Digital Citizen

The Digital Practice and the iTero® Element™ Scanner
Based on presentations given by Dr. Francesco Garino.


You refer to your practice as a ‘digital’. How did you get to this point?
When I first considered going digital, I felt like I was looking at a maze. It was overwhelming. So I broke it down to three basic questions. How will it impact my workflow? How will it impact my patients? How will it impact my staff? The more I looked at it, the more the words time and efficiency kept coming up.

For me, the scanner was a way to close the loop on what was already a digital practice. With the scanner, I was not only adding a new tool to my clinical repertoire, but anticipating potential needs and trends with my patients. I don’t want to work quickly, but I want to work efficiently. These were the things I had in mind when I sat down with my business partner, who was also my dad, to discuss whether a digital scanner made sense.

Ultimately we decided yes, and so we went with the iTero. At the time, it was the only scanner with certified interoperability with Invisalign®.

What other considerations drove your decision?
Like I said above, it kept coming back to time and efficiency. If we could eliminate inefficient processes, it would impact everything else. The traditional impression process is four steps: mixing, impressing, getting the model and shipping the model. With the iTero, it was just two steps: take the impression and email it.

Obviously it’s a less time consuming process. It eliminates all the back-office work. There are no boxes or trays, there are no materials that need to be ordered and tracked and stored. There are no shipping costs, and the lab fees are far less. So just to summarize, we’ve eliminated tray selection, material mixing, letting the PVS set, disinfecting, preparation and shipping the impression. That’s already a lot.

Let’s not overlook the importance of this efficiency to the patient. We know now that one of the big reasons they come to us is because we have the scanner. Adult patients tell us they still recall the original impression process that they had done as a kid. It’s a standout memory as being there for the worst parts of having braces. So we’re eliminating a truly unpleasant process.

But more than that, it’s about less disruption to their day, and to their life. With the iTero Element Scanner, it’s possible to combine appointments in the beginning. Rather than having separate appointments for the initial consultation, the impression, the record collection, we can do that all in the first appointment. That way we can show the patient the ClinCheck the next time they come in.

How did you present your decision to your staff?
It’s important to remind yourself that your staff is the front line of shaping the patient experience. Everyone has a comfort zone they like to stay in, myself included. So I told everyone in the practice let’s do the training and we’ll give it one month. If after one month, anyone who wants to go back to the traditional impression process is free to do so. Even as we were still mastering the process, the patient experience was drastically improved. The impression is one negative thing that everyone remembers.

It really builds good rapport among the team. Not only are they excited to be included in the use of the new technology, but it’s something they tend to brag about professionally. Because the process is entirely paperless, it makes ending the day easier. There’s not that burned out feeling from shuffling papers all day.

How does the scanner impact the ClinCheck process?
It also reduces the time it took to receive the first ClinCheck plan. It’s about 50% faster. There are occasional times when I’ll get my ClinCheck in 24 or 48 hours. I can tell you this makes a huge difference to the patient. We’re no longer waiting 2 or 3 weeks to get the ClinCheck back. It just lets us get started faster.

You say the most common question you get from your colleagues is about the cost. How do you respond to these questions?
It’s important to ask the right questions to get the right answers. After I tell the price, I ask them to think of it like a car. Most people don’t think of the price in terms of the lump sum, but the financed rate. Consider the cost, but also divide the cost by 48 (months). I tell them this isn’t a luxury, but an investment in a tool that will help them grow their practice. Finally, I tell them to consider all of the ways it will impact their practice. My goal isn’t to convince them one way or another. My goal is to get them to think about if it makes sense for them.


You’ve mentioned how much adults appreciate the ease of the procedure. What about your younger patients?
Some colleagues think a digital impression would be difficult with how much children squirm. But kids and teenagers love the scanner. But I have a trick! When they’re sitting down, I ask the kid if they’ve ever seen their mouth in 3D? When they say no, I tell them “if you want to see it, you’ll need to be still for me for a few minutes”. Well they take that as a challenge! It’s like working on statues from that point on.

What other benefits stand out to you? Are there any negatives?
As a practice, we’ve gotten our average scan time down to under three minutes. I once completed a scan in one minute and 59 seconds. I keep coming back to time and efficiency. The touch screen display is fantastic, it’s like having a giant iPhone there with you. The precision of the impression is just perfect. I haven’t had a redo since 2011. And I’d be remiss if I didn’t mention the online support. With the iTero Element, they can log on to my machine and walk us through anything we’re having a problem with. There’s none of that “describe what you see”.

The Invisalign Outcome Simulator is a big plus. I use it as a clinical tool as well as an educational device. It sometimes helps when a patient is unsure and wants to see the big picture. It’s also a great tool for patient conversion. It really engages the patient and lets us have an actual discussion about their condition. I can also use it to test out a few different plans. For example, I can run it ‘with’ and ‘without’ an extraction and compare the results. We can really show the patients what their options are.

As far as negatives, I will reveal that I was involved with beta testing the new machine last year. I had to sign a non-disclosure agreement to do so. As a result, I couldn’t really talk about this incredible new machine in my practice. That was definitely the hardest part of getting the new machine!

So the iTero Element Scanner figures into your marketing mix?
Yes, prominently. It’s one thing that clearly sets us apart.

We always try and let patients know we’ve got the machine prior to coming into see me. We display the scanner promptly on our website as well as on our Facebook page. In the office, we have the iTero displayed promptly. We have several posters of the scanner posted that build up the mystique. When they see the real one in the office, it kind of creates a smile.

Is there anything else you’d like your colleagues to know?
I like the fact that it’s a green technology. There’s no chemicals that you’re mixing and then throwing away. There’s no pollution from cars and planes when you’re shipping things. I like the fact that my staff is working with a cleaner process. But for me, it all comes down to time and efficiency.

Thank you for your time Dr. Garino.
My pleasure.


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