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Its not the scan, its the plan!1

With version 10, it has never beenso easy to plan! SimPlant falls intothe hands of Dr. James. Dr. Jamesis our top researcher, and he hasplaced his knowledge in thecomputer. If you tell him where thebone is, and where you want theteeth, he will tell you how to planthe implants, taking into accountboth biomechanical and aesthetical

considerations. You don't have toagree with Dr. James: you canchange his plan according to yourinsights. Dr. James has spentseveral years of research on this.We even managed to write downhis ideas in a software patent, avery rarely conceded patent type.

But Dr. James is not the onlyimprovement in SimPlant 10. Seehow you can move around

implants more precisely, gocheck how you can place virtualteethor little text comments in theproject. Find out about SimPlant 10with this document!

1Courtesy of Dr. Ganz

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Table of Contents

Table of Contents

Chapter 1: SimPlant View .........................................................................7Chapter 2: SimPlant Planner ....................................................................7

1. Planning has never been so easy....................................................... 72. Advanced Planning ............................................................................ 163. SimPlant makes full use of the third dimension.............................. 214. SimPlant is your communication tool! ................................................ 245. Installation and Passwords ................................................................ 256. Overall changes ................................................................................. 25

Chapter 3: SimPlant Pro .........................................................................291. Discard small parts............................................................................. 292. Welcome screen................................................................................. 303. Overall improvements ........................................................................ 31

Chapter 4: SimPlant Master ....................................................................331. Dicom Print Control Software............................................................. 332. Other Improvements .......................................................................... 33

Chapter 5: Known Problems: ................................................................. 37

1. Compatibility with 8.33 ....................................................................... 372. Rendering Issues ............................................................................... 37

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Chapter 1: SimPlant View

SimPlant View has undergone its first face-lift since birth. Get ready to meetan entirely NEW SimPlant View, with increased user-friendliness andincreased tools for plan review.

Planned implants can be chosen in drop down list (previously, hadto use the arrows in the toolbar)

Implants can be made opaque or not opaque. This allows you tosee the bone BEHIND the implant. SimPlant View becomes, morethan ever, a real tool for evaluation of a plan.

SimPlant on sma files can now be navigated!

Chapter 2: SimPlant Planner

1. Planning

has never been so easyDr. James

Who is this Dr. James?

Dr. James is your virtual planning assistant. As a preparation, you need:

o Segmented bone

o Segmented prosthesis or virtual teetho Optionally: Nerves

o Optionally: segmented Teeth

As an output, Dr. James will try to plan an implant for you at every toothlocation. He will also tell you what you could do when he could not place animplant, e.g. because of too little bone, or very small prosthetic element.

Note that Dr James will not work if you dont have enough bone, if youdont dispose of a well-segmented case, and if you do not locatethe nerve. Dr James does an especially good job on distal

mandible cases with 5mm bone width.

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How to call Dr James

You can find Dr. James in the tools toolbar: . Dr. James has a special

menu item dedicated to him as well.In Figure 2, you need to define the objects as nerves, teeth, bone, etc. Youcan change that by clicking in the column Type. The first column is usedto decide which elements are taken into account. The advanced buttontakes you to the Dr. James preferences, where you can define how far youwant the implants to be away from each other, from a nerve, from aneighbouring tooth, etc. Among other things, you can choose to have Dr.James plan implants as parallel the prosthesis as possible or allow him totilt the implants a little to place the implants in more bone volume. Note thatin both cases, the implant will go through the prosthetic element andwill be placed in bone (Figure 1)!

Figure 1. Plan types offered by Dr James.

Hit OK and let Dr. James do his work. The OK button is only highlightedwhen you have set al least bone and a prosthesis. Have a coffeemeanwhile.

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Figure 2. Communication w ith Dr. James goes through this screen.

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Automatic Implant Match and Specify

Go to the library, and notice the buttons Set Default (both for maxilla and

mandible, see Figure 3)

Figure 3 Implant Library

Go to your favourite implant. In the example, this is the Zimmer DentalStraight Screw-Vent HA SVWH10 wide platform implant. Hit the Set

Default button.

Now, when you place an implant with the one-click method, that implant willbe immediately matched and specified to the Zimmer Dental StraightScrew-Vent HA SVWH10 wide platform implant.

Precise implant movement

Notice the extended implant toolbar:

Figure 4 Extended Implant Toolbar

The extra icons are greyed out until you select an implant. With an implantselected, pressing one of the icons at the right of the toolbar, the implantcan be respectively translated, rotated around its apical end, rotated aroundits incisal end or rotated around its axis preciselyusing increments editablein that same toolbar (at the far right). You can do the movements eitherusing the mouse and clicking on the white arrows, or you can use the arrowkeys on your keyboard.

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Implant Rotation

When you now look at an axial cross-section of an implant (See Figure 5)and even in the 3D in certain angles, you will notice a white double arrow

pointing sideways. When you click and drag this arrow with the mouse, youcan rotate the implant around its axis.

Figure 5 Brown implant in the axial view with white arrow for implantrotation.

Improved schematical representation

When we have a realistic representation of an implant, we will no longerrepresent the implant as a simple cone or a cylinder in the schematicalrepresentation, but as a combination of cones and cylinders. As anexample, have a look at Figure 6:

Figure 6 Left: new schematical representation. Right: realistic view.

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This is a Straumann Standard Implant 043.135S. On the right is the viewwe are getting used to since SimPlant 9. This view is still the standard.When you now choose to see the schematical representation, you will nolonger see just a yellow cylinder, but the screen in the image on the left: a

combination of cones and cylinders, forming the multi-part representationof the implant. This schematical representation is also used in the bonedensity screen. It allows you to plan the implants vertical position precisely,even if you have a slow computer.

Other improvements

More correct Implant-Nerve collision

For collisions between an implant and the nerve, in SimPlant 9 a not-rounded safety zone around the implant was used (as for all collisions).This can lead to inaccuracies such as in Figure 7:

Figure 7. SimPlant detects a collision, but in fact the implant is at asafe distance.

From SimPlant 10 onwards, collisions between an implant and the nerve

are based on a shell around the nerve instead of a shell around the implant.This will avoid these imperfections (see Figure 8).

No changes were done for the other collisions: implant-implant andrestorative space-restorative space.

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Figure 8. Implant-Nerve coll isions are now based on a shell around thenerve.

Mesiodistal and Buccolingual angle

Tilt and Turn are hard to understand. Instead, we are more interested inthe buccolingual and the mesiodistal angle. A high value for these angleswould result in a perforation (high buccolingual angle) or in a contact withthe tooth root (high mesiodistal angle).

The angles are defined as follows:

1. Mesiodistal angleis the angle made by the projected implant axisand the vertical axis in the plane formed by the vertical axis and themesiodistal line at the centre of the implant. (The mesiodistal line isthe tangent to the panoramic)

2. Buccolingual angle is the angle made by the projected implantaxis and the vertical axis in the plane formed by the vertical axisand the normal tothe panoramic atthe centre of the implant.

Both angles are measured with respect to the active panoramic curve. A

change to the panoramic or a switch to a different panoramic will changethese values.

You can look up these angles in two places: the implant list (Figure 9) andthe implant properties (Figure 10).

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Figure 9. Implant list show the Mesiodistal and the Buccolingual angle.

Figure 10. Implant Properties show the Mesiodistal and Buccolingualangle.

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Improved nerve drawing

In SimPlant 10, a number of enhancements to the nerve-drawing interfacehave been incorporated. It is now possible to add points at the end of anerve. This way, you can extend existing nerves instead of redrawing a newone.

Double-click on object opens properties dialog

In SimPlant 10, a double click on a text message, an implant, etc. will openits properties tab.

Escape

From now on the Escape button deselects the implant.

Improved Implant Preview

The implants in the preview pane of the library can now be rotated, zoomedand panned.

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2. Advanced Planning

Virtual Teeth

What are virtual teeth?

SimPlant 10 will again have the opportunity to enter fake teeth in theproject. Figure 11, Figure 12 and Figure 13 show an example.

Figure 11. VirtualTeeth: no scantemplate.

Figure 12. VirtualTeeth posit ioned.

Figure 13. Theactual position ofthe scan template.

Why is this useful? NOT to replace a scan template! Because the scantemplate has information from the opposite jaw, here you dont. It is goodwhen:

Someone has no scan template, but still wants to have a good ideaof the final aesthetic position.

There is a lot of scatter and instead of segmenting the entireprosthesis, you put virtual teeth over it.

The virtual teeth are compatible with Dr. James which means that you canhave the computer advise you of an implant position once the virtual teethare placed.

Note that the virtual teeth are currently designed to operate in singlegroups. Placing two groups of virtual teeth is nevertheless

possible, although tedious at this stage. The teeth can be rotatedaround their axis and around the mesiodistal direction, but they donot allow any bucco-lingual rotation yet.

How do I place virtual teeth?

To put virtual teeth in the patient, first go to the axial slice closest to the

occlusal plane. Use the virtual teeth button in the tools toolbar: . A newtoolbar will pop up, similar to the nerve and panoramic toolbar. One of thebuttons is the add virtual teeth button. In the next screen, you will be

asked to

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i. name the teeth

ii. tell the computer which teeth you would want to replace.You are invited to click on the two teeth that form theextremity of the prosthesis.

iii. Along which panoramic do the virtual teeth need to beplaced?

When done, the yellow teeth will be placed along the panoramic at positionsbased on statistics, and with the current axial slice as occlusal plane.

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How do I manipulate virtual teeth?

Repositioning and scaling the teeth along the panoramic can be done in the3D and in the axial and panoramic image. You can click and drag the white

points on the panoramic (in the axial slices for movement within the axialplane, in the panoramic view for the vertical dimension), there is thus noneed to select the panoramic toolbox for panoramic curve manipulation.The virtual teeth have four handles, meant for stretching along thepanoramic and in the vertical dimension. Heres an overview of theoperations and how to perform them:

Action you want to do In which image? Where to cl ick?Handles?

Reposition along

panoramic

3D, axial,

panoramic

Click on virtual teeth and

move along panoramic

Stretch along panoramic 3D, axial,panoramic

Handles in the corners

Stretch top/bottom 3D, panoramic Handles in the corners

Change shape ofpanoramic

Axial, panoramic White dots

(axial movement in axialslice, vertical movementin panoramic image)

Change vertical positionof all teeth 3D, panoramic Click on vertical teethand move in verticaldirection

Change vertical positionof a selection of teeth

panoramic See above: changevertical position of whitedots in panoramic image

Lekholm & Zarb

Not all Europeans use the Misch classification of bone densities. We havenow implemented the Lekholm and Zarb classification. This is an extraclassification according to the theoretical classification of Lekholm and Zarb(1985) which was reviewed by Norton & Gamble in 2000 (in Clin. Oral Impl.Res., table 6): Q1: >850 HU ; Q2: 700 850 ; Q3: 500 700 ; Q4: 0 500 ;Q5:


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SimPlant 10 will include abutments from Straumann, Camlog, Friadent, 3iand JMM, and can further be updated through our website.

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3. SimPlant makes full use of the

third dimension in several ways:

Direct 3D Rendering

SimPlant 10 has a new renderer incorporated: Direct 3D. Depending onyour computer, it can make manipulations on the 3D A LOT faster. Set yourrenderer to Direct 3D in the preferences: options | preferences | 3D View.

Place an implant in 3D

You can now drop an implant in the 3D view!

In the one-click method, the point where you click is considered theentry point. The implant will be placed along the inferior/superioraxis (in fact it is the top-bottom axis of the images, which hopefullyis more or less the same depending on the scan).

In the two-click method, the first click denotes the entry point. Atthis moment, clipping and texture mapping turns on. The 3D objectis rotated in a way that it gives you the best view of the clippedplane.

Instant Preview

SimPlant is proud to be able to show an instant 3D preview using so-called volume renderingtechnology. The instant preview can be called inseveral ways:

1. By using the icon in the 3D toolbar (at the right of the 3D pane)

2. In the menu, by going View | Show/Hide | Show Volume Rendering3. By going to the new and improved 3D Preview window (Figure

16). This pops up after import (only for PRO), when opening a filewithout a 3D model, or when pressing the generate 3D button. Inthis screen, you can choose 4 types of volume rendering, illustratedwith a preview on a demo data set.

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Figure 16. New and Improved 3D preview window.

You can see the difference between a volume rendering and regularsurface renderingin Figure 17 and Figure 18.

Figure 17. Volume Rendering onDemo Dataset by Dr. Poukens and Dr.Verdonck (AZ Maastr icht)

Figure 18. Surface Rendering on DemoDataset by Dr. Poukens and Dr.Verdonck (AZ Maastricht)

Volume rendering has the advantage of being a very fast way to generatea 3D. It gives you the impression that it reduces scatter, but it is in fact justtaking the focus away from it. It has the disadvantage that it is in fact justan illusion. You cant click on it to navigate. You cant place implants on anillusion. You cannot hide part of the 3D and make another more visible.Whenever the user attempts to do one of these operations on the renderedmodel, a real model will have to be built (Figure 19).

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Figure 19. The user will be guided towards a 3D model reconstructionwhen he tries to perform navigation on the rendered volume.

Point rendering

Point rendering is the situation where you represent the 3D object as a setof points. This takes less memory. Whenever your computer starts gettingslower, SimPlant will automatically switch to point rendering when you

rotate, zoom or pan the 3D objects.

Clip+scroll

Scrolling the mouse in the 3D while clipping is on takes you on a journeythrough the slices.

New clipping features

You know very well what clipping and texture mapping is. We have

extended the feature. So far, you were only able to texture the grey-scalesIN the 3D object. From SimPlant 10 onwards, you can superimpose thewhole slice in the 3D, or perform clipping without texture mapping.

Figure 20.

Texture mapping.

Figure 21. Full slicetexturing. Figure 22.

No texturing.

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4. SimPlant is your

communication tool!

Annotations

You can add text comments using the icon: . You can see all thecomments you made by looking at the list of text comments (go list |annotations). A text comment is linked to an implant, a nerve, a 3D object oreven an image. When you open a file with comments, the list of commentswill pop up. In View | Show/Hide, you can hide or show all text comments.

You can also visualise the text comments from the list using the glasses inthe list.

Distribute to view

When you are a SimPlant Planner or Pro owner with the View Module, youwant to be able to produce a CD with the file and the View installer easily.Therefore, we have implemented a new feature. You can find it in the menuunder Plan | Distr ibute to View. You will be asked for a folder to save thefile AND the SimPlant View installer to. Distributing SimPlant View throughyour software has never been this easy.

Note:this was already present in SimPlant Master.

Improvements to the Movie Tool

Try this: go File | Movie (also accessible with Ctrl+Shift+M). You will receivethe following screen:

Figure 23. The new Capture Moviewindow.

Figure 24. Options for the moviecapture.

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Virtual Teeth CTRL + 9

Segmentation mode Shor tcut

Masks CTRL + 2

3D Objects CTRL + 3Measurements CTRL + 4Panoramic Curves CTRL + 6

Profile Lines n/aAnnotations CTRL + 8Virtual Teeth CTRL + 9

Embrace CBCT

Cone beam CT scanners have improved over the years and some of the

machines are achieving even better image quality than regular CTscanners. Therefore, we have removed the message that warns the userfor inaccuracies in the CBCT data set. We realise that whoever uses oldermachines, may still encounter problems. Materialise commits itself tomention these problems to the CBCT manufacturers.

Implant Version

It is now possible to see which implants the user has on his machine. Youcan see that by going to the about screen (help | about): you will notice anextra button Implants. When pressed, you will see for each implant

manufacturer a number that allows Materialise to see when the last updatewas done. This is very important for tracking bugs in the implant libraries.

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Figure 25. The help | about screen

New organisation of the preferences

SimPlant 10 would have had 3 rows of tabs using the old way of organizingpreferences. For people using low screen resolutions, it was necessary tosplit a couple of pages into two pages. The new look of the preferences canbe seen in options | preferences. It is a severe change in comparison toSimPlant 9.

The default settings have been regionalised. For instance, in the US youwill be invited to place implants with the one-click method. In Europe, you

can set the tilt immediately to the right position using the 2-click method.

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Chapter 3: SimPlant Pro

1. Discard small parts

Youve already noticed it in Figure 16: there is an extra checkbox Discardsmall parts. This checkbox is also present on the Calculate 3D screen (inSimPlant Pro and Master, Figure 26).

Figure 26. "Discard small parts" checkbox in "Calculate 3D" screen

The difference is best-explained using Figure 27 and Figure 28. In Figure27, small parts were not discarded. Therefore, the 3D contains all the smallbits of hard tissue littering the image. In Figure 28, the discard small partscheckbox was checked, and the spinal cord as well as the bits of scatterwere filtered from the 3D model.

For those of you using SimPlant PRO or Master, you will notice that thediscard small parts is in fact no more than a threshold followed by a regiongrowing, but made easy!

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Figure 27. Previous Situation. Figure 28. New Situation.

2. Welcome screen

The difference between open file and import CT was not very intuitive inSimPlant 9, especially to new users. If the difference was understood, therewere still difficulties finding the correct icons.

SimPlant 10 will welcome you with the screen in Figure 29. The screeninvites you to open an existing SimPlant file, or to read images from a CTscanner. The icons have been restyled for more difference between openfile and import CT images.

Figure 29. The SimPlant Pro Welcome screen.

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3. Overall improvements

PerformanceDepending on the computer you are using, you may notice that SimPlant 10is noticeably faster than SimPlant 9.2 in a number of operations. One of thespeed improvements is in the import: general improvement of about 25% isestimated for the global import process. Smaller improvements for the first(loading of images) and second (convert) steps are expected. Scrollingthrough images has become much faster, especially in segmentation modebut also for some specific cases such as scrolling through panoramicimages when there are density measurements, when there are severalimplants, loaded 3D objects, etc.

Remember Shades in volume and Maskstoolbar

When you change the settings of the shades in the Volume or Maskstoolbar, SimPlant will remember those settings on opening SimPlant again.SimPlant will also show the toolbar if you had the toolbar open when youhave used SimPlant for the last time.

Mask Toolbar

Now, mask toolbar automatically pops up when youve generated your firstmask.

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Chapter 4: SimPlant Master

1. Dicom Print Control Software

SimPlant 10 has Print Control software for printing towards dicom printersdirectly. Master customers are no longer required to use e-Film or anotherthird party software to print from SimPlant to film. A dicom conformancestatement will be available on the website. This feature is implemented as aseparate commercial module.

2. Other Improvements

FOV

The Field Of view is now part of the project information screen.

Remember Printer settings

Printer settings can now be remembered in the print dialog (instead ofhaving to go to the preferences)

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Figure 30. Use "Remember these settings as preferences" to set theprint preferences.

PPU licence is a licence

For PPU clients, paper print, film print and editing were authorised, yet thescreen showed "no license".

DIA remembers images folder

The Dicom Input Application (for Masters and Pro users) now remembersthe images folder from previous installation. This is time saving atinstallation.

Include Images in subfolders

SimPlant provides you with a checkbox "Include images in subfolders" inthe import dialog (like the "Search in subfolders" button in the open projectdialog). When this option is checked on, all images in all subfolders of theselected folder are shown in the file list and are "imported" when the nextbutton is clicked.

Why do we need this? Lots of scanners write out images as follows:

Main folder\SubFolder1\Scout image

Main Folder\Subfolder2\Axial images

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So when processing is done, the user has to go back to "pick up" the scoutif it's in another subfolder of the main images folder.

If all images in all subfolders of the main images folder are shown at once,this loop is avoided and this saves processing quite some time!

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Chapter 5:

Known Problems:

1. Compatibility with 8.33

When saving a file in the SimPlant 10, it will be possible to open it inSimPlant 9 in all cases. It will even open in SimPlant 8.33, except when ithas annotations or virtual teeth. This may be an issue if a master starts

placing virtual teeth or annotations in the converted file and sends it to aSimPlant 8 customer. There are two solutions:

Not place any text comments or virtual teeth

Upgrade to SimPlant 10

2. Rendering Issues

Depending on your graphic card and your renderer (under Options |

Preferences | 3D View), the following problems might occur:

a. Clipping doesnt work or doesnt work correctly

b. Flickering of the screen

c. Impossible to get the SimPlant 3D View on several screensat the time

d. Area under the cursor doesnt get redrawn

For this problem, rule nr 1 is to see of the problem persists with another

renderer (changeable in the preferences).

Rule nr 2 is an update of the drivers of your graphic card. This can usuallybe done by visiting the website of your graphic card and check if there areupdates. To find out which graphic card you have, check the displaysettings.

For more information and a list of unsupported graphic cards, please checkthe frequently asked question section on our website

http://www simplant com

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