Should I buy an intraoral scanner, and if so, which one?
Intraoral scanners for digital impressions aren't what they used to be. In fact, they're becoming the standard of care. If you're thinking of purchasing one, here are the factors you'll need to consider.
Intraoral scanners for digital impressions aren't what they used to be. In fact, they're becoming the standard of care. If you're thinking of purchasing one, here are the factors you'll need to consider.Today’s restorative and specialty practitioners have been influenced by salespeople, advertising, seminars, laboratories, and patients about the need to have a chairside intraoral scanner and milling system. I have been following the development of these devices with great anticipation for more than a decade.
Many clinicians who purchased and integrated early complete systems—including intraoral scanners, design software, and chairside mills—were displeased with the results from a quality and cost standpoint. Promises made about the cost savings and the amount of effort necessary to achieve the desirable fit, form, and esthetics did not seem to hold true for every early adopter.
Today, the business model has finally evolved to a point that buying an intraoral scanner is really starting to make sense.
The marketing opportunity
The marketing opportunity has always been there. Patients prefer it when traditional impression materials are seldom used or not used at all, but to pay $30,000–$50,000 for an intraoral scanner just to market this would not be a winning business strategy. Originally, the wands were too large to get a good scan on molars for many patients; now, lower-cost intraoral scanners with smaller wand sizes are being introduced.
Closed systems versus selectively and completely open systems
This is key to how you will use the intraoral scanner and how often you will use it.
Originally most systems were closed. With a closed system, any scans taken would have a pathway predetermined by the system being used. For example, CEREC scans went directly to the CEREC milling system, leaving clinicians with no choice about where to send the scans.
Selectively open systems evolved because the expense and the limitations of closed systems frustrated many early adopters, and competitors saw an opportunity to license partners into their new systems. An example is the Brontes Technologies digital impression system, which was brought to market by 3M as the Lava Chairside Oral Scanner. This was described as "open" because it was a scanner and not a complete milling system, so it required partners. 3M partnered with Straumann (Etkon) and Authorized Lava Milling Centers. One of these facilities would receive the file from the clinician, design and mill the restoration, and deliver the completed restoration in a few days. This allowed for different material options and restorative possibilities, while limiting competition. In other words, the system was open but selective.
Next are the mostly or completely open systems of today. With open systems, you can send files to almost any service that can receive them. These systems make you the captain of the restorative options and planning process. But even today, not all systems are totally open, so it's important to research all of the systems you consider. Blogs, professional publications, current users of these systems, and manufacturers' product development engineers are all great sources of information. An example of a totally open system is Trios 3 (3Shape).
Ease of use
For me, the biggest question is, "Can it be used?" As I mentioned already, the size of the wand is key. If you can’t use your intraoral scanner, say, 25% of the time because it is too difficult to capture an image due to the size of the wand or how wide a patient can open for the image, you will tend not to use the intraoral scanner. Currently the smallest wand is made by Dental Wings.
Otherwise, the systems are user-friendly. Some systems require you to view the screen while you are scanning. Other systems require you to watch the wand while you are scanning, and then view the screen prior to confirming and sending the file. Many scanners have bells and whistles that can be very helpful. But if you don’t expect to use them, the extra cost might not be worthwhile. While many intraoral scanners do not require the teeth to be covered with titanium dioxide, most do work much better with a spray or brush-on powder. Soon there will also be a rinse to make application quicker and more consistent.
Virtually every system is accurate—more so than traditional impression materials. Every manufacturer has a written analysis of its intraoral scanner's accuracy. When reading about accuracy, make sure the accuracy of the length of the scan is described. In other words, you should find out how accurate a full-arch scan is compared to a scan of 20 mm, for example.
Warranties and service
Warranties and service are extremely important. It's worth paying a bit more just to have a reliable service company. A warranty is often included for one year with the option to extend it for an additional year or two. Most systems will have warranties for up to three years, and updates are usually included (but not always). Knowing who or which dealer has the best and most responsive equipment service and backups is a very important part of your buying decision. Do not overlook this and make sure you compare your options. Note that intraoral scanner wands are very sensitive and require disinfection constantly. Following the protocol properly is essential!
I highly recommend that you do a couple of live demonstrations. This can be a challenge to coordinate due to HIPAA, the need for disinfection, a possible lack of trial systems in the area, and/or setting up a convenient time (intraoral scanner unit, salesperson, technical person, dentist, staff, and patients), but insist on it or at least watch a dentist you know working with one.
Costs have come down considerably. Although $40,000 can get you almost any unit you want, you can get a great system that does almost everything a $40,000 unit does for half of the price. Do not get caught up in the sales messaging from the slickest representative. Do consider the monthly or yearly fees. Some intraoral scanners have almost no fees, while others may cost $3,000 to $5,000 per year. Although you might use much less impression material, you will still need some occasionally. Other costs not to be overlooked include scan bodies for implant scans, CAD model costs, and a possibility of more integrated IT.
After many years of this technology evolving—with lower costs, more competition, and open architecture—it's time to consider an intraoral scanner for digital impressions. By 2020, I believe most practices will use them as a standard of care.
Larry Borman is the lab manager for Tetra Dynamics Dental Laboratory, which was founded in 1990. Mr. Borman holds a bachelor's degree in business and economics from New York University (NYU), and he is a member of the American Prosthodontic Society and the National Association of Dental Laboratories. He has served on the faculty of the full-mouth restorative department at NYU’s School of Continuing Dental Education. Mr. Borman has been involved with instruction, chairside assistance, hands-on lecture presentations, and management of treatment plans for local practices, residents, and students at many institutions, including NYU College of Dentistry, Stony Brook University, North Shore University, New York Queens Hospital, Mt. Sinai Hospital, Nassau County Medical University, and the New York– and New Jersey–area VA hospitals.