Empowering small practices: Advantages and clinical applications of iTero™ Design Suite, a CAD software powered by exocad™ in chairside dentistry
Digital technologies have significantly transformed modern dentistry. However, despite the increasing adoption of digital workflow solutions in dental clinics, many dentists—especially small practice owners or those operating in resource-limited environments—remain hesitant to make the switch. One major barrier is the substantial upfront cost, as many digital systems require dentists to purchase entire proprietary “closed” setups—such as intraoral scanners, design software, and 3D printers or milling machines—that are not compatible with third-party equipment. This lack of compatibility means dentists are compelled to invest in a complete system, making the financial commitment unfeasible for many.
Addressing this challenge, Align Technology recently introduced an innovative, subscription-based design software powered by the global digital design leader exocad. Unlike closed systems, this software is compatible with various existing digital hardware on the market. This flexibility allows small dental practice owners to select 3D printers or milling machines that fit their budget and needs, empowering them to establish chairside digital workflows without having to make substantial investments in new equipment.
The digital dentistry landscape
Digital dentistry has transformed clinical workflows, offering greater precision, efficiency, and patient satisfaction. (Minervini, 2024). Among such innovations, are systems that enabled dentists to provide same-day restorative solutions to their patients with an unprecedented ease. Such systems comprise a suite of technologies including IOS, CAD/CAM software and 3D printers/milling machines.
Barriers to incorporating digital workflow systems in dental practice
Schnitzler and Bohnet-Joschko (2025) argued that currently, a mixed level of digital technology adoption can be observed, with some dentists fully adopting them while other still hesitant towards them. Similarly, a survey of German dentists evaluating their usage of digital technologies in clinical practice showed that only 48% dentists owned a CAD CAM machine, while only 32% used a 3D printer, and 21% relied on digital prosthetic planning software (Schnitzler and BohnetJoschko, 2025). Research shows that financial constraints – such as the high upfront cost of the equipment and maintenance – are among the primary barriers preventing dentists from incorporating digital workflow systems in their office. According to a survey of Indian dentists and technicians regarding the awareness and potential barriers to the use of digital technologies in dentistry, over 94% responded that the major barrier was the high cost of equipment (Acharya et al., 2023). Similarly, a qualitative study by Gebhardt et al. (2025) evaluated the key stressors and resources associated with the adoption and use of digital technologies by dentists. The study identified various problems that prevented dentists from switching to digital dental systems, including the need for staff training, high acquisition and maintenance costs. Furthermore, the respondents – both experienced and inexperienced – felt that rapid obsolescence of the systems resulted in the need for frequent upgradations that further increased the financial burden.
Currently available digital workflow systems are provided as a complete “bundled package”, comprising a proprietary intraoral scanner, digital design software, and a milling machine. Although these so-called “closed systems” offer seamless integration, they incur a steep initial investment and require the complete, manufacturer-specific package for functioning. This means that digital equipment from other companies will not be compatible with these systems. As a result, dentists have to buy the entire system, requiring considerable extensive upfront investment.
While large dental institutions, hospitals, and large dental practices could easily afford these packages, smaller clinics, solo practitioners, and those working in resource-constraint settings are unable to buy these bundled systems due to high cost. Van der Zande et al. (2013) argued that while the benefits of early adoptions of digital dental technologies for dentists remains unclear, initial cost and skill requirement were high. As a result, many dentists were adopting a “wait and see” policy before embracing digital workflow systems in their practice.
iTero™ Design Suite powered by exocad – a cost effective, and intuitive solution
Considering this barrier to accessing chairside designing options, particularly for smaller dental practices, Align Technology has offered, an easy-to-use solution for dentists and staff looking to start in-house designing and fabrication - the iTero™ Design Suite.
Let’s take a look at how the iTero™ Design Suite can be utilized for a wide range of clinical procedures and prosthesis fabrication, and how it has helped dentists achieve aesthetically pleasing, functionally efficient, and durable treatment outcomes.
Case 1: Indirect posterior onlays and post-Invisalign veneer mock-up for a severe attrition dentition
A balanced occlusion is crucial for an aesthetically pleasing smile and optimal oral health. This case presents a full-mouth rehabilitation leveraging the iTero™ Design Suite. A patient requested restoration of #41 (mandibular right central incisor). Clinically, there was generalised, severe erosion and attrition (Fig. 1), a deep bite, and generalised malocclusion.
A multi-disciplinary treatment was proposed for the patient. A Kois deprogrammer was used to establish the centric relation. Using the iTero™ Design Suite, the posterior occlusion and the intended vertical dimension were digitally designed. Indirect composite overlays were then fabricated from the design and used for temporisation to restore vertical height and test function. Subsequently, Invisalign® aligners were employed to correct the overjet and achieve optimal alignment.
Fig. 2: Digital workflow for multi-disciplinary treatment of servery attritioned teeth involving temporisation with overlays, followed by Invisalign treatment , and aesthetic restoration with veneers.
Post-alignment, veneers were placed to restore smile and facial aesthetics. Intraoral scans were captured with an iTero™ scanner and sent to the laboratory for fabrication. The anterior teeth were restored first (#13–23 and #33–43), followed by the posterior teeth.
For full-mouth rehabilitations, patient acceptance is crucial and hinges on efficient communication and education. The recently introduced Mock-up Design feature in the iTero™ Design Suite was pivotal for patient acceptance, allowing visual simulation of the planned outcomes and procedures.
Dr. Ryan Tse
B.D.S, MClintDent,
MSc
Dr. Ryan Tse
B.D.S, MClintDent,
MSc
“The Mock-up Design feature in the iTero™ Design Suite is a boon for dentists and patients. It helps significantly improve patient acceptance and satisfaction by letting patients visualise their smile at the end of treatment – even before we begin ”.
Case 2: Aesthetic restoration of damaged teeth with a digitally designed 3-unit bridge
A patient presented with anterior dental trauma and a recently dislodged 20-year-old PFM bridge replacing teeth #11, 21, and 22 (Please refer to scan and prep sections of Fig. 2). History taking with Periapical radiograph, and an intraoral scan confirmed the condition revealing loss of #21 due to past trauma.
A medium-long term provisional fixed prosthesis was considered to allow for soft-tissue healing. To meet the patient’s request for immediate tooth replacement, a digitally designed three-unit provisional bridge was created using the iTero™ Design Suite. It was easy to use and allowed for the optimal designing of the margins to maximise aesthetics and function.
Fig. 2: Digital workflow for designing a milled 3-unit bridge for missing #11, 21, 22.
Post preparation and design, the pre-op model was printed using a Phrozen printer, and the bridge was milled chairside with a hybrid ceramic via an imes-icore milling machine. The final fixed prosthesis was delivered within 24 hours, and it blended in well with the natural teeth.
Dr. Jack Milgate
Ba HS Dent, Ma Dent
Barwon Heads Dental
Victoria, Australia
Dr. Jack Milgate
Ba HS Dent, Ma Dent
Barwon Heads Dental
Victoria, Australia
“I was impressed by the ability of iTeroTM Design Suite to control the margin of our prostheses, and the subsequent efficiency of chairside production”.
Case 3: Digital wax up for anterior smile makeover
The iTero™ Design Suite helps overcome a wide range of clinical problems by providing a one-stop solution for diagnosis, treatment planning, designing, and fabrication needs. The software offers precise control over the treatment plan process, including the ability to superimpose a 2D photo onto a 3D intraoral scan. The various digital tooth libraries facilitate both the initial digital wax-up and the creation of final restorations, while also allowing for easy adjustments to tooth proportions, shape, and incisal planes. This results in a smooth workflow from digital planning, digital impression to final design.
A patient’s visited the clinic dissatisfied with the aesthetic appearance of the two front teeth and the discoloration of the others. Examination revealed an average smile line, brown calcification on the facial surface of tooth #11, staining on the composite filling of tooth #21 and discoloured teeth (Please refer to the scan and diagnose sections in Fig. 3). It was decided to prepare 3D-printed veneers for teeth #14-24, followed by whitening of the lower teeth.
Fig.3 Chairside 3D-printed veneers for #11,21
A digital impression was obtained using the iTero™ scanner and iTero™ Design Suite was utilized to create a digital smile design by superimposing the 3D intraoral scan with a 2D smile view photo. A digital waxup was designed according to ideal tooth proportions, ensuring an even incisal plane. The STL files were generated and transferred to a 3D printer (Shining 3D, AccuFab-D1s) for the fabrication of printed digital waxup model.
Final digital impressions were taken and afterwards, provisional veneers were applied using spot etch and spot bond, followed by the placement of bis-acryl material. The final scan was accessed from MIDC and opened in the iTero™ Design Suite, where the design for the final ceramic veneers was created.
The margins were drawn on each prepared tooth, the path of insertion was created, and the previous tooth library was selected. The digital wax-up STL file was used as a pre-operative reference to shape and contour the design of the definitive ceramic veneers. The STL files of the designed veneers were sent to TopZir for CAD wax-up fabrication and veneers were milled by Roland DWX milling machine.
The CAD wax-up was pressed with high-translucency lithium disilicate material (Amber Press, HTW3). The veneers for teeth #12 to #22 were designed with an incisal layering, while monolithic lithium disilicate with external staining was used for the other teeth. The prepared veneers had an excellent fit over the prepared teeth and restored the patient’s facial aesthetics.
This software offers precise control over the treatment plan process. Various digital tooth libraries facilitate not only the initial digital wax-up but also definitive restorations, while also allowing for easy adjustments to tooth proportions, shape, and incisal planes. Additionally, it improves communication between the dentist, patient, and dental lab, enhancing collaboration and reducing turnaround times for restorations.
Dr. Alisa Tapananon
DDS, MSc
Dr. Alisa Tapananon
DDS, MSc
“The ability to instantly visualize and adjust the design with precise control over tooth proportions, shape, and occlusion greatly enhances both accuracy and efficiency. Additionally, the user-friendly interface of the software contributes to a faster, more streamlined process, ultimately improving patient outcomes and reducing treatment times.”
Case 4: Single-day 3D printed inlays
Root canal-treated teeth often require reinforcement with crowns. This not only strengthens them and reduces the risk of fracture, but also optimizes function, particularly in the posterior teeth. According to Tikku et al., (2010) the survival rate of posteriors restored with dental crowns is significantly higher than those without a crown support. The decision to support a root canal-treated tooth should be done based on individual clinical needs.
A case is presented where a patient requested a crown for an endodontically treated #15. While the restoration appeared clinically sound on examination, its clinical life could be enhanced significantly by supporting it with a crown (Please refer to the initial photo/scan section in Fig. 4) The initial treatment plan involved placing a 3D printed crown over #15. However, when the treatment plan was shared with the patient, they asked for a more cost-effective treatment option. Therefore, a 3D-printed inlay was considered for treatment.
Fig. 4 Chairside design and fabrication of 3D printed inlay to support an endodontically treated #15 using the iTero™ Design Suit
Final inlay prep iTero™ scan was accessed was accessed from MIDC and opened in iTero™ Design Suite. Designing was done to achieve active/passive fit with optimal margin placement. The Final Inlay design file was printed on Ackuretta SOL Plus using Nextdent Microhybrid C and B resin. Post-printing, the inlay was washed with 99% Isopropyl Alcohol, rinsed and washed with clean water to remove the residue alcohol. Ackuretta Curie plus was used for final curing. The inlay was cemented with G-Cem dual-cure self adhesive universal resin cement.
Dr. Tan Khang Lin
DDS, K.L. Tan Dental
Surgery, Malaysia
Dr. Tan Khang Lin
DDS, K.L. Tan Dental
Surgery, Malaysia
“User friendly interface, easy to access and designing usually requires minor adjustments. The resin cost is low, and this design software is complimentary with iTero™ scanner enabling me to do inlay, crown and bridge chairside.”
Case 5: Customised, in-house 3D-printed paediatric crowns for nursing bottle caries
A paediatric patient presented with multiple caries #54 due to nursing bottle syndrome (Please refer to the pre-op photograph in Fig. 5). The patient lived far away from the practice and requested that their treatment be performed in a single sitting. it was decided to restore carious lesions without pulp exposure with composite fillings. However, tooth # 54 presented an advanced lesion with pulp exposure, necessitating endodontic treatment, a core build-up, and a 3D-printed crown restoration to restore its stability and function.
Fig. 5 Chairside designed,3D -printed, ceramic crown to restore tooth #54 using the ITero™ Design Suite
Tooth #54 was prepared and scanned followed by intraoral scanning using an iTero™ scanner, supplemented by iTero™ Near Infra-Red Imaging (NIRI) technology. A precisely fitting inlay was digitally designed using iTero™ Design Suite. The software is intuitively designed to enable beginners in designing restorations and prostheses using the wizard guided workflow that leads the user to each step to complete the design.
The design process starts by verifying the type of restoration to be designed and production setting. We then review the auto-detected margin line and adjust it if necessary. In our experience, margin line tracing is usually accurate and doesn’t require adjustments often.
“Many patients who live relatively far from the clinic or require single-day treatments for various reasons can now benefit from this workflow. It enables efficient and timely care, making singleday treatments feasible.” Dr Chen
The design file was transferred to SprintRay pro 55S seamlessly via a click of a button in iTero design suite. A SprintRay Ceramic Crown A1 material was used for fabricating the crown. We fabricated the crowns inhouse using our 3D printer and ceramic resin. The design process took about five minutes, printing approximately eight minutes, and washing and curing another five minutes. From taking the scans to having the crowns ready for cementation, the entire process took less than 20 minutes.
Unlike traditional prefabricated stainless-steel crowns commonly used to restore deciduous teeth, 3D-printed crowns offer several advantages. Stainless steel crowns are pre-made and do not fit precisely, often leading to plaque accumulation in marginal areas and subsequent gingival inflammation. Additionally, they are not aesthetically pleasing due to their metallic appearance.
In contrast, 3D-printed crowns are individually fabricated based on the tooth’s anatomy, similar to permanent crowns for adult patients. They can be customized to match the natural tooth colour and morphology, providing a better fit and potentially enhancing their longevity and the periodontal conditions.
Dr. Yi Jyun Chen
DDS, MDS, PhD
Artist Dental Clinic, Taiwan
Case 6: Convenient, in-house design of same-day, ceramic crowns
Here, a patient presented with sensitivity in anterior teeth #31,32,41,42 (Please refer to the scan and prep section in Fig. 5. initial examination revealed that the affected teeth were found to be restored with poor quality crowns having marginal defects. Dr. Ryan decided to remove the old crowns. An intraoral scan was used in iTero™ Design Suite for a digital wax-up, and the abutment teeth were digitally designed. (Fig. 6).
Fig. 6 Digitally designed and milled crowns for #31, 32, 41, 42 with the iTero™ Design Suite
Temporaries were printed using Luxa temp material followed by milling of four Emax crowns using the same design file in Dentsply Sirona Prime mil.
Dr Ryan noted that iTero Design suite software is easy to use, and one of the key benefits is it allows designing of aesthetically pleasing restorations, while ensuring optimal occlusion. The patient was impressed to be able to receive permanent resolution of their chief complaint in a single appointment.
He also shares that complimentary access to the iTero™ Design Suite eliminates the need to buy expensive software for designing, or to relying on an outsourced laboratory.
Overall, it streamlines workflows and elevates the patient experience through speed, convenience, and versatility.
Dr. Ryan Tse
B.D.S, MClintDent, MSc
Dr. Ryan Tse
B.D.S, MClintDent, MSc
“We can design the tooth in-house, which makes it easier to control both the timing and patient appointments. Since everything is done internally, we also have full control over the design. Patients enjoy visiting the clinic because of its efficiency—it allows clinicians to perform same-day dentistry. With the addition of a 3D printer, we can elevate our clinic to a whole new level.”
Case 7: 3D printed deprogramming splint
Temporomandibular joint disorders (TMDs) refer to conditions that can cause pain in the masticatory muscles and the temporomandibular joints. Unfortunately, the prevalence of TMDs has increased considerably over the years. It has been estimated that over 33% of the Asian population suffers from TMDs (Zieliński et al., 2024). Furthermore, these disorders require careful treatment planning and extreme precision while fabricating appliances such as splints, to ensure that the underlying issue is resolved without affecting the dentition.
A patient presented with complains of pain in the lower jaw, and constant pain in the head and neck. Extraoral examination showed tender medial and lateral pterygoid muscles. Intraorally, the patient had a deep bite with a mesially tipped #37 and generalised lower anterior crowding (Please refer to the preop photograph/ scan in Fig. 7). Dr. Karan decided to treat the TMD by providing relief on the first contact point of #37 and prescribing a deprogramming splint (See the design and print section in Fig 6). After providing relief to the contact point at #37, an intraoral scan was obtained.
Fig. 7 3D-printed deprograming splint for TMD using the ITero TM Design Suite
The iTero™ Scans can be opened directly into the ITero™ Design Suite software from MyiTero™ portal. Afterwards, Ackuretta printing machine was used to 3D print the appliance using the iTero™ Design Suite. The overall process was smooth and user-friendly.
Case 8: Anterior Maryland temporary bridge with iTero™ Design Suite
A patient presented with complaints of a broken maxillary #11 (Please refer to the scan and prep section in Fig. 8). Preoperatively, and intra-oral scan and CBCT were used for the qualitative and quantitative assessment of the bone around the affected tooth. The proposed treatment plan involving extraction of the root stump, followed with immediate implant-placement and temporisation with 3D-printed crown.
Fig. 8 Implant-supported temporary prosthesis for missing #11 designed on the chairside using the ITero™ Design Suite.
Instead of waiting for the lab fabricate a temporary prosthesis, the iTero™ Design Suite was used to design and print the temporary with pre-treatment scan.
“Previously, we observed misinterpretations on design between the laboratory and the clinic personnel. The prosthesis was designed in-house using a 3D printer with no laboratory involvement. This significantly helped reduced the treatment duration and ensured optimal clinical efficiency.” Dr Karan
Dr. Karan Bhalla
MDS Ortho
Dentaesthetica, India
Conclusion
Drawing from the evidence above, the iTero™ Design Suite is an open design software that integrates with a wide variety of 3D printers and milling machines on the market. This software is aimed at enabling small- to medium-sized practices to fabricate same-day, chairside temporary restorations or deliver permanent restorations and appliances. Since this software is available complimentary with an iTero scanner through subscription services, it can substantially reduce the initial investment costs for dentists wanting to explore in-house designing and fabrication. The iTero™ Design Suite also allows dentists to use their existing 3D printers or milling machines with iTero™ recommended, compatible hardware.
Dental practices can experience significant returns on investment in the form of lab fee and remake cost savings.
The most important benefit lies in the versatility of the design tool, which supports smile designing, crowns, inlays, night guards, deprogramming splints, Maryland bridges, splints, and temporary restorations.
Unlike other digital design software with steep learning curves, the exocad-powered iTero™ Design Suite is user-friendly for all types of users and offers hasslefree installation and setup.
A unique feature of this system is its ability to streamline the entire design and fabrication process, performing most of the design tasks automatically and requiring minimal input or modifications from the dentist. Additionally, its seamless connectivity with major 3D printers and milling machine, eliminate the need to manually transfer scan files/design files from one system to another. An experienced user can deliver a 3D-printed crown from design to finish in just 20 minutes. This not only saves the dentist’s time but also allows for improved patient care and treatment quality.
References
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Minervini, G. (2024). Digital technologies, materials and telemedicine in dentistry. Prosthesis, 6(6), 1325–1328.
Schnitzler, C., and Bohnet-Joschko, S. (2025). Technology readiness drives digital adoption in dentistry: Insights from a cross-sectional study. Healthcare, 13(10), 1155.
Tikku, A. P., Chandra, A., and Bharti, R. (2010). Are full cast crowns mandatory after endodontic treatment in posterior teeth? Journal of Conservative Dentistry and Endodontics, 13(4), 246–248.
van der Zande, M. M., Gorter, R. C., and Wismeijer, D. (2013). Dental practitioners and a digital future: An initial exploration of barriers and incentives to adopting digital technologies. British Dental Journal, 215(11), E21–E21.
Zieliński, G., Pająk-Zielińska, B., and Ginszt, M. (2024). A meta-analysis of the global prevalence of temporomandibular disorders. Journal of Clinical Medicine, 13(5), 1365.
The opinions expressed in this white paper are those of the author(s) and may not reflect those of Align Technology. The author was paid an honorarium by Align Technology in connection with this white paper.