Digital Smile Design - Apr 30, 2020

Master the DSD first appointment with iTero Element 5D

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The DSD protocols for the first and second appointments are part of what makes Digital Smile Design what it is today. They give us a clearly defined pathway that takes our patient from awareness of their problem to treatment, and it’s all planned out with high precision – before the patient even arrives at our office – to make sure we offer a seamless experience that is nothing short of exceptional.

A crucial part of being successful with this workflow is embracing the power of technology to improve diagnosis, treatment planning, patient communication and of course, the patient experience. And at no time is this more important than in our patient’s first and second appointments. When we approach them in the right way, we are able to give patients a positive experience which demonstrates the value dental treatment can add to their lives.

What happens in the first and second DSD appointments?

This is when we introduce our patient to the workflow of a digital dental clinic. In these appointments, it’s all about emotion; even the smallest of details can contribute to us either gaining or losing emotional credits in the eyes of the patient, giving us an overall ‘total’ which leads them to accept and move forward with treatment, or cancel or postpone.

To create a positive experience that shows our patients what we can do and gets them emotionally invested in the treatment journey ahead, the correct use of technology is crucial. Digital solutions such as the iTero intraoral scanner avoid the negative aspects of dental appointments and replace them with positive ones. 

For example, uncomfortable procedures such as alginate impressions and intraoral pictures are some of those that are most disliked by patients; with iTero scanner, we are able to completely eliminate the need for them. Instead, the patient now has their teeth scanned in minutes with no need to suffer the texture, odour and discomfort of traditional impressions. Then, they have photos and videos taken while they smile and chat with us. Christian Coachman explains: “This is the patient’s experience of a digital dental office in their first appointment. It’s very cool; patients really enjoy the process. It’s smooth, quick, and we emphasize the benefits of having these files in digital, not analogue.”

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Christian believes the intraoral scanner is a vital piece of technology to streamline the first appointment and ensure the highest quality results and experience for patients. While the value of a scanner has been much explored in terms of clinical and technical procedures, the moments where we see the biggest benefits are in fact the first impact, documentation, diagnosis, planning and selling – so the moments before we actually do dentistry. With all of this the scanner becomes your ally in the first and second appointments, as long as you demonstrate the value to your patients: “I believe in the full digital process, I believe it’s a great investment – if you invest in the storytelling as well.”

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Why do we choose the iTero Element 5D Imaging system as our intraoral scanner for the crucial first appointment?

With the advances made to enhance the capabilities of all intraoral scanners, what is it about iTero in particular that makes it stand out? Christian explains: “When evaluating a scanner, I like to divide its performance into four topics: the restorative workflow, the orthodontic workflow, the implant workflow, and then its performance as a ‘first appointment’ scanner. This means the features of the scanner that can help us improve the efficiency of the first and second appointments in terms of documentation, diagnostics and patient motivation.

Quote 3@4xWhile the iTero Element 5D scanner has top-notch capabilities in all four areas, I believe that iTero is a level up compared to others when it comes to scanners for first appointment performance. It is definitely the best scanner for the first appointment experience in terms of documenting and presenting relevant information to the patient, and increasing motivation by doing the orthodontic, artificial intelligence-guided simulation. And to all this we add its diagnostic aid capability with NIRI technology to see and show interproximal caries. 

Quote 1@4xWhen it comes to diagnostics, iTero has a couple of features that are great in a first and second appointment conversation with the patient. We have TimeLapse, orthodontic simulation, case assessment - which means comparing where the treatment is to where it should be when it comes to Invisalign® - and now, new technology: NIRI.”

But why are these features of the iTero Element 5D imaging system so valuable for our first and second appointment workflow? 


  •  Diagnose issues and educate your patients about their oral health

The iTero Element 5D scanner offers Near Infrared Imaging technology that improves our diagnosis and treatment planning by giving us a full visualization of the internal tooth structure: as you scan the patient, the same tip does an infrared reading of the tooth that allows us to see inside it. Thanks to this world-class technology, we have the power to see tooth decay before it even shows up on an x-ray – making the iTero a valuable tool for improved diagnostics which benefits both your patients and your clinic. 

In fact, an Align Technology survey reported that when incorporating iTero Element 5D scanner into their current diagnostic protocol, 87% of surveyed practitioners indicated they increased the number of diagnosed interproximal caries above the gingiva by 56% on average.*

With the iTero scanner, it’s not just that you can see this diagnostic information either – your patients can also see these deeper issues affecting their teeth, in real time. This is a valuable differential which can transform your communication with your patient – especially in the first appointment. The iTero Element 5D’s NIRI technology harnesses the power of visual communication so that you can show, rather than tell your patients what is needed, allowing them to see the situation for themselves and gain a new understanding for why treatment is necessary. “It’s a waste of time explaining something to patients without images,” Christian says. 

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In support of this, the same Align Technology study reports that 100% of surveyed users agree that iTero Element 5D scanner enables better patient education and understanding of their oral health leading to an increase in patient acceptance of treatment plan.*

By scanning your patient at not only their first appointment, but at every following appointment, you can benefit from another key feature of iTero: Time Lapse. This allows us to compare different moments in the patient’s history by overlapping the scans to see the changes in the patient’s mouth over time – another powerful tool for diagnostics and patient communication.

  • Simulate outcomes to motivate your patients 

A second important part of improving our communication with patients involves showing them not just their current situation, but the result of the treatment you plan to perform. To do this, the iTero Element 5D imaging system provides us with the Outcome Simulator

Giving patients this chance to see their results before treatment begins is a hallmark of the Digital Smile Design concept which has fundamentally changed dentistry. It is a crucial part of the first and second appointment process which provides a unique and memorable experience for patients and breaks down communication barriers with those patients who are reluctant to commit to treatment for fear of the unknown. 

Christian elaborates: “I think that’s one of the biggest advantages of iTero intraoral scanner. Allowing us, as a restorative dentist or as an orthodontist, to do a chairside orthodontic simulation with artificial intelligence – an automated artificial intelligence ortho simulation in 60 seconds. This is amazing for patient communication and patient motivation.”

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  • Exclusive link with Invisalign® clear aligner system

One of the biggest advantages of iTero is its link to the best aligner system in the world, Invisalign®, which has an incredibly efficient and intuitive workflow. This link creates a seamless workflow between the scan, the digital orthodontic planning and the manufacturing of high-end aligner solutions. As a result, you can take your patient’s iTero scan and show them how their teeth will be moved as a real-life visual of just how treatment will look for them.

Another feature of this link, which is exclusive to the iTero Element 5D, is Invisalign Case Assessment. This becomes incredibly valuable at later points in your patient’s treatment when you are then able to monitor progress by comparing the current situation of their teeth with the digital plan and the stage they should be at in the process – at any time.

The integration of Invisalign® and DSD is a third advantage of the iTero link with DSD. As a result, you can take your patient’s iTero scan and show them how their teeth will be moved using their face as a guide. This ability to see treatment within the patient’s face in ClinCheck® software – instead of in isolation – gives the patient a real-life visual of just how treatment will look for them. This gives you another added tool to improve your communication with your patient in the first and second appointments. 

Powerful technology for improved case acceptance 

Through features that have a significant impact on diagnosis, treatment planning, patient communication and the patient experience, iTero ultimately becomes a fundamental tool for increasing case acceptance in our dental clinics. 

In the Align Technology survey, 100% of surveyed users agree that the imaging and visualization capabilities of iTero Element 5D scanner lead to 70% increased patient acceptance of recommended caries treatment.*

“ITero is definitely the one that is leading this process of transforming the scanner from being just a scanner to being an imaging communication system. When we talk about iTero we’re not talking about a scanner anymore, we’re talking about an imaging, communication platform and system. It’s like having a new team member beside you to help you see things and communicate things.” Christian says.


In conversation with Dr Peggy Bown, Peggy Bown Dentistry 

5uvka1vMWhat iTero model do you have at your clinic? 

In my clinic I have four iTeros. I have one Element One, two Element Twos and the Element 5D as well.

What is the best feature of your iTero and how does it help you in your clinic in particular? 

I’m very occlusion based – I did a lot of training in the last ten years in occlusion, and I’m very focused on trying to improve the bite or the occlusion first and so one of the big ones (honestly there are four or five, so it’s really hard for me to pick!) is the occlusogram – you can use it very readily, it’s very quick and it gives the patient what almost looks like a topographic map, like a weather map, with the red. Red doesn’t always mean bad, but it quickly tells the patient where red should be. So if we see a lot of red at the front, we can immediately correlate that with the fact that they are having chipping, wear, maybe they’re having recession, and all those things allow us to then track what’s happening.

Was there any other benefit from having your model of iTero that was an unexpected bonus in your clinic setting? 

From a marketing standpoint, I think of my scanner and I use it in my marketing as “we are a digital practice” and use it to talk about how we’re different and provide more value for the patient, but it is my best internal marketing tool.

You need a great website, you need all that, but your scanner could almost be put into your marketing budget if you want to think about it in that way. And it’s really one of those things that, once the team’s onboard, it sells itself. Again, you let the scanner tell the story and it tells the story of how awesome and cool your practice is and also how your practice really stands behind what it’s doing.

What is the one thing you believe every dentist should understand about iTero scanners?

The power of how it can change your practice. It’s not just a tool to take better impressions; it’s about the patient experience, but it’s about these tools. Probably more than 50% of what I do with it is educational. It sets you apart – not everyone is willing to go out and buy a scanner or buy two or three, but the more you embrace that, the more you can really at this point in time in dentistry, really set yourself apart.

In conversation with Dr Ingo Baresel:

Dr Ingo Baresel is an expert in digital dentistry and the restorative workflow using iTero intraoral scanners. Below, he answers a few questions about the iTero Element 5D Imaging system and it has benefitted his own clinic:

What iTero model do you have at your clinic?

We are using an iTero Element 5D and an iTero Element 2 in our Clinic

What prompted your decision to invest in this particular model? 

We have used all iTero models until now, beginning with the HDU, and every new scanner was a step into the future. So we always wanted to have the newest models.

What is the best feature of your iTero and how does it help you in your clinic in particular? 

It is not just one feature, it is the whole system with precise and easy scans for restorative and implant workflow, the perfect connectivity to Invisalign® with outcome simulations, but the new NIRI tool for caries diagnostics makes the scanner really outstanding.


Align has released a series of survey claims from a group of dentists who used an iTero Element 5D for 6 months. One of the claims was: "The majority of surveyed users agree that the Improved communication capabilities of the iTero Element 5D scanner lead to more engaged patients." Is this something you have noticed in your own clinic? 

Yes, this is something I can really approve, patients now see for example the beginning of their caries or changings like abrasions or tooth movement, so they care more about hygiene, wearing splints or viveras.

Another claim from this survey is: "100% of surveyed users agree that iTero Element 5D scanner enables better patient education and understanding of their oral health leading to an increase in patient acceptance of treatment plan." What is your opinion on this statement? 

I absolutely agree: "seeing is believing". For example, X rays like bitewings is nothing a patient understands if you show him some black areas; if he sees the NIRI pictures he understands why he should be treated although he has no pain.

Was there any other benefit from having your model of iTero that was an unexpected bonus in your clinic setting? 

Since we are scanning patients, and we have been doing this now for 8 years, we got a lot of new patients coming to our office because they heard about this technique.

What is the one thing you believe every dentist should understand about iTero scanners?

iTero is not a tool just for Invisalign®, it's a scanner with a restorative history and is now a scanner, diagnostic and communication tool.

In this episode of Coffee Break with Coachman, Christian Coachman and Dr Ingo Baresel talk about their experience with intraoral scanning and the value they add for dentists and patients in treatment workflows.



*Based on a survey in May of 2019 of n = 15 practitioners who participated in a global limited market release, working with iTero Element 5D for an average period of 6 months, representing both GPs and Orthos in CAN, EU and APAC, who were presented with a level of agreement scale from strongly agree to strongly disagree with the following statement: “Incorporating the iTero Element 5D scanner into my current diagnostic protocol, I’ve diagnosed a higher number of interproximal caries above the gingiva, on my patients at my practice”, and then asked to estimate the average increase. Data on file at Align Technology, as of November 15, 2019.


This blog post is created in partnership with Align Technology


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