Updated: Nov 6, 2021
In last week's post, I argued why the iTero would not currently be my first choice among IO scanners on the market. So in this post we look more at the 2 best scanners on the market in 2021.
Trios or Primescan?
Both are good scanners. They're not just good, they're great compared to their predecessors.
The Primescan is clearly the best scanner on the market technically and has the advantage of being portable without having to be switched on and off. The scanner is so intuitive to use that neither you, nor your support staff, need an introductory course to scan with it. (Unlike all other competitors)
I don't know if trios has finally solved the problem of the lack of mobility of their cart models. In the event that you need to use your scanner in more than one clinic and you want a Trios. Then I would definitely recommend either buying a laptop model, or purchasing a UPS that you plug into your cart.
It simply takes too long to shut down your Trios, move it and then start it up again. I'm not one of the fastest dentists in the world. Quite the contrary. Still, the slow handling of a Trios cart was driving me crazy when we had it in my clinic. It is possible post-processing, shutdown and start-up have become faster since my experiences. But I still find that most clinic assistants and dentists who have a state-of-the-art Trios4 become distant when I point out this problem - they completely agree!
Benefits of Primescan
Primescan is developed by Dentsply Sirona, which has more than 40 years of experience in IO scanning. Everything works EVERY time. Workflow and use of Primescan is far more intuitive and user friendly than with Trios (for a beginner). It almost doesn't even require an intro course!
Dentsply Sirona has really listened to dentists. As a result, Primescan is open and can export STL files without any problems. It is extremely easy to export STL files and works super well.
Another cool, but overlooked, feature is that you can get the scanner head with a fixed scanner tip but also alternatively with disposable or autoclavable tips. This way, any need the clinic may have is covered. This focus on the individual dentist's wishes and needs runs through the entire design of the scanner and its software. It's just super nice all the way around.
If you ever want to produce in-house prosthetics, no one comes close to the workflow Sirona Dentsply has refined with Cerec over the past 40 years. It works extremely well and works every time. (We've tested both Cerec and Trio's in-house prosthetics workflows. There is no doubt that Trios is far behind Cerec - please contact me for a more detailed explanation)
In a later post, I'll talk about why it's a really good business to work with Cerec in your clinic. If you want to be sure to receive future posts on the blog, sign up by clicking on "login" in the top right corner. Follow the instructions and you will receive a link to the latest post each week.
Challenges with Primescan
There are a few challenges with Primescan that you should be aware of before investing. First, the scanner head is somewhat larger than that of the Trios. This means that it can be more difficult to get distal to the posterior molars when scanning here. Conversely, Primescan is better at capturing larger surfaces at a time than Trios. Which means that, in principle, you only need to scan a tooth row 2 times (buccal oblique and oral oblique) - unlike Trios, which requires 3 scans (occlusal, buccal and oral). This is rarely a problem, but it does occur.
You wouldn't think it, but scanning from a Trios doesn't work optimally with software from Dentsply Sirona and vice versa. We have tested it several times and can see there is a difference. Where this difference lies, we are not aware of. However, we can conclude that STL is not "just" STL.
The STL files form a series of triangles that create a 3D surface. We suspect that the inaccuracies may be related to differences in the size of these triangles. But frankly, I haven't delved into the technical details enough to give you a competent guess as to where the differences lie specifically. However, I can pass on to you the experiences that my team and I had using the different systems in combination with several different dental laboratories in Denmark and abroad.
If your dental lab uses Trios lab software, the prosthetics you receive after a scan with Primescan will not fit as well as if it comes from a dental lab with Dentsply Sirona lab software. Similarly, prosthetics from a lab using Dentsply Sirona software will not fit as well if they come from a Trios as if they come from a Primescan.
Therefore, it is important that you research what software your dental lab uses before investing as large an amount as it takes to acquire an IO scanner.
Trios call for focus on mobility
Where Primescan is only available as a cart that can be moved seamlessly from room to room. You can get Trios as a cart and as a free scanner connected to a laptop. The laptop models were previously challenged by the laptops not being powerful enough to pull the software. However, this is no longer a problem. Since the Trios cart by default does not have a battery that allows you to easily move your scanner. It is my clear recommendation to buy a laptop model. It may not be as aesthetically beautiful as the latest Trios cart. It just works better in an everyday dental practice!
Invisalign, Trios & Primescan
Last week I described a bit about the challenges of the closed system associated with Invisalign.
Invisalign are unhappy that Primescan and Trios are far superior to their iTero as well and that Dentsply have their own version of clear aligners - Sure Smile. At present (as far as I know) only Trios are still allowed to upload scans to Invisalign. However, only with Trios3 and only in Europe. (This may change quickly though - just look at the lawsuits between align and 3shape in the US).
With the ability of exporting STL from both Primescan and Trios to a third party, it is obvious to start looking for alternatives to Invisalign, such as ClearCorrect, Spark or Sure Smile. There are pros and cons to all systems, which you can read about here.
3Shape does not produce any aligners themselves. However, they have a software package that allows the design and production of clear aligners in-house. However, this is by no means recommended for any regular clinic as the workflow is far too time consuming and the software too expensive. Overall, this means that in-house aligner production will be far more costly than a better solution from the big players in the market - Invisalign, ClearCorrect, Spark and Sure Smile.
However, I would like to praise Dentsply Sirona for having a direct integration to both Sure Smile and their competitors: ClearCorrect and Spark. It shows a focus on their customers' wants and needs, and a belief that their own product (Sure Smile) is better than the others. It's not yet, but I'm sure it will work hard to achieve a leading position in the future.
Colours on a Primescan are lost when exported in STL format. However, only patients and dentists usually like them, so it doesn't really matter.
3Shape has been at the forefront of sending scans to stakeholders via their communicate platform. Dentsply Sirona, however, has not been asleep at the switch and is now pretty much on board.
In my eyes, anything regarding caries detection and the like related to IO scanners is indifferent advertising junk. It makes no sense to have a mega expensive scanner at the dentist's office for that kind of task. Instead, the clinic should invest in the latest KaVo Diagnocam - which the hygienist will love! Here you will get 3 photos in one - an intraoral , fluorecence and transillumination photo. It's better for the function of the hygienist and costs a fraction of an IO scanner.
What to choose?
Both Trios and Primescan are good scanners. As in really good!
What you should consider carefully before your purchase is what digital workflow you foresee in the clinic in the future?
Primescan doesn't lock you in, but isn't always as easy to integrate with third party software as Trios. Conversely, Trios and 3Shapes software are known to promise more than it can deliver, while being unstable when it comes to updates.
When it comes to daily use, the most important thing is that the equipment works!
It's great to have smart features.... when they work. There's nothing worse than sitting in the clinic with a software problem that prevents you from finishing a treatment. Maybe you need to mill a crown and haven't taken a provisional impression because the patient needs multiple crowns milled and cemented on the same day. If a single link in your workflow is not working, you have a huge problem - this is seen relatively frequently with 3Shape. Whereas the Cerec workflow only extremely rarely gives you that kind of challenges.
You may also need to perform a full jaw scan for a treatment. If you can't scan, you'll have to call the patient back in another day and maybe cancel several patients before you get the software and hardware right. This costs an extreme amount of money, as your chair hours are super expensive. Trios is almost notorious for creating this kind of problem for their customers. Whereas Dentsply Sirona rarely gives clinics problems of this nature.
Trios has the ability for many cool ADD on software features that seem incredibly cool when you see 3Shape's marketing material. 3Shape has always been quick to come out with new really cool features. Often so fast that it is becoming a common knowledge among Trios users that you must NEVER make updates when they are released. You have to wait at least 6 months to make any software updates. Just to make sure the scanner and software works as it should!
This effectively means that you feel like a beta tester, even though you have paid full price for your equipment with 3Shape.
Primescan is part of Dentsply Sirona = German quality that always works.
Because everything is checked so many times before release. It also means that their latest features may seem somewhat old-fashioned compared to competitors' when they are finally released. On the other hand, it always works.
Whatever scanner you choose, expect a learning curve. It takes time to get good at scanning. Just as it takes time to get to know the workflow and the software. Take your time, get comfortable with your expensive equipment, and enjoy the fact that you'll never have to fuss so much with impressions again. It really is a great piece of equipment.
Happy hunting for your optimal scanner.
.... And remember - in 5 years there will definitely be a new and even more amazing model on the market. If it goes like all other modern technology, you'll probably have to invest in the technology that comes on the market by then. The price of all this modern hardware makes it increasingly important to look at the business model of the equipment you buy. You will be quickly penalised on the clinic's bottom line if you make a bad purchase. That's too bad because it helps reduce your freedom.
Ultra short summary
The tests I've read and the subjective assessments I hear from colleagues who have actually tested both scanners all come out in Primescan's favour.
Primescan now has an open software platform and thus talks to all other open systems. (It CAN be connected to Cerec, but is not a must. If you do, you have the absolute best and most reliable system on the market for in-house production)
Primescan is as intuitive to use as an iPhone. For all demos you don't need any prior instruction and it works!
Primescan seems to have the same accuracy as Trios.
Dentsply Sirona has no legal conflicts with Invisalign. (By the way, be aware that Primescan is not yet approved by Invisalign and unlikely to be as long as it is superior to iTero - you may want to use Clear Correct instead).
Primescan works every time. The updates from Dentsply Sirona are always thoroughly tested so you don't have to worry about the function of your scanner every time you make an update (as with Trios - read the international posts from countless frustrated Trios users around the globe)
As the market looks right now, I would choose Primescan.
It's only a matter of time before an even fatter scanner comes on the market. Competition among the leaders is fierce as the industry is making a killing selling IO scanners right now!
If you insist on an IO scanner ONLY for scanning invisalign cases, the iTero is undoubtedly the best.
For EVERYTHING else, it is far from optimal. (Buy a Trios or Primescan instead. It gives you more flexibility and more value for money)
Additionally, it's interesting to see how Invisalign has fared against their competitors. Both in the aligner and scanner market. An iTero will probably tie the clinic even more to Invisalign as the competitors in the aligner market gain more market share (keep in mind that Invisalign is an American product and that Invisalign has a very American business culture)
There is some evidence that Invisalign is trying to lock Dentists into Invisalign's "closed system" while companies like Sirona Dentsply have gone the other way and opened up to the outside world (Primescan is an open system that can export STL files like everyone else - unlike their previous scanners)
In addition, it is interesting to observe how easy it has been for ClearCorrect from Straumann to enter the clear aligners market in Europe. Their system is simpler, costs nothing to become "certified" in using, is not locked to a particular scanner and is somewhat cheaper.
So think twice before spending your money on an iTero.
Getting the most out of your scanner
If you want to know more about how you can optimize your workflow and get a better return on your expensive IO scanner, feel free to contact me. My mission is to help dentists achieve their dreams. That's why I teach and coach dentists and their their teams on all the topics we were never taught in dental school.
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Many kind regards
Jesper Hatt DDS
T: +41 78 268 00 78