It’s my goal as an iTero Element® trainer to help the entire dental office use the iTero Element intraoral scanner more efficiently – and have fun doing it! Over the last six years working as a trainer, there are dozens of tips and tricks I have learned along the way that accomplish both goals. One of my very favorites is called the Toothbrush Technique, used when completing a full-mouth scan. Now, there may normally be a disclaimer or warning along the lines of, “Don’t try this at home,” but in this case, try this at home! Grab a toothbrush and follow along as we walk through the Toothbrush Technique.
The Toothbrush Technique for iTero Element
Everyone in dental office knows how to brush teeth; scanning with the iTero Element is done in the same exact way. When you brush your teeth you move the entire tooth brush as one solid piece. You do not place the bristles on the teeth then move the handle of the toothbrush in circles. It stands to reason when you use place the wand in the mouth you should move the entire wand as one solid piece. The most common error during scanning is leaving the tip of the wand on the tooth and circling the cord end of the wand all over the mouth.
Handling the iTero Element Wand
When handling the wand, always hold it from beneath like a large pen. Over-hand grabbing of the wand will force your elbows up and out from your sides, which means the weight of the wand will rest on your shoulders and upper arms. Holding from beneath will allow your elbows to relax and remain close to your sides.
Proper Brushing is Proper Scanning
Like any good brushing technique, the goal is to use all the bristles of the toothbrush to effectively clean the teeth. When scanning, make sure the scanner head is flat on the tooth surface and touching as often as possible. As you can’t brush teeth with the toothbrush in the air above the teeth, you can’t properly scan that way, either.
Scan the occlusal surface first. It’s common for most people to following the incisal pathway, instead you should make a “U” with the wand. New learners tend to move the cord-end of the wand and leave the tip in the same position. A common error is the horizontal movement from canine to canine. The entire wand is moved horizontally not just the cord end. Time to try this at home…Take out your tooth brush and place it vertical to the floor and move it from left to right horizontally. Keeping the bristles and the handle vertical the whole time. This is a horizontal movement from canine to canine with the wand.
Start the occlusal scan with the most distal tooth (left or right, your choice) then slide the scanner on the occlusal surface, pulling the entire wand as one piece straight out of the mouth towards the canine. Once you see the canine in the viewfinder box, tilt the cord-end into a slight lingual position and slide the scanner horizontally from canine to canine. Once you reach the canine on the other side drop the cord end back to the occlusal and slide it straight back into the mouth towards the most distal tooth. The trick for a smooth pass is to ensure the incisal edges are at the top of the viewfinder box during the horizontal movement from canine to canine. Grab your toothbrush and try to “scan” your teeth as it’s described above.
Before we move on to the next step, let’s address the retraction technique. As clinically minded people, we always watch what we do in the mouth. The retraction technique – AKA the “fish hook” is pulling the cheek to the side to get a good view of all the teeth. But here’s the thing: With the iTero Element, we have to understand that in order to be successful and efficient when scanning, we are not looking into the patient’s mouth while we work. This is the hardest thing to unlearn or teach, as it goes against what we know as clinicians. But it will make or break your ability to scan. And because your eyes must be focused on the monitor to watch the scan as it builds, fish-hooking the cheek is not required. In fact, the wand tip is designed specifically to do all the retraction in the posterior. Which means placing a finger in the posterior of mouth with the wand will not work. Always remember fingers out of the cheek when posterior scanning. The correct retraction method used is just a simple pointer finger laying horizontal in the vestibule to stop the lip from being pinched under the scanner by the anterior teeth.
Next, scan the lingual. To do this, you’ll incorporate the “twist” method. The “twist” is the rotation of the body of the wand when attempting to scan the mesial and distal on the lingual. It’s done similar to revving the gas on a motorcycle. Pick your toothbrush up and follow along. Lift the toothbrush up horizontally and twist the body of the toothbrush on its axis like the gas on a motorcycle. Can you see the bristles rotate as you rev, towards you and away? Now place the toothbrush in your mouth on the lingual and twist the toothbrush so the bristles are flush with the lingual surface. If you feel the handle of the toothbrush on the incisal edges of your anterior teeth, just raise or lower the handle accordingly to become perpendicular to the jaw.
From the occlusal you twist the scanner into the lingual, pulling the entire wand slowly out of the patient’s mouth, making sure that the flat scanning surface “bristles” are flush with the lingual. The trick is to really over-exaggerate the lingual angulation from the terminal molar to the canine. Once at the canine, you slowly twist the body of the scanner towards the front of the mouth and slide the scanner horizontally to the canine on the opposite side. Twist the scanner to be flush with the lingual again and slide the scanner down the lingual path using the wand tip to push the tongue away. Using your toothbrush in your mouth, feel how you would slide it gently down the lingual pathway towards the terminal molar and how the back of the toothbrush is pushing the tongue away from the lingual surface of the teeth. Remember the twisting motion and feel the bristles flush against the lingual as you slide.
Jamie Miller, RDH iTero Clinical Trainer