaction statistics on its Web site. Prospective clients can verify these claims as they evaluate the product for themselves.

  • 98% of dentists indicate greater visualization of the tooth prep area
  • 93% of dentists appreciate real-time software evaluation of the tooth prep area
  • 93% of dentists welcome the elimination of impression materials and trays
  • 90% of dentists praise the value of looking at the digital impression while consulting with a laboratory
  • 84% of dentists believe the technology will add to their image as a high-quality practice

Impression Milestones

Impression technology breakthroughs follow decades-long cycles.

  • 1937—Sears introduced agar as an impression material for crown preparations
  • 1965—ESPE, GmbH introduced the first elastomeric material, Impregum™, a polyether material specifically produced for dental impression making.
  • 1987—Sirona Dental Systems LLC introduced CEREC®,the first commercially viable CAD/CAM system for the fabrications of dental restorations.
  • 2007—Cadent introduced iTero, which uses parallel confocal imaging combining laser and optical scanning to digitize tooth and gum structure
A Closer Look, Summer 2009

About the author

Dr. Johnny Overby maintains a practice in Tromso, Norway.
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