The iTero optical scanner for use with nvisalign: A ... · Earn 2 CE credits This course was written for dentists, dental hygienists, and assistants. The iTero optical scanner for

Earn2 CE creditsThis course was

written for dentists, dental hygienists,

and assistants.

The iTero optical scanner for use with Invisalign: A descriptive reviewA Peer-Reviewed Publication Written by Dr. Perry Jones

AbstractOptical/digital scanning technology now replaces conventional VPS impression taking. The tooth movement technology of Invisalign can now be used with digital data derived from the iTero scanning device, improving accuracy, patient communication, streamlining work flow and reducing aligner delivery time. This article will review the development of the iTero technology, describe the iTero unit, and outline the differences in current scanning technologies. New iTero v4.05 enhancements and software such as the new “Simulated Outcome” tool are described in this article. The benefits of the iTero scanning device are detailed for both patient and practitioner. As highly accurate iTero polyurethane plastic models may be used to eliminate the stone medium, the article details many practical uses for these models, for example, as a matrix for the use of various thermoplastic materials. Model and modeless restorative solutions as well as the use of STL files will be discussed.

Learning Objectives:The overall objective of this article is to provide information on the ITero optical/digital scanning device. Its development, physical features, scanning technology differences, model/modeless restorative solutions, use of STL files, iTero v4.05 software features/tools as well as Outcome Simulator. After reading this article the reader should be able to:1. Briefly describe the development of the ITero optical/

digital scanning device.2. Describe the physical features of the iTero scanner.3. Discuss the difference in scan technology.4. Describe the uses of polyurethane models.5. Describe the features of model and modeless restorative

solutions.6. Discuss the use of iTero STL files.7. Describe the tools and use of the Invisalign “Outcome

Simulator.”

Author ProfileDr. Perry E. Jones is the Director of Continuing Education and Faculty Development at Virginia Commonwealth Univer-sity, School of Dentistry where he is also Associate Professor, Adjunct Faculty, Department of Oral and Maxillofacial Surgery. He is a Fellow of the Academy of General Dentistry and Director of the Virginia VCU/AGD MasterTrack program. He has been a member of the Align Technology Speaker TEAM since 2002 presenting more than 250 Invisalign presentations. Dr Jones has been involved with Cadent/ iTero optical scanning technology since its first release and was a beta tester for the iTero v4.05 software. Dr Jones belongs to numerous dental organizations and maintains a private practice in Richmond, VA.

Author DisclosureThe author of this course has no commercial ties with the sponsors or the providers of the unrestricted grant of this course.

This course has been made possible through an unrestricted educational grant.

Supplement to PennWell Publications This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content.Requirements for Successful Completion: To obtain 2 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%.

CE Planner Disclosure: Michelle Fox, CE Coordinator does not have a leadership or commercial interest with Align Technologies, the commercial supporter, or with products or services discussed in this educational activity.

Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

Registration: The cost of this CE course is $49.00 for 2 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

Go Green, Go Online to take your coursePennWell designates this activity for 2 Continuing Educational Credits

Publication date: Feb. 2012Expiration date: Jan. 2015

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Educational ObjectivesThe overall objective of this article is to provide information on the ITero optical/digital scanning device. Its develop-ment, physical features, scanning technology differences, model/modeless restorative solutions, use of STL files, iTero v4.05 software features/tools as well as Outcome Simulator After reading this article the reader should be able to:1. Briefly describe the development of the ITero optical/

digital scanning device.2. Describe the physical features of the iTero scanner.3. Discuss the difference in scan technology.4. Describe the uses of polyurethane models.5. Describe the features of model and modeless restorative

solutions.6. Discuss the use of iTero STL files.7. Describe the tools and use of the Invisalign “Outcome

Simulator.”

AbstractOptical/digital scanning technology now replaces con-ventional VPS impression taking. The tooth movement technology of Invisalign can now be used with digital data derived from the iTero scanning device, improving accu-racy, patient communication, streamlining work flow and reducing aligner delivery time. This article will review the development of the iTero technology, describe the iTero unit, and outline the differences in current scanning tech-nologies. New iTero v4.05 enhancements and software such as the new “Simulated Outcome” tool are described in this article. The benefits of the iTero scanning device are detailed for both patient and practitioner. As highly accurate iTero polyurethane plastic models may be used to eliminate the stone medium, the article details many practical uses for these models, for example, as a matrix for the use of various thermoplastic materials. Model and modeless restorative solutions as well as the use of STL files will be discussed.

IntroductionAlign Technology has delivered significant technological advances to the field of tooth movement as evidenced by the Invisalign clear aligner products. Recently released innovations termed G3 and G4 deliver Invisalign pro-viders sophisticated movement systems derived from laboratory testing. The FMA or Force Measurement Apparatus helps Align’s R&D engineers, develop and test planned movements, to produce more predictable at-tachments and clinical movements. These solutions have produced tremendous benefits to patients and practices, both in terms of clinical application and profitability.

Until recently, achieving highly accurate impressions for optimizing aligner benefits has been challenging. Various impression materials have their drawbacks, and process inconsistencies have often led to additional ap-

pointments and adjustments. The “impression” experi-ence was often unpleasant for both patient and doctor.

Today, digital impressions, such as those delivered by the Align iTero TM scanner, are providing practices with superior accuracy, cost savings, patient satisfaction, restorative solutions, implant solutions and orthodontic solutions as well as supporting multiple practical uses of polyurethane models.

New software enhancements offer users the ability to scan full arches for Invisalign submission. Submission time is dramatically reduced with ClinCheck treatment plans posted in 2-3 days. Features such as an eraser tool and missed data highlight outline tool, further aid users in the efficient capture of full arch scans.

Development of the digital scanning deviseSimultaneous with the advances in development of CAD/CAM technology, development of an optical scanning devise dates back several decades. Although industry has used many different computer aided de-sign and computer aided manufacturing (CAD/CAM) systems, there has been only one system available to the dental practitioner for taking direct intraoral digi-tal impressions for several past decades. The CEREC system was developed as a one visit in-office scanning and milling system to produce ceramic restorations from prefabricated ceramic ”blocks”. The much different Cadent system developed an in–office intraoral optical scanning unit that used digital data sent via the internet to a centralized milling center, or a specific dental labo-ratory. As the concept of digital impression taking has become more popular, other systems such as E4D, Den-sys 3D, Lava C.O.S. and TRIOS have been developed with many others likely to soon reach the market place. This article is intended to give a descriptive review of the iTero scanning technology as well as give an overview of the features and benefits of the iTero system.

Development of the iTero scanning systemCadent history dates back to the 1995-1999 period when formation and early development began in Israel by vet-erans of Technomatrix (NASDAQ: TCNO). The first commercial product was released in 2001 with a success-ful digitized scanning system, termed OrthoCAD. This devise allowed conventional stone models to be scanned to produce 3-D computer images. The scanned data could then be used to archive model information, create virtual tooth set-ups, as well as fabrication of urethane models and orthodontic bracket placement applications. This unit is now termed the iOC unit (Figure 1), and it is marketed primarily to the Orthodontic community.

Development continued with introduction of iTero (Figure 2) intra-oral scanning as outlined in (Figure 3). To summarize Cadent development: In 2006 Cadent

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launched the iTero Digital Impression System with quadrant scans and crown restorations, expanding in a few months with indications to include inlays/onlays. Cadent expanded restorative indications in 2007 to in-clude 3/4 crowns, implant abutments and veneers. Mea-surement tools were added as well as a hardware upgrade to a quad processor for enhanced capture speeds.

Full arch scanning was added in 2008, with indica-tions to include bridges, cantilever and bonded bridges. Upgrades included an enhanced video view window, im-provements with a rapid scan technique, and milled ref-erence models were made available for patients without restorative preparations. In 2009, the iTero user interface was upgraded to Windows XP, new software upgrades improved the display of the 3D image, enhanced algo-rithms for the occlusal clearance map and improved view control tools were added. The iOC powered by iTero orthodontic scanner and software applications was launched in 2010. In conjunction with Whipmix, iTero released a mounting system for Denar articulators (and now Hanau articulators). In 2010, upgrades allowed modeless restorations to be produced in a 100% digital production workflow without a Cadent milled model.

Figure 1: iOC screen saver logo

Figure 2: iTero screen saver logo

Figure 3: Cadent development timeline

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In 2011 Cadent partnered with implant companies and dental laboratories such as Glidewell Dental Laboratory, to develop fixture level implant scanning with dedicated scan bodies available for different implant systems. The current iTero v 4.05 software was released with full arch scan capability expanded to Invisalign.

Description of the iTero digital scanning deviseThe iTero devise consists of a mobile cart measur-ing about 29 inches in height, 26 inches in width and 15 inches in depth (Figure 4). It is mounted on caster wheels to facilitate moving the unit between operatories. There is a hand held scanner wand attached to the cart via a cord to carry scan data to the unit. A battery is contained in the unit to allow an uninterrupted power supply such that the unit may be unplugged from the AC power source and moved to different locations. The iTero unit has a dedicated wireless router that will send a wireless signal to a modem devise thus allowing internet connection capability. A wireless “mouse” and a sealed keyboard on the horizontal surface support data entry, allowing disinfection techniques to be used (Figure 5). Images are displayed on a 19 inch liquid crystal display (LCD) attached to the mobile iTero cart.

A wireless foot control/foot pedal may be used to enter data and navigate the system, allowing the opera-tor to enter data remotely. This may free the operator’s hands to hold the scanner wand, bypassing the keyboard and/or wireless mouse, allowing a single operator to manage the unit.

A hand held scanning wand is used in the patient’s mouth to collect the scan data. The video “camera” contains the laser light source, the focusing motor and analogue to digital converters. The camera is balanced

with a “notch” for the operator’s hand at the optimal balance point (Figure 6). Inexpensive single use dispos-able sleeves, designed to fit over the “camera” end of the scanning wand, help prevent patient cross contamina-tion (Figure 7). The scanner sleeve is very useful as a retraction aid for cheeks, tongue, and soft-tissue, as well as offering a method to steady the camera. The optics of the iTero camera, allows a useful feature of resting the “sleeve” directly on the patient’s teeth or soft-tissue (Figure 8).

Figure 5: Sealed keyboard/ wireless mouse

Figure 6: Notch for hand at optimal balance point

Figure 7: Single use disposable sleeve

Figure 4: iTero digital scanning unit

19 inch LCD Screen

Scan Camera Wand

iTero Unit w/ Wireless & Battery

Sealed keyboard for Asepsis

Wireless Mouse

Wireless Foot Control

Caster Wheels for Mobility

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Accuracy Optimizes Results and EfficiencyAccuracy is essential to optimizing clinical results and ef-ficiency, yet producing an accurate replica of the teeth has been a huge challenge. Varying impression materials, in-cluding plaster, rubber base material, polyether, reversible hydrocolloid, irreversible hydrocolloid, and VPS (vinyl polysiloxane) material have unique properties and idio-syncrasies, which make it difficult for dentists to produce consistently outstanding results. For example, impression taking with VPS is prone to pulls and tears; bubbles and voids; distortion; tray to tooth contact; poor tray bond; de-lamination; sensitivity to temperature, technique, time and chemistry; varying shrinkage; stone model pouring; and die trimming discrepancies (Figures 9,10).

The Align iTero scanning technology eliminates these issues. It does not require any powder, powder dusting or accent frosting, regardless of the type of scan or restora-tion desired. The full arch scanning and detailed coronal reproduction required for Invisalign submission mandate a high-quality scan with interproximal detail and accu-racy. The iTero powder- free technology delivers highly accurate digital impressions of the interproximal areas and ensures arch width dimensional stability.

Accurate reproduction of the coronal portion of the teeth often requires retakes. Studies indicate that about 1/3 of dentists retake impressions three or more times per

month, and on average, one-third of dentists reappoint patient impression taking at least once a month(26). Studies have shown iTero optical scanning dramatically reduces retakes(27).

Technology Enables FlexibilityThere are two different digital scanning technologies available to the dental scanning industry; parallel/confo-cal and triangulation sampling (Figure 11). The iTero’s scanner’s parallel/confocal scanning technology uses laser and optical scanning to digitally capture teeth, gingival surfaces and contours.

The operative principle used in the iTero scanner is called “parallel confocal”. A light source passes through a small filtering pinhole which focuses the light on the target object. The light then reflects off of the object and only the reflected light that is in focus passes back through the pinhole. Reflected light will be blocked if not in the confocal plane. Only reflected light that is in focus will return through the filtering mechanism. Better images are produced, as out of focus information is rejected and depth of field control is enhanced.

Figure 8: Resting on teeth to steady image capture

Figure 9: Margin inaccuracy/ Distal run/ Material run/ Tray show through

Figure 10: Margin inaccuracy/ Material separation/ Inaccurate margin/ Tray separation

Figure 11: Triangulation sampling vs. Parallel confocal

Other scan systems (CEREC/ E4D)

Triangulation Sampling• Angled cone of light• Triangulation of light• Requires powder dusting

iTero Technology

Parallel Confocal• 100,000 points laser light• Out of focus light rejected• No power dusting

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iTero captures 100,000 points of laser light in per-fect focus at 300 focal depths in a 14 x18 mm pattern, producing a 15mm scan depth. An analogue to digital converter in the camera wand, acts to convert the re-flected light into digital data in about 1/3 of a second, with an accuracy of 15 microns. The confocal technol-ogy is a true optical scan, and does not require powder dusting.

In contrast, triangulation/ sampling technology, as used in devises such as CEREC or E4D, require a powder coating and apply one angled cone of light to capture a single image at 15,000 microns. The term is based on applying the theory of “triangulation of light” such that 3 beams of light intersect to locate a point in space. One of the problems with this technology is that various surfaces disperse light differently and this may affect the accuracy of the scan. In order to reduce this effect, triangulation sampling technology uses a thin coating of an opaque power such as a titanium dioxide/zirconium oxide mix to provide a uniform light disper-sion to enhance the accuracy of the scans.

Powderless scanning and 360- degree visualization capabilities enable iTero to operate with surface contact in the scanning technique for highly accurate digital impressions. Accompanying analytical tools enable dentists to measure and verify design of the prepara-tion. The doctor can use the scanner for almost any procedure, select the desired restoration material, and send the scan to a lab of choice. The iTero 4.05 software seems to produce a noticeably better aligner fit(28).This observation was further supported by a 2011 study, which found that 7 times fewer fit issues occurred with scanning versus impressions(29).

Improved Patient ExperienceTraditional impression taking techniques are unpleas-ant at best. Patients object to the taste, tray size, bulky material and common gag reflex. Digital scanning elimi-nates all of these objections. In addition, iTero scanning enhances patient communication because patients can see their dentition on the computer screen as a real-time 3-D representation. The 3-D images are “cleaned” (Figure 12) with extraneous soft-tissue (such as tongue and cheeks) removed in real time without the necessity to send the images electronically to technicians in Israel, as was done in the past with the Cadent process. iTero scans are posted on the Invisalign Doctor Site (Figure 13) in minutes and ClinCheck treatment plans are posted for doctor review in 2-3 days, creating a much reduced time line for Invisalign delivery, resulting in overall aligner delivery time cut by almost one half. iTero software significantly accelerates the ClinCheck treatment plan, which greatly improves patient acceptance and com-munication.

iTero v 4.05/ Restoration with modelsDigital scanning with iTero provides an open platform for creating highly accurate polyurethane models, instead of stone models, that any dental laboratory can use to create any indirect restoration. Current advances in laboratory technology can also use scanned data with CAD/CAM systems to produce modeless milled ceramic restorations. The absence of stone modeling offers a further cost offset versus conventional lab costs.

iTero 4.05 software can support restorative solutions with or without modeling. In the case of modeling, ex-tremely accurate polyurethane models are created with precise dies that fit securely into position (Figure 14) unlike conventional stone modeling with die “wobble” often created from repetitive use during restoration fabrication. A single model functions as both a working model and soft tissue model (Figure 15). The soft-tissue is maintained with the die preparation to allow more accurate and efficient laboratory fabrication of all types of restorations. Models can be mounted using a precise hinge articulator or mounted on a semi-fixed articula-tor with custom mounting plates to Denar, Hanau and Whipmix articulators (Figure 16).

Figure 13: iTero scans posted on Invisalign Doctor Site

Figure 12: Cleaning and merging image

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iTero v4.05/Modeless restorationThe iTero 4.05 software supports construction of mode-less restorations that are CAD designed in a virtual, modeless environment and CAM milled from materials such as zirconium. Dental laboratories such as Glidewell, support use of iTero optical scanning, virtual planning, restoration design, and custom milling to create single unit, multiple units as well as bridges in a 100% “mode-less” workflow environment (Figure 17). The process is streamlined such that lab fees may be reduced (Glidewell) when restorations are created modeless.

iTero v4.05/Implant restorationSimilarly, implant solutions are supported by the iTero 4.05 software, as purpose made scan bodies may be used with the iTero optical scanner. Digital scanning has ad-vanced implant practice integration as implant companies such as Straumann and 3i have proprietary scan bodies and systems. Dental laboratories such as Glidewell have developed an “open” system of dedicated scan bodies to be used with the iTero optical scanner and 4.05 iTero software. Different unique scan bodies are referenced with a library of virtual implant analogues that fit different im-plant systems Figure 18, 19).

Figure 14: Precise/ secure seating iTero polyurethane model dies

Figure 15: iTero model: soft-tissue is maintained

Figure 16: ITero models mounted on Denar articulator

Figure 17: CAD design on iTero scanned data virtual model

Figure 18: Purpose made implant scan body on Nobel implant fixtures

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Uses of Full Arch Polyurethane modelsFull arch scanning allows very precise polyurethane models to be created for a multitude of uses, especially for the GP practice. Uses include: models used to fab-ricate full arch (Figure 20) thermoplastic appliances, canine to canine (Figure 21) appliances used to aid finishing, occlusal equilibration, occlusal “settling” as well as retention. Models may be used to create “pontic” appliances (Figure 22) used in conjunction with implant solutions, as well as models used to create prosthetic surgical guides (Figure 23). Polyurethane models may be used to fabricate occlusal guards (Figure 24), bleach-ing trays (Figure 25), and mouth guards (Figure 26). Provisionals (Figure 27), provisional bridges (Figure 28) and even limited removable partial dentures (as tissue scanning may allow) summarize possible uses of iTero urethane models supported by the iTero 4.05 software. One of the most useful features of the urethane models is that they may be used multiple times, unlike stone models which are often useless after teeth break upon appliance removal. The iTero 4.05 software provides the practitioner with a wide variety of useful tools and features both for restorative solutions and orthodontic evaluation.

Figure 19: Glidewell Inclusive Scan Abutments for Nobel Implants

Figure 20: Full arch Thermoplastic Appliance made on iTero model

Figure 21: Canine to Canine Thermoplastic Appliance made on iTero model

Figure 22: Pontic Appliance made on iTero model

Figure 23: Prosthetic Surgical Guide made on iTero model

Figure 24: Occlusal Guard made on iTero model

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Merge of DICOM and STL filesSoftware development now enables merging of CBCT DICOM files with Align ITero STL files. Virtual “wax-up” and planning may be done to create surgical guides with simultaneous consideration of hard tissue and op-timal restoration location. Users may use various third party CAD/CAM services such as implant planning services and digital labs for restorative and orthodontic treatment services. Generic STL files, the CAD/CAM standard format, can now be exported directly from user’s “My Aligntech” accounts.

The iTero software now supports direct export of STL files. This has opened fields such as the merge of CBCT DICOM files and iTero files to create 3-D renderings that support software such as Cybermed/ In-2-Guide, that support virtual planning of prosthetic restoration and crown down planning of hard tissue consideration to allow processing of tooth and soft tissues supported surgical guides. (Figures 29, 30, 31) demonstrate a tooth supported surgical guide made with the merge of CBCT DICOM files and iTero STL files. The pictures are from this author’s patient and depict the intraoral view, soft-ware planning and intra-oral guide placement of the In-2-Guide for placement of two Nobel Replace Select fixtures.

Figure 25: Bleaching Trays made on iTero model

Figure 26: Athletic Mouthguard made on iTero model

Figure 27: Provisional matrix appliance made on iTero model

Figure 28: Provisional restoration

Figure 29: Intraoral view

Figure 30: Software planning: In-2-Guide

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Increasing Practice EfficiencyPractice productivity is increased with the new iTero v4.05 enhancements because records and submission times are accelerated. For restorative productivity, resto-ration time is reduced by approximately 50% due to the iTero scanning accuracy and predictability. The scanner itself may be viewed as cost effective. For example, if we assume $500 of hourly production, an average 15 min-utes of chair time saving would compute as $125 savings per production hour. If we assume only one scan per day, and a conservative estimate of 120 production days per year, that computes to a $12,500 to $16,250 savings per year. Even with a conservative model, one can make the case that the technology costs are quickly offset with the projected time savings.

ConclusionDigital scanning with the Align Technology iTero sys-tem has greatly enhanced clinical accuracy, productivity, and flexibility for a wide variety of tooth movement/alignment and restorative procedures. Digital informa-tion can be used for Invisalign submission to create a significantly more efficient work flow. The iTero 4.05 software presents sophisticated software tools that can be used for detailed orthodontic diagnosis and analysis. The iTero 4.05 software helps improve patient com-munication. Precise polyurethane models offer a wide variety of uses especially in the general dentist practice. Digital scan impressions with the iTero 4.05 software offer real time on-screen visualization and a much im-proved patient experience with no impression mess. iTero 4.05 offers an open architecture software platform with the ability to use digital data to fabricate all types of restorations from single unit to multiple units. The iTero 4.05 powderless impressions provide digital data that supports the dental laboratory fabrication of any indirect restoration from provisionals, all metal (gold), porcelain fused to metal, porcelain full, partial veneer coverage to inlays/onlays of any type material.. The

iTero technology supports modeless restorations that are now routine offering improved accuracy, which results in time and cost savings. Implants may be scanned with dedicated scan bodies to create screw or cement retained model or modeless restorations. The merging of CBCT DICOM and ITero STL files offer virtual “waxup” and crown down planning to create precise tissue and tooth supported surgical guides. This article has attempted to present an overview of the features, uses and benefits of the iTero scanning technology. The future of scan tech-nology and its benefits for the everyday practitioner are here today!

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Figure 31: In-2-Guide intraoral try-in

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26. Research commissioned by Align Technology. Published by Consilium Associates, 17 Mayapple Way, Irvine, CA 92612. Pub 2011.

27. Research commissioned by Align Technology. Published by Consilium Associates, 17 Mayapple Way, Irvine, CA 92612. Pub 2011.

28. Published data from Align Technology, Clear Essentials II Training Course 2011, Align Technology, Inc., 2560 Orchard Parkway, San Jose, California 95131.

29. Published data from Align Technology, Clear Essentials II Training Course 2011, Align Technology, Inc., 2560 Orchard Parkway, San Jose, California 95131.

Author ProfileDr. Perry E. Jones is the Director of Continuing Education and Faculty Development at Virginia Com-monwealth University, School of Dentistry where he is also Associate Professor, Adjunct Faculty, Department of Oral and Maxillofacial Surgery. He is a Fellow of the Academy of General Dentistry and Director of the Vir-ginia VCU/AGD MasterTrack program. He has been a member of the Align Technology Speaker TEAM since 2002 presenting more than 250 Invisalign presentations. Dr Jones has been involved with Cadent/ iTero optical scanning technology since its first release and was a beta tester for the iTero v4.05 software. Dr Jones belongs to numerous dental organizations and maintains a private practice in Richmond, VA.

Author DisclosureThe author of this course has no commercial ties with the sponsors or the providers of the unrestricted grant of this course.

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Questions

1. Cadent’s development of an optical scanning devise began in ______ by Technomatrix veterans. a. United Statesb. Israelc. Iran d. Mexico

2. The original ________ scanning devise allowed conventional stone models to be scanned.a. OrthoPEDb. OrthoCAMc. OrthoCADd. CAMtech

3. In 2006 Cadent first launched iTero w/ ________ scans and crown restorations.a. full archb. veneerc. implantd. quadrant

4. In 2011 Cadent full scan capability was expanded to ________ submissions.a. Invisalignb. Clear Correctc. Simpli 5d. Ortho Clear

5. The Cadent unit sits on ___________ to allow the unit mobility.a. Fixed Legsb. Metal supportsc. Caster wheelsd. Adjustable rubber legs

6. A ________ is contained in the iTero unit to allow an uninterrupted power supply.a. Breaker switchb. Voltage meterc. Batteryd. Power cord

7. A single operator may bypass the keyboard and mouse with a wireless ___________.a. Foot controlb. Modemc. Switchd. Camera

8. ____________ placed on the camera end aid help prevent cross contamination.a. Plastic bagsb. Glass coversc. Disposable sleevesd. Cloth inserts

9. The scanner sleeve may be used to directly rest on the patient’s ________ to steady the camera.a. Armb. Facec. Handd. Teeth

10. Impressions taken with VPS (vinyl poly-siloxane) are prone to: ______________a. Shrinkageb. Distortionc. De-laminationd. All of the above

11. The iTero scanner uses __________ digital scanning technology.a. Vertical infusionb. Triangulation samplingc. Parallel confocald. Horizontal inversion

12. Only reflected light _________ is rejected by a filtering mechanism with parallel confocal.a. In focusb. Out of focusc. Between focusd. Spherical

13. ___________ scan technology requires powder dusting.a. Parallel confocalb. Triangulation samplingc. Ellipsoid samplingd. Square focus

14. The theory of “triangulation of light” applies __________ beams of light to locate a point in space.a. 1b. 2c. 3d. 6

15. Patients object to ___________ with traditional impression techniques.a. Tasteb. Tray sizec. Gag reflexd. All of the above

16. The ________ may be used to manipulate individual teeth in a virtual model.a. Clinical Checkerb. Outcome Simulatorc. Alignment Stylusd. Movement Stylus

17. A single iTero polyurethane model can serve as both working model and ___________ model.a. Soft tissueb. Refractoryc. Inversiond. Porcelain

18. Custom plates allow semi-fixed articula-tors such as __________to be used with iTero models.a. Hanaub. Denarc. Whipmixd. All of the above

19. Implant solutions are supported by iTero as dedicated __________ bodies may be scanned.a. Scanb. Porcelainc. Diesd. Titanium

20. iTero polyurethane models may be used to create _____________________a. Thermoplastic appliancesb. Prosthetic appliancesc. Pontic appliancesd. All of the above

21. Generic _________ iTero files may be exported directly from “My Aligntech” accounts.a. DICOMb. STLc. ADAd. AGD

22. Practice productivity is _________ with iTero 4.05 due to records and submission times being shortened.a. Increasedb. Decreased

23. Digital scans with iTero v4.05 software offer benefits such as:__________.a. No impression messb. Powder free scansc. Real-time on screen visualizationd. All of the above

24. Merged CBCT DICOM and iTero STL files offer precise surgical guides for _______ placement.a. Implantb. Pinc. Postd. Impression

Notes

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Notes

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Notes

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.

For immediate results, go to www.ineedce.com to take tests online.

answer sheets can be faxed with credit card payment to (440) 845-3447, (216) 398-7922, or (216) 255-6619.

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P.O. Box 116, Chesterland, OH 44026 or fax to: (440) 845-3447

ALIGN212DE

COURSE EVALUATION and PARTICIPANT FEEDBACKWe encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please e-mail all questions to: [email protected].

INSTRUCTIONSAll questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination.

COURSE CREDITS/COSTAll participants scoring at least 70% on the examination will receive a verification form verifying 2 CE credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is 4527. The cost for courses ranges from $29.00 to $110.00.

PROVIDER INFORMATIONPennWell is an ADA CERP Recognized Provider. ADA CEROP is a service of the American Dental association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, not does it imply acceptance of credit hours by boards of dentistry.

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The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# 320452

RECORD KEEPINGPennWell maintains records of your successful completion of any exam for a minimum of six years. Please contact our offices for a copy of your continuing education credits report. This report, which will list all credits earned to date, will be generated and mailed to you within five business days of receipt.

Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

CANCELLATION/REFUND POLICYAny participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

© 2012 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell

Educational Objectives1. Briefly describe the development of the ITero optical/digital scanning device.

2. Describe the physical features of the iTero scanner.

3. Discuss the difference in scan technology.

4. Describe the uses of polyurethane models.

5. Describe the features of model and modeless restorative solutions.

6. Discuss the use of iTero STL files

7. Describe the tools and use of the Invisalign “Outcome Simulator”

Course Evaluation1. Were the individual course objectives met? Objective #1: Yes No Objective #3: Yes No

Objective #2: Yes No Objective #4: Yes No

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0

3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0

7. Was the overall administration of the course effective? 5 4 3 2 1 0

8. Please rate the usefulness and clinical applicability of this course. 5 4 3 2 1 0

9. Please rate the usefulness of the supplemental webliography. 5 4 3 2 1 0

10. Do you feel that the references were adequate? Yes No

11. Would you participate in a similar program on a different topic? Yes No

12. If any of the continuing education questions were unclear or ambiguous, please list them. ___________________________________________________________________

13. Was there any subject matter you found confusing? Please describe. ___________________________________________________________________ ___________________________________________________________________

14. How long did it take you to complete this course? ___________________________________________________________________ ___________________________________________________________________

15. What additional continuing dental education topics would you like to see? ___________________________________________________________________ ___________________________________________________________________

ANSWER SHEET

The iTero optical scanner for use with Invisalign: A descriptive review

Name: Title: Specialty:

Address: E-mail:

City: State: ZIP: Country:

Telephone: Home ( ) Office ( ) Lic. Renewal Date:

Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 2 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 216.398.7822

AGD Code 370

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Customer Service 216.398.7822