How to use the iTero-exocad Connector

By Dr. Steven Glassman and David Lampert

Align Technology presented the latest version of the iTero- exocad Connector last October. The software was previously introduced at the exocad Insights conference in Mallorca in 2022. Dr. Steven Glassman and David Lampert, Town & Country Dental Studios, were among the select group of doctors and laboratory owners who had early access to explore the system’s functionalities.

Here, they detail the clinical and laboratory procedures of an implant case to demonstrate the advantages of the iTero-exocad Connector, which directly links the iTeroTM intraoral scanner with the exocadTM DentalCAD software and allows all external case-related images and files to be attached to the iTero Rx form. 

Restorative Challenge: The patient presented with a mobile upper right lateral incisor (tooth #7). Both this tooth and the central incisor (#8) had porcelain crowns, prior root canal treatments and periapical lesions. Additionally, the central incisor had a root fracture and the periapical lesion on the lateral incisor was deemed untreatable by an endodontist. (See Fig 1-2)

Treatment Plan: Both teeth #7 and #8 required extraction and the patient opted for an implant-based, two-unit bridge with the lateral incisor as a cantilever restoration. 

Clinical Procedure: For aesthetic cases like this one, my usual approach would be to ask my lab to create a digital waxup and share it via exocad DentalCAD webview so I could evaluate the design and let them know my corrections to ensure the best possible result. 

As we were at the prosthetic stage of this case, the new iTero-exocad Connector was introduced; we used it and my life was immediately easier. Instead of using multiple communication channels such as WhatsApp, Dropbox, WeTransfer and email with my technicians, we now have one platform where we can share everything: scans, pictures, X-rays, etc. 

In the past, we’ve encountered challenges, particularly in implant cases, because the laboratory, surgeon and GP weren’t all working on the treatment plan together and there was a lack of comprehensive facial and prosthetic planning. With the ability to attach images to the iTero Rx form, we can dis- cuss the treatment plan with the lab immediately, which allows for a holistic view of the plan, enhancing the likelihood of successful outcomes. 

During the consultation appointment, the upper right lat- eral incisor exhibited mobility; the post and crown dislodged during the examination. iTero and CBCT scans were taken, and the patient was referred to an oral surgeon for an implant consultation. 

At the next appointment, teeth #7 and 8 were extracted, and the bone grafting procedure was per- formed simultaneously. The patient received a removable provisional acrylic partial denture. 

Three months later, a ZimVie T3® Tapered Certain dental implant (4.1 x 10mm) was placed and torqued to 45 Ncm. Due to inadequate bone thickness, only tooth #8 could support an implant even with the bone grafting procedure. A scan body was seated and scanned, followed by a custom healing abutment. The custom healing abutment was removed for an emergence profile scan, followed by a scan with the scan body. Photos were attached to the iTero Rx form and sent to the lab. (See Fig. 3-7)

Lab Design Procedure: 

All case-related records — including scans, photographs, prescription forms and other files — were automatically imported to exocad DentalCAD software through the iTero-exocad Connector. (See Fig. 8)

The pre-op scan of the emergence profile and scan body were aligned to ensure the proper fit. (See Fig. 9)

The smile image was aligned with the models to provide in-face visualization of the restorative outcome. (See Fig. 10a-b)

The teeth were placed and the abutment was adapted to the emergence profile. (See Fig. 11a-b)

The lab shared the design from the exocad DentalCAD software (top image) via exocad webview directly to Dr. Glassman’s MyiTero.com portal (bottom image). (See Fig. 12a-b)

The final design for review: Dr. Glassman had one correction that he communicated via the platform: he asked the lab to make the gingival area of implant #8 higher to match #9. (See Fig. 13)

Fabrication: The lab milled the restorations using the 5-axis DWX-52D mill from Roland DGSHAPE. The material of choice was a high-strength, multi-layer, pre-shaded zirconia featuring a gradient from the incisal to gingival that gives the crowns a natural appearance. The ceramist handled the final fitting, contour- ing and staining and glazing. 

Final Result: A week later, the final cantilever bridge was seated, verified with an X-ray and torqued to 20 Ncm. The occlusion was adjusted and final photos and a scan were taken. (See Fig. 14-15)

“The patient was thrilled with the final results,” says Dr. Glassman. “As you can imagine, it was pretty traumatic for her to lose both teeth and she was quite concerned about achieving a great cosmetic result. The results are outstanding!” 

Digital Workflow with the iTero-exocad Connector^TM 

The iTero-exocad Connector directly links the iTeroTM intraoral scanner with the exocadTM DentalCAD software. The dentist can attach external case-related images and files to the iTero Rx form, and the data is immediately
transmitted to the lab. “This new integration also allows real-time feedback and adjustments while the patient is in the chair, eliminating the need for return visits for additional scans,” says Dr. Steven Glassman. 

The system facilitates a seamless transfer of all the necessary information and enhances collaboration between the laboratory and dentists. “It streamlines our workflow as well as our ability to get information and easily communicate with the dentist, all of which offer better coordination and improved outcomes,” says David Lampert. “It saves us time, so we’re able to focus more on craftsmanship and aesthetic precision, which enhances the quality of the final restorations.” For more information, visit itero.com.