Innovations in Aiding Caries Detection: How iTero

Caries detection can normally range dependent on the tooth surface area in question. For occlusal pit and fissure lesions, visual and tactile detection can ordinarily suffice. Bitewing radiographs have lengthy been the most practiced system for detection of interproximal lesions, nevertheless there are constraints this sort of as the inherent use of ionizing radiation for imaging, overlapping contacts, and unclear publicity contrast. Due to these types of criteria, choice options for early caries detection have been sought just after to health supplement traditional radiographs. Some approaches that have caught traction are centered on the optical homes of tooth framework and incorporate procedures based mostly on laser fluorescence as well as transillumination with close to infra-red gentle. The target of this paper will be on how close to infra-purple light has proven to be an efficient method for aid in detecting interproximal caries.

Caries detection applying near infra-red gentle is based on the diverse ways that varying tooth composition interacts with explained light. For occasion, intact enamel is observed to be fairly clear when transilluminated with it. This, nevertheless, is not the case when a carious lesion is present. Lesions in the enamel result in scattering of this light-weight, and it is this simple fact that enables for distinguishing among sound and carious enamel with this technological know-how.

When making use of an intraoral scanner with built-in in close proximity to infra-pink mild reflection technology, teeth are exposed to around infra-crimson light and their reflection is provided as a grayscale image. Listed here, audio enamel, appears darkish, even though the carious lesion, which scatters and demonstrates the in the vicinity of infra-pink mild, seems brighter in comparison. Dentin is also reflective and will appear brighter than enamel. An instance of a program that utilizes this technology is the iTero Aspect 5D scanner, an built-in intraoral dental imaging technique that simultaneously captures 3D coloration pictures of the dentition and creates in close proximity to infra-red light visuals (NIRI) which can be utilized to help in interproximal caries detection. The translucency of the scanned tooth construction when uncovered to in the vicinity of infra-pink light translates to the brightness level in the resulting captured impression. The iTero Element 5D imaging method can capture NIRI visuals from several angles and quickly retail outlet them throughout the scan.

The efficiency of NIRI technologies has help from the findings of various reports. One particular these examine was a multicenter, prospective, study performed in 5 individual common exercise clinics in Canada and Germany, with the purpose to assess detection of early interproximal caries applying reflected in close proximity to infra-crimson imaging and bitewing radiographs under serious-lifetime problems [1]. A complete of 100 people, all of whom attended these clinics among April and November of 2020, consented and were involved in the research (n=20 per clinic). All of the provided patients ended up scheduled for bilateral bite wing radiographs as component of their common treatment, as well as a entire scan of the two maxillary and mandibular arches making use of the iTero Aspect 5D imaging process. This scan produced an NIRI image in gray scale together with the 3D colour impression of a specified tooth or pair of teeth. Equally the bitewing radiograph and the NIRI impression were applied to detect interproximal caries. In addition, the analyze as opposed NIRI and bitewing radiography to visible caries debridement.

The outcomes shown substantial precision (p<0.0001) detection of early enamel lesions (88.6%) and of carious lesions involving the dentino-enamel junction (96.9%) [1].  When compared against clinical evaluation of posterior proximal lesions observed during caries debridement, the NIRI technology of the iTero Element 5D imaging system was 66% more sensitive than bitewing X-ray and demonstrated 96% sensitivity for posterior interproximal lesions detections.

The results of this study support the efficacy of the iTero Element 5D’s NIRI interproximal caries detection aid feature when compared to traditional bitewings. In fact, this study found that while NIRI had comparable sensitivity to bitewings in the detection of interproximal caries reaching the dentino-enamel junction, it had higher sensitivity in the detection of early interproximal enamel lesions [1].  This illustrates an important potential benefit for utilizing this technology as a diagnostic aid tool and gives good reason to consider adding this technology to any modern practice.

A second study recently completed in Germany has also found favorable results regarding the iTero Element 5D imaging system’s caries detection capabilities [2].  Here, 250 extracted permanent molars and premolars, selected from a pool of anonymous patients, were vertically mounted, paired off, and approximated to mimic a natural proximal contact. Both bitewing radiographs and scans were completed on the teeth and caries detection capabilities were compared. These teeth were also assessed with µ 40 micro-computed tomography scanner, which was used as a reference for caries detection.  The results of this study showed that the iTero Element 5D imaging system’s detection capabilities were comparable to those of bitewing radiographs. In fact, the NIRI with and without the trilateral (buccal/lingual/occlusal) information was able to detect initial caries defects in enamel with higher sensitivity than bitewings.

This study also highlighted an innovative and effective diagnostic aid function of the iTero Element 5D imaging system.  Another added benefit is that since the images are recorded from various angles, surfaces of teeth are recorded from all sides, providing more information than other intraoral scanners that save individual images [2]. This data is all displayed on the monitor for both practitioner and patient to see. Combined, these features not only assist practitioners in diagnosis of caries but can also aid in patient education and allow the patient to gain a better understanding of their current state of oral health.

Originally created to replace traditional impression materials for the purposes of records and fabrication of dental appliances, contemporary intraoral scanners provide practitioners with much, much more. For instance, modern advancements like oral health assessment tools and integrated intraoral cameras can aid practitioners in diagnosis and treatment planning, while visualization tools serve to improve communication and patient education. With the iTero Element 5D scanner, these benefits are all acquired with just one scan leading to improved workflow. And with its integrated NIRI technology, this system can help practitioners detect supragingival interproximal caries  that could have otherwise gone undetected, preventing potential irreversible damage before it has the chance to occur. Such technological advancements are helping revolutionize the field of dentistry and are increasingly making an impact in dental clinics around the world. From personal experience, the versatility of the iTero Element 5D scanner has helped my office run more efficiently and streamlined procedures. Its ease of use and all-in-one functionality have allowed for improved workflow, all while helping me educate patients on its impressive display monitor. Overall, this product has improved clinical life for both me and my staff, while helping create better clinical outcomes for my patients.


  1. Metzger Z, Colson DG, Bown P, Weihard T, Baresel I, Nolting T. Reflected near-infrared light versus bite-wing radiography for the detection of proximal caries: A multicenter prospective clinical study conducted in private practices. J Dent. 2021 Oct 24
  2. Litzenburger F, Heck K, Kaisarly D, Kunzelmann KH. Diagnostic validity of early proximal caries detection using near-infrared imaging technology on 3D range data of posterior teeth. Clin Oral Investig. 2021 Oct 12.


Steven Glassman, DDS

Dr. Steven Glassman has treated more than 2,000 Invisalign patients since 2002 and has been a member of the Align Faculty since 2004. A pioneer in digital scanning, Dr. Glassman was one of the first users of the iTero digital scanner in the world and continues to publish and lecture on comprehensive digital workflows. In 2005, he was recognized by his peers as the winner of the Invisalign Case Shoot Out, where his case was chosen from among thousands of entries. He is a proud graduate of Brandeis University and the Columbia University School of Dental Medicine. He practices with his wife in the Lincoln Center area of New York City and focuses on cosmetic, implant, and aligner therapy. In 2018, he was named to the Zimmer Biomet faculty, adding to the digital workflow of aligners and implants. In 2020, he received the award for 15 years of service. Recently, he was the first to use the iTero Element 5D imaging system in the United States


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