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April 2008 | Dental Products Report
Techniques | iTero Make a clean impression Cadent’s iTero digital impression system eliminates the need for messy materials while giving clinicians more accurate impressions. By Bradley Dykstra, DDS, MBA. Information provided by Cadent Inc.
Imagine creating an impression that’s more accurate than what’s typically achieved through conventional techniques—without putting material in the patient’s mouth and without pouring up, trimming, or storing models. That day has arrived, with one of the messiest areas of dentistry undergoing a major clean up. Digital technology is revolutionizing digital impression taking. The Cadent iTero digital impression system, which entered the mainstream dental market in 2007, is one of the first digital systems designed to replace conventional impression-taking methods, which can bare often uncomfortable and imprecise. Common applications include taking digital impressions for crowns, bridges, inlays, and onlays. This system provides the precision, accuracy, fit, reproducibility and other CAD/CAM benefits without the expensive milling system, associated supplies, and in-house maintenance; it also eliminates the voids, pulls, distortions, and the general margin of error found in conventional impression techniques and modeling processes. Learning the system was virtually painless. A trainer guided me and my staff and me through the process in one day. After the first few cases, the scanning process almost became second nature. These steps illustrate how to use iTero: 1. Open the program and enter the patient’s name and insertion date. Choose the restoration, appropriate shade, and lab from the pull-down menus. Choose the tooth scheduled to be restored from the chart and the restoration from the pull-down menu. Chart missing teeth or spaces. 2. Next, the scanning process begins, with no powder coating or any special requirements necessary. The computer voice prompts the tooth and view it wants the scanner to capture. The first and most critical scan is an occlusal view of the prepared tooth, which must show the margin’s circumferencetially (Fig. 1). The doctor can keep or redo this scan. 3. Once this first view is accepted, the computer voice continues to prompt the tooth and view that it wants next. The second capture is the palatal view at 45° (Fig. 2). The monitor instantaneously shows the scan on the screen; if it is not acceptable, it is easy to delete it and retake the view. The number of scans ranges from 20 to 30, depending on the number and location of the prepared teeth. 4. When the initial scanning is complete, the virtual model is ready for viewing on the monitor (Fig. 3). It can be viewed from the side and top, like a poured model, or from underneath where it looks like a traditional impression. It is helpful to examine both views. It can be rotated in any direction so the adjacent teeth proximal contact areas can be clearly viewed; it can be viewed in color to show areas of contact and the amount of space for the restoration (Fig. 4). 5. If the reduction is not enough, it is easy to reduce the prep and rescan. This is better than receiving a call from the lab technician informing you there is not enough space to construct the restoration. If certain areas of the model are not clear, take more scans. 6. Once the digital impression is complete, the digital file is transmitted via a wireless Internet connection to Cadent headquarters, where trained lab technicians review it; any soft tissue or unnecessary information is removed in the “modeling” process. After modeling, the virtual models look like the final physical models generated from the data file. A trained iTero technician reviews the modeled files, does the initial case design, identifies finish lines, and determines the path of insertion. 7. Next it is sent to the lab (and the dentist if requested) where the virtual impression is reviewed and the model milled (Figs. 5 and 6). The physical model is sent to the lab, where a precise physical restoration is created and sent to the dentist. Conclusion It takes 3 to 7 minutes to complete scanning, which is about the time required for conventional impression materials to set. With no time devoted to preparing impression trays, pouring up and trimming models, and the associated clean-up, the time saved can be significant. The precision of these computer generated models (Fig. 7) results in accurately fitting crowns that require minimal adjustment. My seating time has been reduced by about 5 minutes per restoration. There shouldn’t be any remakes if the system is used correctly, which may more than pays for the system and improves the relationship between the dentist and the lab. The improved patient experience is also is a big positive. Patients appreciate not having impression material in their mouth. They are often fascinated by the process, and because seeing their virtual model is so unique, they talk about it with friends and family—an unexpected but effective practice builder. With benefits including increased patient satisfaction, improved clinical outcomes, and enhanced office efficiencies, this system will enhance your reputation as a high-quality practice and help maximize your potential as a 21st century dentist.
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