Episode Transcript
Welcome back to the Evolution of Dental Podcast, brought to you by Evolution Dental Science. Today we're joined by a pioneer of digital dentistry, one of the first eight to have adopted the iTero system in North America. The doctor on the forefront of the new art advanced restorative treatment program from iTero. Hello, Doctor Glassman, how are you today?
I'm doing great, Robert. It's great to be here. I'm really excited with the partnership I've had with Evolution Dental Science for almost two years right now. So it's been great. Done some remarkable cases, changing people's lives every day. So this is what I live for.
Excellent. How would you say, how would you say this has shifted from when you first brought the iTero into your practice in 2008?
Was actually believe it or not 2006. 2006? Yes. 2006. I, as you said correctly, I was one of the original eight. Conversation went out to my laboratory. They thought it would not be a great fit for my office. They were looking for more of a bread and butter, a lot of volume crowns and stuff, and I was more comprehensive esthetic.
And then, one of the VP's of Cadent, which, that was the company's name before it was iTero said, you know, let's get Doctor Glassman to do it. And so I got involved with it. Back then, it would take maybe for a single crown about six minutes, which today is probably 30–40 seconds with the new technology.
So, it was groundbreaking. We did a double blind study comparing the crown scanned with the Cadent iTero unit back then as well as conventional taking a PVS impression and something that was like, 2 to 1 or 3 to 1 preferred the scanned crowns in terms of fit, contact, and occlusion.
3 to 1 is hard to argue with. And so you moved from using it for restorative dentistry into ortho.
That's also a very interesting story. At the time, one of my patients, pretty high up on the Invisalign advisory board or corporate ladder, so to speak, was also a patient. And one day he comes in and he's asking me about the scanner because I had been to all the convention shows, the Greater New York every year, trying to get the two companies to work together.
And I hear from Align, “not ready yet. We need to get more roots.” One day he comes in and says, what do you think of the technology? I said, well, I love the technology. I’m not 100% on the company. The company needs a little bit more guidance. And a week later, Align I think paid $180–190 million for the technology.
So to bring it into the ortho world and that then became all over, it started to expand. And the big change was going from the older units to the Elements, which had more of that continuous scanning at that point. And it was really a gain for them because they realized that the scanned aligners fit better. If they fit better, it means the case is going to finish faster.
Absolutely. So how did that influence the way you practice dentistry?
Well, as I got more involved with doing clear aligners and having some background, I started to realize that orthodontics was the foundation for all restorative and perio. We can be so much more effective and so much less invasive—putting teeth into proper position, putting crowns over the roots, looking at everything.
And then when the restorative would fall in place—which a lot of these cases would have worn enamel or chipped enamel—we could sometimes just finish the case with direct bonding resin. And even those cases that required a laboratory, typically cases that may have undersized upper laterals, by using the ortho and leaving space, we can do veneers and the case will look better.
All these are just great learning experiences. I had an associate come in and his patient came in and broke a central incisor. And so what did he do? Like trained in dental school, he treats the symptom and the problem without looking at the cause. So he ended up doing a root canal post and crown on a patient that had a malocclusion deep bite, only to find out in three months the tooth broke and needed an implant.
And I went back and tried to educate them. I said, you know, you set the scale against you by putting your case in something that was not lined up for it. And now the patient has to go through an extraction. It would have been better if you would have previsualized him, corrected the deep bite, did the occlusion, and then finished the crown.
So really this type of thinking has revolutionized the way I see patients. I look at people not through just one set of glasses—restorative glasses or ortho glasses. I look at them as both: the ortho-resto glasses. And now since Align has grown not just to be a company that made Invisalign and iTero scanners, but a complete platform, and with the purchase of exocad five, six, seven years ago, the integration is what separates it from every other company.
We now have a platform where we can bring aligners in many different ways. The doctor can recommend it, but also my CAD designers, my partners at Evolution Dental Science, can look at this and recommend to their doctors: “Doc, if you rotate these two teeth, let me show you with my restoration how much less enamel you'd have to remove—or maybe you could even do non-prep cases.”
So you're directing it both from the doctors and the CAD designers who are working these cases every day.
Excellent. So a more comprehensive approach then. A more partnered approach with the laboratory.
Correct. And you know what? You may get away early in your career doing dentistry that maybe you hope and pray will last. But if you're practicing as long as I am—41 years—you see the errors you missed. You see cases you treated right holding up 21, 25, 30 years.
As opposed to the case where the tooth broke in a few months. So yeah, it really is less invasive. And the patients appreciate it because ultimately they will spend less money over a lifetime on their dentistry.
That's excellent. And as far as I understand, you have a facially driven approach when it comes to analyzing treatment for a patient as well as the esthetics of a case.
That’s correct. Big influences for me were John Kois and Frank Spear. They talked about facially driven treatment planning as opposed to articulator-driven models. So when the patient comes in, we take a wide smile photo—teeth slightly separated so I can see the lower incisors.
Then we use Align tools. A lot of people into digital dentistry don’t understand: other scanners exist, other software exists, but this is the only ortho-resto ecosystem. When I can show a patient a preview with their face of where the teeth should be, they’re more likely to say, “Let me hear more.”
And they don’t all need aligners—maybe it's an all-on-X case or a denture case. Then we translate our photos into the ones we need for exocad: full-face retracted, teeth closed, full-face smiling. With intraoral scans and exocad designers, I can plan every aspect.
We can see chipped teeth, incorrect gingival margins, gummy smiles, etc. Some need ortho, some need crown lengthening, some need both. I can communicate with my periodontist by bringing CBCT into the planning. We show previews, get the yes, then finalize the design.
If we’re doing same-day dentistry, even better—scan, adapt the digital wax-up, get the design from the lab, print it, place it. In the analog days this took days with unpredictable results.
And so one of these tools you're referring to is the exocad TruSmile videos and Exact Smile Creator, perhaps?
Yes. Those are excellent tools. They're available in exocad and now on iTero. With Smile Architect and Outcome Simulator Pro, I can show ortho-only and ortho-resto simulations instantly.
This eliminates lab mockups, saves money and time. We also have Smile Video. My purpose is to get the patient to say yes, then finalize the design. With TruSmile video, I can test libraries and shapes, and all three of us—the lab partner, clinician, and patient—agree on the best look.
In the past, we’d ask patients to bring photos from magazines that didn’t match their face. Now they see their own face—no waiting, no physical mockup.
And it's in-office and an actionable CAD file. You can print these. It's not just Photoshop.
Exactly! I can show it digitally, print a trial, or use it as a previsualization. Tons of options.
Are there any tools upcoming that you're excited to get into?
Yes—two areas. Right now our smile simulations are 2D. But I'm already doing 3D facial scans in my office. When we merge those with intraoral scans, we can assess profiles, soft tissue, vertical changes, lip support—things 2D can't show.
We can scan faces at rest, retracted, smiling. But we’re not fully at predictive simulation yet. That’s the next step.
Other companies like MODJAW track dynamic jaw movement. Align now lets us take multiple bite records—protrusive, lateral, open bite—which helps the CAD designer. But dynamic tracking integrated into exocad via mobile apps? That’s the future.
So in your opinion the next phase is multiple facial scans in different situations for better simulation?
Correct.
And AI will likely tie this together well.
Exactly. Right now patients often can’t visualize wax-ups. Digital solves that. They can see outcomes before committing to treatment.
So are you doing any 3D printed try-ins?
Mainly digital tools because they’re instant. But for particular patients or detailed planning, we do printed veneers or try-ins. Materials are getting better. But printed try-ins require time, labor, and materials, so I reserve them for specific cases.
And it helps you meet patient expectations.
Correct. We can toggle designs quickly—ten restorations, eight, six, four—whatever fits their goals and budget. And you’d be surprised who says yes. I've had patients who look like they can’t afford treatment become full-arch cases.
Now, are there any cases you want to look at today?
Yes, let’s look at the first one. Here's my workflow for exams. Technology is making us rethink how we do exams. We start with a wide smile photo. Then I do my intraoral scan.
I get the patient involved—like a museum touchscreen exhibit. They see their scan and start asking questions. They relate much more to digital scans than X-rays. We magnify areas, use the Oral Health Suite, which breaks concerns into Gum Health, Tooth Health, Alignment, Bite—terms patients understand.
Near-infrared imaging shows interproximal caries before X-rays. We screenshot areas of concern. Alignment shows wear patterns, fractures, open contacts. Perio? We assess margins. Restorative? We zoom in on margin integrity.
At the end we run Outcome Simulator Pro and compare original, ortho, and ortho-resto simulations. If the patient doesn't need ortho, we show restorative only. It's all right there.
If I think they'd value a cosmetic preview, I add the 30-second Smile Video. I engage them emotionally—vacations, weddings, sports teams. They see themselves smiling next to the AI simulation and say, “Oh my god, this is amazing!”
Before they leave, they get a full digital report via QR code—every screenshot, every simulation, every video. We walk them to the front desk and summarize perio issues, restorative needs, alignment concerns, veneers, etc. That report boosts case acceptance by 35%.
And it's amazing.
And that's why I tell doctors—you don’t need more volume. You need the right patients, and you need to help asymptomatic patients understand their conditions.
Seeing is believing.
Correct. We scan all new patients, emergencies unless they're in too much pain, and hygiene once a year. If they say no to treatment, we rescan the next year and use Time Lapse to show changes—wear, shifting, chipping. Gradual changes become obvious.
It's like my hairline—I look back 15 years and wonder where it went. Same with enamel. Wear isn’t linear, but patients assume if it looked fine last year it’s still fine. We must stop being complicit in enamel wear by missing early signs.
Absolutely.
This next patient came in for a second opinion. I wish I could show her smile, but she had provisionals on the lower right. Her dentist wanted crown lengthening because her teeth were too short—after cutting them shorter to fit crowns. Makes no sense.
Her incisors were 7–8 mm; they should be 10–11. I assessed her wear, her large masseters, her grinding habit. I explained we needed to replace lost enamel and restore chewing protection—not cut more tooth. She was interested.
I made the diagnosis, ortho checklist, functional assessment. Then we used Outcome Simulator with Smile Architect. Only tooth #7 had a minor overlap, but since it needed a crown we skipped ortho and showed restorative only. She said, “Wow, this is cool.”
We showed videos of simulated upper and lower restorations. We opened her vertical. The final outcome matched the simulation. Facial scans helped us plan incisal edge position and profile changes.
We scanned her with QLONE—three facial scans in 60 seconds each—and merged them in exocad. Then we sent everything to the CAD designer at Evolution Dental Science for the design.
Provisionals were printed same day. She later decided she wanted the lower incisors improved, so we used non-prep printed veneers. Materials are now ceramic-filled and durable.
Her final photos show her looking younger, happier, with improved facial proportions. The video comparison nearly matches the simulation.
This brings us to same-day dentistry. Using exocad and iTero Design Suite, I can scan full arches in under five minutes, make adjustments, and get STL files same day. Digital planning avoids bite issues entirely.
This relates to the new ART program from Align—the Advanced Restorative Treatment program. We’re testing it on a patient with severe wear and missing molars. ART integrates CBCT, tooth movement, and restorative design so doctors can see exactly how much to move teeth before prepping.
Many restorative doctors don’t appreciate how much ortho helps restorative outcomes. With ART, designers can recommend tooth movement that saves enamel—sometimes reducing prep to as little as 0.1 mm.
We’ve used ART to create implant space in upper laterals, plan implant positions, previsualize restorations, design temps on tie-bases, and print them in minutes. Analog workflows could never match this accuracy.
Doctors need to stop fearing ortho. Even if they use other scanners or aligners, the concept is the same: tooth movement makes restorative less invasive and more predictable.
Most dentists only use the “hammer” they were trained with—cutting down teeth for everything. But that causes more endo, more fractures, more failures.
I started my own Glassman Academy of Ortho-Resto to help doctors bridge the gap between digital, restorative, and ortho workflows. They don’t need to master exocad, but they need to understand it. iTero even has an exocad Lite Design Suite.
With Design Suite, doctors can do crowns, bridges, mockups, occlusal guards, and 3D printed final restorations. Midas materials are now strong enough for finals. Insurance covers it. 3D printing will replace milling.
My course teaches iTero Design Suite, ART, exocad collaboration, 3D printing, ortho-resto thinking—all the stuff other courses separate.
A comprehensive approach, just like your practice.
Correct. Many insurance-driven offices miss huge restorative opportunities. But with a 35% increase in acceptance, you elevate care without “selling” anything. You're genuinely improving outcomes.
We have options: direct bonding, injectable bonding, printed veneers—less invasive than ceramics.
Now, about Midas—it's on my list. Milling is one unit at a time; Midas prints nine. A standard printer can do full arches.
Let me show the next case—one of the first with a Lumina.
Patient from 2017 with failing upper endo, thin mandibular bone, budget concerns. We extracted upper/lower, placed locators, opened vertical. Huge transformation—she looked younger.
She disappeared for seven years and came back with a broken central incisor she Krazy Glued to her denture. She wanted fixed restorations. We assessed CBCT, converted locators to multi-units, and used Lumina with EZ-Refs for full-arch scanning.
We redesigned everything with exocad at Evolution Dental Science. The PMMA prototypes fit perfectly. After healing, final zirconia restorations were delivered—her face looked even younger than before.
Her before-and-after photos and X-rays show massive improvement. Digital workflows made it predictable and efficient.
Final thoughts?
Go digital. Before we plan, we must digitally scan.
Excellent. Thank you so much for your time.
My pleasure.
Thank you for joining us for this episode of the Evolution of Dental Podcast, brought to you by Evolution Dental Science. These podcasts are available on YouTube, Spotify, Apple Podcasts and of course, your favorite platform. Please don't forget to like, subscribe and share this video with all of your dentists and dental technician friends. We look forward to seeing you on the next one.
