The iTero Digital Impression System: Ten Steps to Speed, Efficiency, and Success

The iTero Digital Impression System: Ten Steps to Speed, Efficiency, and Success
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Digital impressions have many distinct advantages over conventional impression techniques. In our 18 months using Cadent's iTero unit, the biggest advantage has been how efficient we have become with our indirect procedures.

Before iTero, a single unit crown would be scheduled for an 80-minute prep appointment and a 50-minute delivery appointment. With digital impressions, we now schedule 60 minutes for the preparation and 30 minutes for delivery. That's 40 minutes total we save with every crown! If "average" per hour production of a dental office is $500/hr, then we have the potential to produce $330 more dollars which we can directly attribute to our use of the iTero.

Let's look at the 10 steps we use every day that allows improves our efficiency with indirect restorations using the iTero unit:

1. The patient is seated and a small amount of topical anesthetic is placed on a cotton roll. The cotton roll is placed next to the injection site.

2. Keeping the cotton roll in place, the assistant takes a pre-op impression using a fast setting polyvinyl alginate substitute material using a stock closed tray ("triple-tray"). These fast setting materials set up in less than 2 minutes. Some examples on the market today are: Alginot FS by Kerr, Status Blue by DMG-America, Silginat by Kettenbach. The reason for the using these materials is that the impression can be saved in the office (we store in a ZipLoc bag with the patients name on it) and are available in the rare occasion that a patient loses their temporary.

3. While the pre-op impression has been setting the topical anesthetic on the cotton roll has had sufficient time to allow for some localized anesthesia to the injection area. Now the dentist or the dental hygienist can administer a much more comfortable local injection.

4. Upon completion of the injection, the dental assistant scans the opposing arch using the iTero. This process takes less than 3 minutes to complete. Once the scan is complete the patient should have profound local anesthesia to the tooth/teeth to be prepared.

5. Next the tooth/teeth are prepared for the restoration prescribed.

6. Upon completion of the preparation, the dental assistant will load the pre-op impression with an automix temporary material. Examples would be: Luxatemp by DMG-America, Venus Temp C&B by Heraeus. This is placed in the patient's mouth and they will close on the tray. The material is allowed to set for 3 minutes. During this time the dental assistant begins to clean up the work area.

7. The dental assistant removes the temporary and takes it to the lab to trim and polish.

8. While the temporary is being finished the doctor completes the scanning of the prepared arch. The final digital image is evaluated and additional scans are taken if needed.

9. The dental assistant returns from the lab with the completed temporary and cements it to place.

10. While the assistant is cementing the temporary restoration, the doctor completes the electronic prescription form and sends all the information and the digital impression to the model fabrication facility.

After 18 months with the iTero digital impression system, the above work flow system has allowed us to become much more efficient during our preparation appointments. To gain 20 minutes on each single unit preparation procedure certainly adds to our bottom line.

But it's not just the preparation procedure that has become more efficient. Our delivery appointments are also noticeably shorter since using the iTero digital impression system.

And interestingly, we have done nothing different in our workflow to save time at delivery. It's just that restorations fabricated on an iTero-generated model fit more accurately! The accuracy of the digital information combined with the accuracy of the milled polyurethane models provides the lab with ideal casts. Margins are excellent, interproximal contacts are accurate, and occlusal contacts require minimal adjustments, if any. So the 20 minutes saved at the delivery appointment can be directly attributed to the increased accuracy of the digital impression and the milled models.

We are not alone in this observation. Dr. Gary Henkel published in Compendium 2007 similar clinical finds when testing for clinical time savings.

But when you look at technology that allows you to do better dentistry faster and is more profitable to your practices' bottom line, and make the procedure a more comfortable experience for your patient……, how can you not consider bringing that technology into your office?

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