Thursday, July 29, 2021

Experience with iTero Element 5D Plus


As promised yesterday, here is a fairly long post about my experiences with the newest scanner from iTero.  Hopefully this provides some of you with the insight into the product that you need to make a decision of whether it is right for your practice or not...

I still remember it like it was yesterday, only it was fifteen years ago… fifteen years! I was walking the exhibit floor of the American Dental Association meeting in Las Vegas when I came across a very small booth with a very intriguing device. The company was Cadent and the device was named iTero.

It was a digital impression system, but unlike the other systems at the time, it didn’t also come with a mill.  The unit acquired a digital  impression and then, using WiFi, sent the data to a Cadent milling facility where huge mills turned all of those 1s and 0s into an actual hard plastic model and then sent the model to the doctor’s lab.

As a tech lover I was intrigued.  At long last there was a company for all the doctors that wanted the advantages of digital impressions but didn’t want to buy or use a mill.  I began to do my research and before long, I owned a unit. My staff was thrilled and once we implemented our iTero into our workflow, we never looked back.

A few years later, we upgraded by purchasing the then state of the art iTero Element unit.  The staff and I were thrilled with the improvements to both the hardware and the software of the system. I had originally planned on having the staff use both of my iTero units, but the Element was so much faster and easier, that our first unit quickly began gathering dust as the Element took over.

So after all of this time using their products, I was more than thrilled when the company reached out to Dental Products Report and myself with the idea of letting me do a Test Drive on their latest and greatest unit, the iTero Element 5D Plus.

First Look

I love watching devices evolve and the Element line is no exception.  The unit has taken the advantages of the original Element unit and improved upon them.  The stand is more stable and more aesthetic.  The wheelbase has been expanded a bit and the length of the wheel arms extended slightly which greatly increases stability.  The unit has also been given some light and dark accents that give it much more of a ‘space age’ look.

The unit was shipped to us disassembled and my trusty assistant and ‘fix-it gal’ Nicky had it assembled and ready to roll in less than a lunch break.  When she first turned the unit on we were asked to connect to our secure WiFi and then to input our account information.  Being existing iTero customers, we put in our customer information and within moments all of our previous cases and settings were downloaded from The Cloud and we were ready to roll.  It was easy and impressive.  

In the Clinic

In order to better keep track of how the Element 5D Plus performed, I decided that for the length of our Test Drive we would use ONLY the Element 5D. Plus.  So we took our beloved Element and mothballed it until the Test Drive was over.

Our office is a three doctor practice and all clinical personnel are trained on using our iTero.  So needless to say, there was a bit of jockeying to see who got to use the Element 5D Plus first.  I think that alone says something about the unit.  We already had a unit everyone was familiar with but everyone wanted a turn with the new one.  I’m pretty sure that Nicky pulled the trump card of “Hey, I assembled this unit” because she got the first case.

We were both blown away.  The screen resolution is *stunning*.  Details are easily and clearly identified and the scans are gorgeous.  The processing power is also downright impressive.  We always position the iTero so that the patient can easily see the monitor while the scan is taking place and the speed with which the data appears on the screen is phenomenal.  When I started with digital impressions in the late 90s the operator was actually taking photos with the device by tapping a foot pedal and then when enough still images had been acquired, the system’s software would assemble those still images into a 3D digital representation.

Watching the iTero Elements 5D Plus scan the mouth is akin to watching water flow over an object.  The system takes thousands of images per second and combined with the processing power of the device, the scan appears smoothly and precisely.  Patients are practically hypnotized by the experience.  The color depth allows for easy margin discernment and the resolution allows the user to enlarge the image on the screen with no loss of detail.

One other clinical feature bears mentioning.  I love efficiency and the time savings it brings.  In the past when moving our iTero from operatory to operatory, it was necessary to power the unit down, wheel it in, plug it in, and then go through the boot sequence.  While it wasn’t a tremendous weakness, it did impede clinical progress on many occasions.  Being a three doctor practice there are times when the scanner is in use by another clinical team while the second team waits for the unit.  The power down and power up steps simply added time to the process.  Now that problem is history.  The Elements 5D Plus comes with a built-in battery.  That means when one team is done, the unit can be unplugged and moved to where it is needed next without fussing with the ‘power problem’.  Now the unit is wheeled in, plugged in, and working on the next case in a matter of seconds.  This has saved time and, more importantly, frustration for clinical personnel.


The clinical results have been phenomenal.  The cases we have performed with the help of the Elements 5D Plus have been accurate and the prosthetics require minimal chair time to seat.  One of the best things about iTero scans is the time they save both on the front end and the back end.  The system is fast and accurate on the front end and this leads to incredible accuracy on the back end.  In the old days of analogue impressions when a case went to place with no adjustments it was a high-five moment.  Now when adjustments are necessary we evaluate what happened on the front end to make that happen.  Our expectations are now that cases fit with minimal to NO adjustments.

It’s also a tremendous advantage of the system that our lab receives the case within minutes.  We can discuss the case with the lab if need be almost as soon as it is done.  It also means for cases that are done model-less, the lab can begin to design the case practically before the patient has left our office.

The scans have also been used to create restorations with our Axsys 5x 400 mill.  Obviously having a mill is not a requirement to have the iTero experience in your office, but if you do own a mill or are considering purchasing one, your iTero scanner will provide incredibly accurate data for your design process.

Additional Applications

The Elements 5D Plus is a terrific intraoral scanner, but it does more… much more.  In addition to scanning cases for fixed prosthetics, the device has several other uses.

Intraoral Camera

In addition to scanning, the system can also take beautiful intraoral images.  This is a nice time saver/efficiency booster for documenting things.  Need to have photos of your preparation to send to third party payers?  No need to stop and pick up your operatory intraoral camera.  You can take those photos directly with the iTero.


I think all of us have probably had the experience of saying to a patient something along the lines of, “Your teeth are showing signs of excessive wear.”   Only to be met by the response, ‘No they aren’t.”  Or, “It looks like you are grinding your teeth.” And we hear, “No I’m not.”

My undergrad Psychology degree has always wondered why so many people have a hard time admitting to bruxism, but they sure do.  I tend to think it’s because they don’t realize they are doing it, combined with the fact that they cannot see it either.  These situations are much easier to deal with due to one of the great iTero features, the Occlusogram.  Now rather than *telling* a patient they brux, within a few seconds you can *show* them.  In my office we prefer to scan and discuss what we see before we even mention the problem verbally.  This makes the acceptance of the situation much easier.

Humans are visual creatures.  Over 85% of what we discern about our environment comes through our eyes.  The Occlusogram plays to that advantage.  It shows the teeth with a color ‘weather radar’ appearance that clearly identifies the patients wear patterns.  It is a tremendous educational tool and is a great adjunct to our office philosophy of Focus, Educate, Relationships.


Have you ever monitored a patient for several years and at an exam you really wish you could show them how the condition of their dentition has changed over the last few years?  This magic is now at your fingertips.  iTero’s TimeLapse feature does just that.  If you scan a patient multiple  times over the span of their time in your office, the Elements 5D Plus can combine those scans and create a video that shows the changes that have occurred right before the patient’s eyes.  

This is a powerful tool that can provide, literally, years of data in the span of a few seconds and greatly increases patient understanding.  Because the Elements 5D Plus scans so quickly and is so easy to use, we have incorporated scanning every new patient to the practice.  This is helping us to build a baseline of patient data.  Our goal is to incorporate a digital scan into our normal six month hygiene visits.  This will allow us to easily and efficiently monitor every patient.

Near Infrared Imaging

Another benefit built into the Elements 5D Plus is the implementation of Near Infrared Imaging.  NIR (pronounced NEAR) in science circles, is a tremendous addition to the digital scans acquired by the system.  

The infrared spectrum is outside of the visual spectrum so the energy is invisible to the human eye, but this harmless wavelength easily penetrates tooth structure.  This allows the Elements 5D Plus to also operate as an incredibly accurate and powerful transillumination device.  As the operator moves the wand around the teeth, the NIR energy is passed through the tooth and picked up by the camera.  After completing the scan, the operator can tap an icon on the screen and see the scan through the eyes of NIR imaging.

Viewing the dentition through NIR is one more data gathering tool for the doctor to help render a clinical decision.  Combining things such as NIR with the data acquired through digital radiographs can add accuracy to a clinical situation that might have been difficult to create a diagnosis with a high degree of certainty without these extra data points.  NIR is also non-ionizing meaning that it can be used on pregnant patients and young children without any concern regarding radiation.

Whether used as a diagnostic scan in hygiene or reviewing scans taken for routine prosthetic cases, NIR is a feature that is accurate, always on, and simple to use.  During our Test Drive I encountered several areas of decay that I would otherwise have not identified.


Acceptance of digital scanners is continuing to increase in the profession; now at a bit over 30%.  The current generation of systems are highly accurate and easy to use.  I no longer hear questions about their ability to capture correctly or the fit of prosthetics made from digital scans.  My office is now to the point of taking an analogue impression for fixed prosthetics about twice a year or one every six months.  

A full mouth scan takes approximately 5 minutes.  For a team member that has never used a scanner previously it might take a bit longer at first, but the learning curve is ridiculously short.  Even our study models are now done digitally and the models created using our 3D printer.  Gone are the days where study models were taken in alginate and then poured immediately to minimize distortion.  Cases are stored in The Cloud and can be reprinted easily if the need arises.

Also as I mentioned previously, the seating of cases is tremendously easier than before.  Single unit cases (which are the majority of cases seated in the average general dental practice) are frequently accomplished in 10 minutes.  We normally block 30 minutes for a single unit seat, but it is now a rare occasion when it takes longer than 10 minutes.  

While I’m at it, allow me to let you in on a secret… patients *hate* impressions.  They are fascinated and impressed with the Elements 5D Plus and they talk about it to their friends and relatives.  One of the unseen benefits of the system is that the technology markets itself.  We get referrals based on digital impressions and our overall use of technology to improve patient outcomes.

Wrapping Up

I’ve been an iTero client for well over a decade… for good reasons.  However, I’m not just impressed with the Elements 5D Plus simply because of that fact.  No, I’m impressed because the system does so darn many things!  I also feel that as a long term client I have a better appreciation for how much their systems have improved.

Caries detection, occlusal analysis, time lapse videos, intraoral photography, and digital impressions are all wrapped up in a highly aesthetic and highly mobile high tech package.  I know a lot of you that have not yet made the jump to digital are weighing your options.  The lack of trade shows for over a year hasn’t helped.  However, if you are looking to make a purchase in the not too distant future and you saw an iTero unit a few years ago, you owe it to yourself to take a close look at the Elements 5D. Plus  

Suffice it to say if you haven’t seen iTero haven’t seen iTero.

Oh… one other detail I should tell you.  There is a time limit to my Test Drives and there always comes that point in the process when the product has to be sent back to the company that was gracious enough to allow me to have time to evaluate it.

This time was a bit different.  I was so impressed with the Elements 5D Plus that I called the company and had them start the paperwork so that I could have one of my very own.  In just a couple of months the technology had become indispensable to my team and I.  The Elements 5D Plus is an impressive device.  I’m so impressed that I cannot do without it.  I think you will feel the same way.

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