7.5 suresmile advanced customer upgrade guide...1. click the tooth or arch label to switch between...

1

7.5 SureSmile Advanced Customer Upgrade Guide

DPPT-500053-2

The major enhancements for this 7.5 release are:

• Staging - Improved staging for aligner-based therapy, including:

• Tooth-by-tooth movements across multiple groups

• Differing movement constraints based on antagonistic or synergistic

combinations and stand alone movements

• New Staged Timeline features control movements of individual teeth

• Ability to recalculate the staging while excluding one or more teeth

• Attachments - Automated, rule-based placement of attachments

• Overcorrection of particular movements

• Blockouts - Tools to plan and apply blockouts for undercuts

• Trimline Height Control - Select trim height preference for both aligner and

attachment templates

2DPPT-500053-2


Improved staging for aligner-based therapy, including

• Tooth-by-tooth movements across multiple groups

• Differing movement constraints based on antagonistic or synergistic

combinations and stand alone movements

• New Staged Timeline features control movements of individual teeth

• Ability to recalculate the staging while excluding one or more teeth

Previously, when using multi-group staging, tooth movements in a group would

not begin until all teeth completed all movements in the prior group. This meant

that teeth that completed their planned movements for one group had to wait for

the other teeth to complete their planned movements in the active group before

any movements for subsequent groups could begin.

Now you can adjust the staging for individual teeth to:

• improve the efficiency of each stage

• reduce the number of stages needed.

This new staged timeline lets you switch from the global staged timeline

showing movement types to a staged timeline for individual teeth showing

movement per tooth and displacements.

We’ll discuss these new single-tooth staging features in the next few slides.


DPPT-500053-2 3

To repeat from the last slide, before, when using multi-group staging, tooth movements in a group would not begin until all teeth completed all movements in the prior group.

In 7.4 the staged timeline just provided a read-only view of the maximum movements across all teeth in an arch—it was just summary info.

In this 7.5 release, however, you have interactive control over individual teeth. This is helpful if you have one or more teeth that require extensive or complex movement. Rather than slowing down the staging of the other teeth until the movement of one or more problematical teeth is fully expressed, you can now stage those movements independently within separate staging groups.

When you choose Selected Tooth, the Staged Timeline shows staging for just the tooth selected in the small tooth cross. This screenshot shows movement staging for just a single tooth, UR1.

Steps:1. Click the tooth or arch label to switch between upper arch, lower arch, or selected tooth. 2. Under the Alignment column, choose Start, Spread Out or End to set how you want each non-rate limited

movement* staged:• Start to stage movements starting at first stage and moving forward• Spread Out to divide movements equally among stages• End to stage movements starting at last stage and moving backward

3. Click in the cells for each stage to enter or adjust movements. You can enter each value individually or use the up-down arrows to enter values incrementally. To save time, shift-click a group of cells and use the Edit Selection control to add a value to multiple cells. The values shown represent actual displacements for each stage and are not cumulative.

* Non-rate limited movements – If the tooth is moving in multiple directions at the same time, the tooth will finish one movement later than the other movements. The movements that finish before the last one are non-rate limited movements.

# = Final stage showing the setup.

O = Overcorrection stage. We’ll discuss these new green Overcorrection stages in a few moments.

Note: We’ve moved the Order tab to the right as this better reflects a typical workflow of 1) reviewing the staged model displacements, 2) updating the staging, and then 3) ordering your aligners.


DPPT-500053-2 4

The Aligner Constraints tab on the Preferences page shows the maximum

movement rates (values) for each movement type per stage.

Having the ability to set parameters based on combinations of antagonistic and

synergistic movement pairings, or on standalone movements, greatly improves

SureSmile’s staging capabilities.

• Antagonistic movement rate – when a combination of movements slows

down the typical tooth progress as expected with standalone movement.

• Synergistic movement rate – when the combination of movements

improves the typical tooth progress compared to standalone staging

(company default preferences with options for doctor customization).

• Standalone movement – the movement rate expected when the tooth

moves independently of antagonistic or synergistic combinations. Standalone

movement is the default preference for all teeth.

Note that we have separated mesial and distal movement, and mesial and

distal angulation into separate staging movements. This allows for greater

control of staging because mesial movements can be used in combination with

other antagonistic or synergistic movement pairings.


DPPT-500053-2 5

You can now exclude selected teeth from staging, and then control their

staging directly from the Individual Tooth Staged Timeline:

When a tooth requires a large amount of correction (e.g., a very large rotation

correction), you can exclude this tooth from staging to avoid increasing the total

number of stages.

Steps:

1. From the Displacements tab, click Recalculate Staging. The Constraints

dialog box opens.

2. If not already displayed, under Aligner Constraints, click the drop-down

arrow next to Edit to select the Aligner Constraints set you wish to edit. Click

Edit.

3. Scroll down to Excluded Teeth. If the tooth diagram is not already displayed,

click the drop-down arrow to display the tooth diagram.

4. Mark each tooth you wish to be excluded from staging. Click Legend for an

explanation of color doing.

5. Click OK. The software recalculates the staging for all teeth except those

marked.

Legend for excluded teeth

Blue: Tooth movement is adjusted so that stage count is not increased.

Red: Tooth is fixed (click 2-3 times to cycle through colors)


DPPT-500053-2 6

To speed up correction without increasing number of stages, increase the

Maximal Values of your aligner constraints.

Steps:

1. From the Displacements tab, click Recalculate Stages. The Aligner Design

dialog box opens.

2. If not already displayed, under Aligner Parameters, click the drop-down

arrow next to Edit to select the Aligner Constraints set you wish to edit and

then click Edit.

3. Under the Maximal Values section, increase the Antagonistic, Standalone or

Synergistic values and Click OK. The software recalculates the staging. You

should see a reduction in the number of stages.


DPPT-500053-2 7

New color coding on the Displacements tab

• Yellow tabs equal stages with one or more conflicts

• Green tabs equal overcorrection tabs

• A yellow cell means there is a conflict. These are threshold violations as set in your

aligner constraints.

• An orange cell means there is an intersection conflict, which were not present in the

last stage as IPR.

• When there are only intersection violations, the stage tab is orange.

• When there are only step threshold violations, the stage tab is yellow.

• Orange trumps yellow—if both intersections and step threshold violations are

present, the stage tab appears orange.

Demo:

1. Go to a stage model that is highlighted yellow indicating there is a conflict

associated with that stage.

2. Modify the displacement value highlighted yellow (e.g., reduce the value)

3. After the yellow displacement value is modified, you should see a Gap/Intersection

value highlighted orange indicating there is an intersection conflict.

The easiest way to understand threshold violations is to have the same amount of

movements on all teeth – this makes it easier to recognize and explain differences in

constraints settings. For instance: all teeth move exactly 0.5 mm and rotate 5°. The

other quadrant -0.5 and -5°.


DPPT-500053-2 8

With 7.5, you no longer need to manually place your attachments. Instead,

SureSmile automatically selects and places attachments based on planned

movement type, amount, and direction.

Don’t worry though, you can still modify the placement and timing of

attachments as needed.

You can customize your default attachment parameters under the new

Attachment Placement Constraints tab on the Preferences page.


DPPT-500053-2 9

Choose Automatic Attachment Placement Constraints

Steps:

1. As soon as you create your staged model sequence, the Aligner Design

dialog box appears with the Aligner Parameters tab open. After you’ve

selected your Aligner Constraints, click the Attachment Parameters tab to

select the set of Automatic Attachment Constraints to use.

2. From the dropdown list, use the Standard or default settings provided by

SureSmile, or select your own set of attachment parameters. If you do not

wish to use automatic attachments for a case, select No Automatic

Attachment Placement.

3. After you make a selection, click OK on the dialog box. That’s it! SureSmile

will automatically place your attachments per the parameters you selected.

FYI: To create your own customized set of attachment parameters, there is a

new tab called Attachment Placement Constraints on the Preferences page.


DPPT-500053-2 10

Use the Attachment Placement Constraints on the Preferences page to specify

the following parameters:

• Type of attachment (Rectangular or Ellipsoidal)

• Movement threshold to trigger automatic placement

• Which teeth to place attachments on

The best way to create your own set of attachment preferences is to copy the

default (Standard) preferences and customize it to match your own

preferences.

In the initial attachment placement, all needed attachments will start at the 1st

stage and end at the last stage for which they are needed (i.e., the stage at

which the planned movement has been achieved.) If there is an indication for

multiple attachments for the same tooth (e.g., there is a large rotation,

angulation, and extrusion planned for same tooth), the system will place all

attachments overlapping each other on the tooth. You must manually determine

the sequence for each attachment, that is, on which stage you will remove an

attachment and add the next so they do not overlap.

You can also update your practice attachment preferences for specific patients.


DPPT-500053-2 11

When you review your staged models, you can adjust the proposed attachment

placements. You can change when to start and end an attachment, change an

attachment type or remove an attachment.


DPPT-500053-2 12

You can change the Starting or Ending stage for an automatic attachment.

Steps:

1. Click on the attachment in the 3D window. The bounding box and a

“hamburger” menu display.

2. Click the hamburger menu. A drop-down menu opens with three selections:

• Start-End

• Type

• Remove

3. Select Start-End.

4. Select different start and or stop stages from the drop-down menu.


DPPT-500053-2 13

You can change the type for an automatic attachment.

Steps:

1. Click on the attachment in the 3D window. The bounding box and a

“hamburger” menu display.

2. Click the hamburger menu. A drop-down menu opens with three selections:

• Start-End

• Type

• Remove

3. Select Type. The Attachment Panel opens near the selected attachment.

4. Click in the panel to select a different attachment shape or size. The newly

selected attachment will automatically replace the current attachment. The

new attachment placement will include any manual repositioning done to the

previous attachment.


DPPT-500053-2 14

You can also remove an attachment in any stage and or adjust its position.


DPPT-500053-2 15

A new button has been added to the Displacements tab when a staged model is

displayed in the 3D workspace.

Clicking Recalculate Attachments does not affect the staging, but overrides

any attachments that were placed previously, regardless whether placed

automatically or manually.


DPPT-500053-2 16

The Recalculate Staging, Recalculate Attachments, Update Previous Stages or Update Next Stages buttons affect attachments as follows:• Start-end stages:

• If you did not previously change the start or end stages for the attachments or did change but clicked the undo button, using these buttons resets the attachments to their initial placements (i.e., all attachments will start at the first stage and end at the last active stage).

• If you did previously change the attachment’s start or end stages, these changes are maintained (i.e., the attachments start and end on the same stage numbers.

• Shape or position of the attachments: • If you had applied any changes to the shape or position of the attachments,

these changes are not affected by using the recalculate/update buttons.• If you had applied any changes to the shape or position of the attachments

but then clicked the undo button, these changes are not preserved, and are disregarded.

• Setup (or the last active stage representing setup): • If you had changed values in the setup, using the recalculate/update

buttons automatically overrides any attachments automatically placed previously and replaces them with attachments referring to the new setup values. Changes made to attachments manually are not affected.

Note: If during the Aligner setup/staging review, you change values in the setup or the last active stage, the Approve/Order button becomes disabled because the DL needs to recalculate staging before you can Approve and order the product.


DPPT-500053-2 17

This new feature allows you to specify overcorrections to be included in the appliance design beyond the final setup as needed to achieve your treatment goals. Overcorrections are sometimes used to plan for possible relapse or to ensure that the final correction will be more stable. Some SureSmile doctors routinely use over-correction to augment the movements in the setup.

With DIY cases, SureSmile customers can add some additional movements to their simulation. Overcorrection does not need to be automated.

With Full-Service “Select” and “Complete” cases, however, the software allows you to specify overcorrection amounts as part of the preferences. Under the Aligner Overcorrections tab on the Preferences page, you can select thresholds for initiating overcorrection for each individual movement type. You can also choose to exclude overcorrection for a particular movement type.

Select overcorrection triggering thresholds based on the total amount of a movement of staged movement for a particular tooth.

The amount of overcorrection can be set in terms of degrees or millimeters, or in terms of a percentage of the threshold.

For example, if you’ve set a threshold of 1.6mm for buccal anterior movement for a particular tooth, when the total amount of movement exceeds this amount, an overcorrection of .2 mm of the threshold will be applied. You can display this overcorrection as an amount such as .2 mm, or as a percentage, such as 12.5% (i.e., 12.5% of 1.6 mm = .2 mm).

The suresmile default settings can be copied and edited to create your own personalized overcorrection settings.

The stages with the overcorrection will include this misalignment added on top of the setup movements.

You can exclude or include any movement type. For example some doctors will never overcorrect for angulation.


DPPT-500053-2 18

Click Display and click the “O” to toggle on/off.


DPPT-500053-2 19

To turn on Automatic Overcorrections, select the Overcorrection option on the

Aligner Constraints tab on the Preferences page.


DPPT-500053-2 20

Next, go to the Aligner Overcorrections tab on the Preferences page.

1. Indicate whether to display the amount of overcorrection by amount of

degrees or millimeters, or by percentage of total of movement from the first

stage to the final setup.

2. Next select those movement types which you want to overcorrect.

3. Adjust the thresholds as needed from their defaults.

4. Enter the maximum number of stages you want to use for the

overcorrection.

5. Click Save.

Tip: Most doctors limit the maximum number of overcorrection stages to 3.


DPPT-500053-2 21

To set overcorrection thresholds, go to the Aligner Overcorrections tab on the Preferences page.

As shown in the screenshots above, if rotation threshold is X, this means that if a tooth has a total movement (of the type for the row) from the malocclusion (therapeutic or diagnostic model) to the final setup of more than X, then automatic overcorrection for that tooth will be triggered.

• The amount of overcorrection is set in the Amount or Over % column. If you choose the Over-Correction Type option Amount, the amount is an arbitrary amount that you manually enter. (The default amounts shown in this column are SureSmile’s recommendations.)

• If you choose the Over-Correction Type option Percent, then the percentage you enter is a percentage of the total amount of the tooth movement type from the malocclusion until the final setup stage. (The default amounts shown in this column are SureSmile’s recommendations.)

Let’s walk through the first movement shown above in the screenshots, buccal anterior. As you can see, when the Over-Correction Type is set to Amount, the Over Amount is 0.2 mm. This means that if there has been more than 1.6 mm total buccal anterior movement in all the stages from the original malocclusion to the final setup, overcorrection of 0.2mm will be trigged, and additional stages will be added as needed.

As you can see at the bottom of the chart, for this example we have set the maximum number of stages for overcorrection to 2. (Apply Stage Count Maximum). Normally this value is left blank by default.

For the sake of our example, let’s say that for our Aligner Constraints preferences we have set the maximum amount of movement per stage for buccal anterior movement to 0.1.

Still following our example, this means that if the tooth has had 2.0 mm of total buccal anterior movement, two overcorrection stages will be automatically added after the final setup. If we leave the defaults as set above:• If you select the Overcorrection Type of Amount, each overcorrection stage will have 0.1 mm of buccal

anterior movement. • If you select the Overcorrection Type of Percent, each overcorrection stage will have 10 percent of the

total buccal anterior movement from the initial malocclusion to the final setup.


DPPT-500053-2 22

Blocking Out:

Use the new blockout tools to block out undercuts or other marked areas.

Image on left shows areas marked for blockouts. Image on right shows 3D

visualization of blockouts.

When creating a staged model sequence for an aligner case, you will now have

the option to block out undercuts.

Blockouts will need to be applied to the staged models when there is spacing,

gingival recession, exposed roots, black triangles and lingual retainers. The

blockouts need to be added beginning at Stage 1 and should be assessed from

all views. Block any spaces between teeth if larger than 1 mm and block only

one third (1/3) from the gingiva.


DPPT-500053-2 23

Click Blockouts on the menu bar:

• Mark Undercuts: Click to apply undercut marks. Hold down the Ctrl key to

erase marks. Hold down the Shift key to activate the Camera Navigation tool

so you can move the model as need when marking the blockout.

• Show Undercut Marks: Selected by default when ‘Mark Undercuts’ is

selected. Shows the green markings where undercuts have been marked.

Click to show or hide the undercut marks.

• Show Blockouts: Click to generate to a 3D visualization of the blockouts on

the model. Click again to hide.

• Mark Next Stages: Selected by default. Applies marked undercuts to

following stages in staged model sequence. When the button is not selected,

the blockout markings are only applied the current stage.

Important: Upper and Lower stages are not synchronized. You must mark

undercuts on each arch.


DPPT-500053-2 24


DPPT-500053-2 25


DPPT-500053-2 26


DPPT-500053-2 27


DPPT-500053-2 28

This new feature allows you to select the trim height preference for aligners and

attachment templates.

Go to the new Trim Height tab on the Preferences page.

Trim Height Preferences are specific to each doctor.

The range for both aligners and attachment templates is 0 to 2 millimeters in

0.1 mm increments

• The default trimline height for aligners is 2 mm.

• The default trimline height for attainment templates is 0 mm.

Note: The reference (zero value) for the Trim Height Control is the minimum

gingiva margin at each tooth.


DPPT-500053-2 29

Starting in February, join SureSmile faculty mentors for expert insights, clinical

solutions, and software tutorials that will give you greater treatment precision,

in-house control, and the digital freedom that SureSmile technology delivers.

Coordinate training and practice implementation through your Clinical

Implementation Specialist (CIS).

For more information, go to https://suresmileu.com/

30DPPT-500053-2


Please contact Customer Care. We will have your Clinical Implementation

Specialist contact you.

Reach out to SureSmile Customer Care at [email protected]

United States 888.672.6387

Europe, Australia, New Zealand, Japan & South Korea +800.6655.1234

All other countries +1 972.728.5902

31DPPT-500053-2


mailto:[email protected]

7.5 suresmile advanced customer upgrade guide...1. click the tooth or arch label to switch between...

Documents