Digital Smile Design - Oct 17, 2019

A dentist’s guide to incorporating an intraoral scanner in your clinic

Coffee Break with Coachman with Dr Ingo Baresel


In the latest episode of Coffee Break with Coachman, a series of video interviews between Christian Coachman and other influential personalities and thought leaders in the dental industry, Christian spoke with Dr Ingo Baresel from Germany -- an expert in digital dentistry, an iTero user, and expert in the restorative workflow with iTero.

In this episode, Ingo and Christian spoke of their experiences with using different brands of intraoral scanners, delving into their features and evaluating the value that a scanner can add to treatment workflows. After a comment-provoking discussion on Instagram which took place a few weeks ago, in this interview they talked specifically about iTero and the new iTero Element 5D imaging system that Dr Baresel uses in his clinic. Read on for an overview of their discussion and to listen to the entire interview.



Christian: “A few weeks back, Ingo and I had a good discussion on Instagram after I posted a video about the iTero scanner being a good choice for restorative dentistry. I decided this was an important discussion and invited him onto this show so we can talk about it in more detail.”



Meet Doctor Ingo Baresel

Dr Ingo Baresel has an office with his brother and his father in Karlsburg, a small town near Nuremberg. He has used intraoral scanners for eight years and is a big fan of them -- speaking about the topic is important to him. Ingo also organized an event focused on intraoral scanners that took place in Dusseldorf October 2019. Over two days, speakers discussed and compared the different scanner systems while participants were able to try various scanners for themselves through focused topics such as implant workflows and scanners for children.



So, how do you choose a scanner?

Christian: As I mentioned before, you made an interesting comment on my Instagram post about the iTero scanner which created a mixed response - there were some dentists who completely disagreed with me.
You said: 


‘You all have to accept that there are many IOS on the market which are all accurate and can be used for restorative work. I have different scanners in my office including an iTero element 2 and 5D, a Trios 3 and a Straumann Virtuo Vivo, and have worked with nearly any scanner on the market including Carestream, Medit, Dental Wings and Sirona. We did about 3000 cases with iTero and it works perfect and easy. That doesn’t mean the others are bad, you have different scanning strategies, setting options, software features... and I could talk for hours about the advantages and disadvantages of every single scanner. It’s the same thing with buying a car, different companies are on the market and we can discuss if Audi, Mercedes or BMW is better but honestly all are great cars. Finally you have to try which fits best to you but stop blaming the others.’


Christian: I really love to talk to people that are privileged enough to have all the scanners and try all of them in their clinic. Tell me, how did you come to this opinion? What did you learn throughout these years comparing all the systems?


Ingo: “The main reason why I choose a scanner is accuracy. This is still the most important thing in dentistry. We have to have an accurate scanner. But when you look at all the research, which was done especially in recent months and the last year, and you compare all those scanners, most of them are accurate enough to make a full-arch scan. We talk about five microns better and 10 microns worse, but to be honest, in our daily business five microns are not really important. We have to accept, and everybody who's talking about intraoral scanning has to accept now that intraoral scanning is accurate. Not just on single T, we are accurate in full-arch scans. So this is the main reason to choose a scanner. When I have a scanner which has no research about it I would not choose it because sometimes, as we all know, the companies tell us everything to buy something. So I want to have accuracy and research. That's the most important thing.

'The main reason why I choose a scanner is accuracy. This is still the most important thing in dentistry.'

But then when we accept that most of them are accurate, I have to look at the features. What do I need? I have to look at the price. What can I afford? What do I want to do with the scanner? And there are so many differences between all those scanners where you have to think about which is the right one for me.


So my personal opinion is, I look at the scanning strategy and I look at the scanning position. This is the most important thing for me. That means, the way I scan a patient is the strategy behind it. How do I scan a patient with many, many, many preparations in an accurate way? And there are big differences between all those scanners, and there are several other features like caries detection, time lapse functions, recording the bite movement already, HD photos, whatever. There are so many options now that we can choose. I have to choose which fits me best.


It doesn't make sense to blame any other scanner because they're accurate, and you have to have experience with a scanner. If you are used to the scanner from company A and you grab the scanner from company D, it's a quite different way of scanning. So you cannot say I can do it with A and I cannot do it with B and this is bad.”



Workflows and special features of iTero

Christian: What is your favourite feature of the iTero and why? 


Ingo: “With iTero, the main reason for me to use iTero is the workflow, the scanning strategy. I always say we have two things: we have a scanning path and we have a scanning strategy. The scanning part is something every company tells us: to scan the patient usually from the occlusal, the lingual and the buccal side. This is still the same with nearly all scanners.


The big advantage of iTero is that you can scan one tooth after the other. One preparation after the other. So this morning, I did a patient with 14 teeth in a row. We made a huge case. I scanned the first one, put out the retraction aids, scanned the first one, took my time, scanned the second one, did the other retraction aids, scanned the third one, and so on. So I can just care about one at a time. This is how iTero thinks. Compare this to most of the other scanners where you have to scan everything in one scan. So you have to take out 14 retraction aids and scan them occlusal side, lingual side, buccal side, and we also did lower, which I did today. 


So what will happen? First of all, I cannot control 14 teeth just collecting gingiva, blood, saliva. This is analogue dentistry. This is how we did it before. What I'm doing when I'm scanning with another scanner is to scan it all in the scanning part, occlusal, lingual, buccal. What will happen to the tongue? The tongue will overlap on one side every time. So, afterwards I go back to the scan and have to correct it in every single area. And I have to cut it out, re-scan it, cut it out, re-scan it. And then we have the same problem, we have stitching. We have, again, matching situations. I want to have as few of them as possible. But this is really hard work. And with iTero you scan just one after the other, then again on the whole area, and you have time to care about one after the other. And this is, for me, the main reason that makes it so simple to scan the patient even with many restorations.

'If you use digital thinking like analogue you're missing the point'

Christian: “I loved when you said, if you use digital thinking like analogue you're missing the point. You're not taking full advantage. So when you have a digital tool, you need to understand that the digital tool allows you to reinvent yourself, to do things in a different way.”

'When you have a digital tool, you need to understand that the digital tool allows you to reinvent yourself, to do things in a different way'


Scanning in 5D: the iTero Element 5D imaging system

Christian: So how do you use iTero?  How and when and how often do you use it? Has it changed the way you do dentistry? 


Ingo explains “5D offers a powerful way to detect caries; you see lesions and caries in a very early state which is really brilliant.” When patients come to our office we talk to them, we can show them their problems on the scanner, we can show them caries on the scanner. If somebody sees the caries on the scanner, they believe us because seeing is believing.


Every dentist knows that when you tell the patient: ‘I see there is some caries in between your teeth’, the patient's answer is always the same: ‘Yeah, but I don't have any pain. Why do you want to treat me?’


Now, you have a tool to talk to the patient, to show the patient their problem, and they all understand that there is something wrong. So then, if you say we need a treatment, they believe you, they know that it's necessary to do a treatment. 


We can also do a time-lapse function, which means we have an overlapping of the two scans and the scan shows us the changes. So, we can monitor the patient much better and show it to the patient. And the patient really understands the problems much better than before. This the main thing that has changed in my office. We use the scanner as a communication tool. And this is brilliant.

And what is important with the 5D when you scan with the iTero is that you have it in just one step. You don't have to do any extra scans because the wand is taking the infrared pictures while you're scanning like you're used to, so you don't have to put on any extra tips or do extra scans. It's just in one scan.”


Christian: “So we need to analyze the scanners for the specific, I say, treatment workflows. I call it treatment workflows meaning the scanner workflow for orthodontics and aligners, the scanner workflow for restorative, the scanner workflow for implants, let's say the three main ones. This is clinical. Clinical performance with the scanner, and each scanner is a little bit better here and there, but they're all doing a great job there and iTero is definitely of the top ones there.”



How do you get started with iTero?

Do you have any advice for clinicians who are new to iTero and want to make the most of it? 


Ingo: “First of all, training, training, training, training. For example, I have so many colleagues who were telling me at the beginning when I was showing them the scan in three minutes that this is not possible, that they need 15 minutes for a scan.

'Train with it and use it. Don't put it away, and say, ‘It's not working, bring me my analogue impression because I'm in a hurry'

It will get better. You have to train it, and you will be able to do it. And every one of my colleagues is now able to do it in between three to four minutes. This is the first thing. Train with it and use it. Don't put it away, and say, ‘It's not working, bring me my analogue impression because I'm in a hurry.’ Take your time, train in scanning, and the most important thing, take great care with retraction because you cannot cheat with a scanner. When there is a little bit of bleeding you will see it on the scanner. When you have an analogue impression you can press something around and hope that nobody sees it.”

'Take great care with retraction because you cannot cheat with a scanner'

“The second thing is to care about your preparation, and care about your retraction. This is something for restorative, but if you have an iTero don't think it's an impression machine. Again, use it for every patient. Think about a new strategy in your office.”



Found this blog post interesting? You can watch the full interview between Christian Coachman and Ingo Baresel here.




This article was created in association with Align Technology.

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