SimPlant 10: whats new?

Its not the scan, its the plan!1 With version 10, it

has never been so easy to plan! SimPlant falls into

the hands of Dr. James. Dr. James is our top researcher, and he has placed his knowledge in the

computer. If you tell him where the bone is, and

where you want the teeth, he will tell you how to

plan the implants, taking into account both

biomechanical and aesthetical considerations. You

don't have to agree with Dr. James: you can

change his plan according to your insights. Dr.

James has spent several years of research on this.

We even managed to write down his ideas in a

software patent, a very rarely conceded patent

type.

But Dr. James is not the only improvement in

SimPlant 10. See how you can move around implants more precisely, go check how you can place virtual teeth or little text comments in the project. Find out about SimPlant 10 with this

document!

1 Courtesy of Dr. Ganz

SimPlant View.................................................................................................................................. 3 SimPlant Planner............................................................................................................................. 3

1. Planning has never been so easy..................................................................................... 3 I. Dr. James.......................................................................................................................... 3 II. Automatic Implant Match and Specify ........................................................................... 5 III. Precise implant movement ............................................................................................ 6 IV. Implant Rotation ............................................................................................................ 7 V. Improved schematical representation ........................................................................... 7 VI. Other improvements ...................................................................................................... 8

2. Advanced Planning ......................................................................................................... 11 VII. Virtual Teeth ................................................................................................................ 11 VIII. Lekholm & Zarb ........................................................................................................... 13 IX. Realistic Abutments..................................................................................................... 13

3. SimPlant makes full use of the third dimension .......................................................... 14 X. Direct 3D Rendering .................................................................................................... 14 XI. Place an implant in 3D................................................................................................. 14

XII. Instant Preview ..................................................................................................... 15 XIII. Point rendering ............................................................................................................ 16 XIV. Clip+scroll ................................................................................................................ 16 XV. New clipping features .................................................................................................. 17

4. SimPlant is your communication tool! ............................................................................. 17 XVI. Annotations .............................................................................................................. 17 XVII. Distribute to view...................................................................................................... 17 XVIII. Improvements to the Movie Tool ............................................................................. 18

5. Installation and Passwords ............................................................................................. 18 XIX. Planner vs Pro license ............................................................................................. 18 XX. Update installer............................................................................................................ 18

6. Overall changes .............................................................................................................. 19 XXI. XP look..................................................................................................................... 19 XXII. New Keyboard shortcuts.......................................................................................... 19 XXIII. Embrace CBCT........................................................................................................ 20 XXIV. Implant Version ........................................................................................................ 20 XXV. New organisation of the preferences ....................................................................... 21

SimPlant PRO................................................................................................................................ 21 XXVI. Discard small parts .................................................................................................. 21 XXVII. Welcome screen................................................................................................... 22 XXVIII. Overall improvements .......................................................................................... 23

SimPlant Master ............................................................................................................................ 23 XXIX. Dicom Print Control Software .................................................................................. 23 XXX. Other Improvements ................................................................................................ 24

Known Problems:........................................................................................................................... 25

SimPlant View SimPlant View has undergone its first face-lift since birth. Get ready to meet an entirely NEW

SimPlant View, with increased user-friendliness and increased tools for plan review.

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

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

SimPlant on sma files can now be navigated!

SimPlant Planner

1. Planning has never been so easy

I. Dr. 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 teeth o Optionally: Nerves o Optionally: segmented Teeth

As an output, Dr. James will try to plan an implant for you at every tooth location. He will also tell

you what you could do when he could not place an implant, e.g. because of too little bone, or very

small prosthetic element.

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. You can change that by

clicking in the column Type. The first column is used to decide which elements are taken into

account. The advanced button takes you to the Dr. James preferences, where you can define

how far you want the implants to be away from each other, from a nerve, from a neighbouring

tooth, etc. Among other things, you can choose to have Dr. James plan implants as parallel the

prosthesis as possible or allow him to tilt the implants a little to place the implants in more bone

volume. Note that in both cases, the implant will go through the prosthetic element in an

aesthetically acceptable manner, and it will 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 highlighted when you have set al

least bone and a prosthesis. Have a coffee meanwhile.

Figure 2. Communication with Dr. James goes through this screen.

II. 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 Dental Straight 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 will be immediately

matched and specified to the Zimmer Dental Straight Screw-Vent HA SVWH10 wide platform

implant.

III. 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 implant selected, pressing one

of the icons at the right of the toolbar, the implant can be respectively translated, rotated around

its apical end, rotated around its incisal end or rotated around its axis precisely using increments

editable in that same toolbar (at the far right). You can do the movements either using the mouse

and clicking (without dragging) on the white arrows, or you can use the arrow keys on your

keyboard.

IV. Implant Rotation

When you now look at an axial cross-section of an implant (See Figure 4) 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, you can rotate the implant around its axis.

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

V. Improved schematical representation

When we have a realistic representation of an implant, we will no longer represent the implant as

a simple cone or a cylinder in the schematical representation, but as a combination of cones and

cylinders. As an example, have a look at Figure 6:

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

This is a Straumann Standard Implant 043.135S. On the right is the view we are getting used to

since SimPlant 9. This view is still the standard. When you now choose to see the schematical

representation, you will no longer see just a yellow cylinder, but the screen in the image on the

left: a combination of cones and cylinders, forming the multi-part representation of the implant.

This schematical representation is also used in the bone quality screen. It allows you to plan the

implants vertical position precisely, even if you have a slow computer.

VI. 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 a safe 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 and restorative space-restorative

space.

Figure 8. Implant-Nerve collisions are now based on a shell around the nerve.

Mesiodistal and Buccolingual angle

Tilt and Turn are hard to understand. Instead, we are more interested in the buccolingual and

the mesiodistal angle. A high value for these angles would result in a perforation (high

buccolingual angle) or in a contact with the tooth root (high mesiodistal angle).

The angles are defined as follows:

1. Mesiodistal angle is the angle made by the projected implant axis and the vertical axis in the plane formed by the vertical axis and the mesiodistal line at the centre of the implant. (The

mesiodistal line is the tangent to the panoramic)

2. Buccolingual angle is the angle made by the projected implant axis and the vertical axis in the plane formed by the vertical axis and the normal to the panoramic at the 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 change these values.

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

(Figure 10).

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

Figure 10. Implant Properties show the Mesiodistal and Buccolingual angle.

Improved nerve drawing

In SimPlant 10, a number of enhancements to the nerve-drawing interface have been

incorporated. It is now possible to add points at the end of a nerve. This way, you can extend

existing nerves instead of redrawing a new one.

Double-click on object opens properties dialog

In SimPlant 10, a double click on a text message, an implant, etc. will open its 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, zoomed and panned.

2. Advanced Planning

VII. Virtual Teeth

What are virtual teeth?

SimPlant 10 will again have the opportunity to enter fake teeth in the project. Figure 11, Figure 12

and Figure 13 show an example.

Figure 11. Virtual Teeth: no scan template.

Figure 12. Virtual Teeth positioned.

Figure 13. The actual position of the scan

template.

Why is this useful? NOT to replace a scan template! Because the scan template has information

from the opposite jaw, here you dont. It is good when:

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

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

The virtual teeth are compatible with Dr. James (see page Error! Bookmark not defined.), which means that you can have the computer advise you of an implant position once the virtual

teeth are placed.

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 new toolbar will pop up, similar to the nerve and

panoramic toolbar. One of the buttons is the add virtual teeth button. In the next screen, you will

be asked to

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 the extremity of the prosthesis.

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

When done, the yellow teeth will be placed along the panoramic at positions based on statistics,

and with the current axial slice as occlusal plane.

How do I manipulate virtual teeth?

Repositioning and scaling the teeth along the panoramic can be done in the 3D 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 axial plane, in the panoramic view for the vertical dimension),

there is thus no need to select the panoramic toolbox for panoramic curve manipulation. The

virtual teeth have four handles, meant for stretching along the panoramic and in the vertical

dimension. Heres an overview of the operations and how to perform them:

Action you want to do In which image? Where to click? 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 of panoramic Axial, panoramic White dots

(axial movement in axial slice, vertical

movement in panoramic image)

Change vertical position of all

teeth

3D, panoramic Click on vertical teeth and move in

vertical direction

Change vertical position of a

selection of teeth

panoramic See above: change vertical position of

white dots in panoramic image

VIII. Lekholm & Zarb

Not all Europeans use the Misch classification of bone densities. We have now implemented the

Lekholm and Zarb classification. This is an extra classification 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:

Figure 15. Abutment properties.

The realistic abutments are completely different from the abutments in SP9 and earlier versions.

The latter abutments are still provided in SimPlant 10 as Predefined abutments, but they are not

automatically linked nor are they a schematic representations of the realistic abutments.

SimPlant 10 will include abutments from Straumann, Camlog, Friadent, 3i and JMM, and can

further be updated through our website.

3. SimPlant makes full use of the third dimension in several ways:

X. Direct 3D Rendering SimPlant 10 has a new renderer incorporated: Direct 3D. Depending on your computer, it can

make manipulations on the 3D A LOT faster. Set your renderer to Direct 3D in the preferences:

options | preferences | 3D View.

XI. Place an implant in 3D

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

o In the one-click method, the point where you click is considered the entry point. The implant will be placed along the inferior/superior axis (in fact it is the top-bottom axis of

the images, which hopefully is more or less the same depending on the scan).

o In the two-click method, the first click denotes the entry point. At this moment, clipping and texture mapping turns on. The 3D object is rotated in a way that it gives you the best

view of the clipped plane.

XII. Instant Preview SimPlant is proud to be able to show an instant 3D preview using so-called volume rendering technology. The instant preview can be called in several 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 Rendering

3. By going to the new and improved 3D Preview window (Figure 16). This pops up after

import (only for PRO), when opening a file without a 3D model, or when pressing the

generate 3D button. In this screen, you can choose 4 types of volume rendering,

illustrated with a preview on a demo data set.

Figure 16. New and Improved 3D preview window.

You can see the difference between a volume rendering and regular surface rendering in Figure 17 and Figure 18.

Figure 17. Volume Rendering on Demo Dataset by Dr. Poukens and Dr.

Verdonck (AZ Maastricht)

Figure 18. Surface Rendering on Demo Dataset by Dr. Poukens and Dr.

Verdonck (AZ Maastricht)

Volume rendering has the advantage of being a very fast way to generate a 3D. It gives you the

impression that it reduces scatter, but it is in fact just taking the focus away from it. It has the

disadvantage that it is in fact just an illusion. You cant click on it to navigate. You cant place

implants on an illusion. You cannot hide part of the 3D and make another more visible. Whenever

the user attempts to do one of these operations on the rendered model, a real model will have to

be built (Figure 19).

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

XIII. Point rendering Point rendering is the situation where you represent the 3D object as a set of points. This takes

less memory. Whenever your computer starts getting slower, SimPlant will automatically switch to

point rendering when you rotate, zoom or pan the 3D objects.

XIV. Clip+scroll Scrolling the mouse in the 3D while clipping is on takes you on a journey through the slices.

XV. 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-scales IN the 3D object. From SimPlant 10 onwards, you

can superimpose the whole slice in the 3D, or perform clipping without texture mapping.

Figure 20.

Texture mapping.

Figure 21. Full slice texturing.

Figure 22.

No texturing.

4. SimPlant is your communication tool!

XVI. Annotations

You can add text comments using the icon: . You can see all the comments 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 or even an image. When you open a file with comments, the list of

comments will 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 in the list.

XVII. Distribute to view

When you are a SimPlant Planner or Pro owner with the View Module, you want 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 menu under Plan | Distribute to View. You will be asked for a folder to save the file AND the SimPlant View installer to. Distributing SimPlant View through your

software has never been this easy.

Note: this was already present in SimPlant Master.

XVIII. Improvements to the Movie Tool

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

Figure 23. The new Capture Movie window.

Figure 24. Options for the movie capture.

If I press the button with the red dot, I will start registering every move that happens on my

SimPlant window. In the end, a movie file will be created in the directory C:\DentalData, and it will

be called Marge__003.avi. I can still limit the registration to any of the panes, just like in SimPlant

9.2. As an extra, the new movie tool has:

The possibility to hide the mouse when capturing An auto rotate function, which exports a movie containing a rotation of your 3D

object in a certain fashion.

An option to play the movie after recording. Shortcuts for record/pause (shift + F8) and stop (shift + F9)

5. Installation and Passwords

XIX. Planner vs Pro license

When a Pro enters a password for a Planner, the user will receive a message that explains the

mistake. Previously, the message was just Registration succeeded, but the program wouldnt

start. This should solve a lot of support issues.

XX. Update installer

With the new installer, you will be able to just update your current version of SimPlant 10.0. This

is great when sending out bugfixes!

6. Overall changes

XXI. XP look

We have given all the icons a new modern look.

XXII. New Keyboard shortcuts SimPlant 10 is full of new keyboard shortcuts:

In the 3D pane (after you have clicked in the pane): o Arrows will rotate o CTRL and arrows will zoom o SHIFT and arrows will pan o PgUp, PgDn, Home and End do the same as the arrows but in bigger increments (10x). o Tab will toggle views (front, left, etc.)

In any 2D pane (axial, cross-section, panoramic, after you have clicked in the pane) o Arrows will scroll through images o CTRL and arrows will zoom o SHIFT and arrows will pan o PgUp, PgDn, Home and End do the same as the arrows but in bigger increments (10x).

Access to the lists can be granted through keyboard shortcuts (see tables). The shortcuts will be mentioned in the lists menu.

Plan mode ShortcutImplants CTRL + 1 Volumes CTRL + 2 3D Objects CTRL + 3 Measurements CTRL + 4 Nerves CTRL + 5 Panoramic Curves CTRL + 6 Profile Lines n/a Collisions CTRL + 7 Annotations CTRL + 8 Virtual Teeth CTRL + 9

CMF mode ShortcutVolumes CTRL + 2 3D Objects CTRL + 3 Measurements CTRL + 4 Nerves CTRL + 5 Panoramic Curves CTRL + 6 Distractors CTRL + 1 Cutting Paths CTRL + 7 Soft Tissue Simulations CTRL + 0 Profile Lines n/a Annotations CTRL + 8

Virtual Teeth CTRL + 9

Segmentation mode Shortcut Masks CTRL + 2 3D Objects CTRL + 3 Measurements CTRL + 4 Panoramic Curves CTRL + 6 Profile Lines n/a Annotations CTRL + 8 Virtual Teeth CTRL + 9

XXIII. Embrace CBCT Cone beam CT scanners have improved over the years and some of the machines are achieving

even better image quality than regular CT scanners. Therefore, we have removed the message

that warns the user for inaccuracies in the CBCT data set. We realise that whoever uses older

machines, may still encounter problems. Materialise commits itself to mention these problems to

the CBCT manufacturers.

XXIV. Implant Version

It is now possible to see which implants the user has on his machine. You can see that by going

to the about screen (help | about): you will notice an extra button Implants. When pressed, you

will see for each implant manufacturer a number that allows Materialise to see when the last

update was done. This is very important for tracking bugs in the implant libraries.

Figure 25. The help | about screen

XXV. New organisation of the preferences

SimPlant 10 would have had 3 rows of tabs using the old way of organizing preferences. For

people using low screen resolutions, it was necessary to split a couple of pages into two pages.

The new look of the preferences can be seen in options | preferences. It is a severe change in

comparison to SimPlant 9.

The default settings have been regionalised. For instance, in the US you will 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.

SimPlant PRO

XXVI. Discard small parts

Youve already noticed it in Figure 16: there is an extra checkbox Discard small parts. This

checkbox is also present on the Calculate 3D screen (in SimPlant 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 Figure 27, small parts were not

discarded. Therefore, the 3D contains all the small bits of hard tissue littering the image. In Figure

28, the discard small parts checkbox was checked, and the spinal cord as well as the bits of

scatter were filtered from the 3D model.

For those of you using SimPlant PRO or Master, you will notice that the discard small parts is in

fact no more than a threshold followed by a region growing, but made easy!

Figure 27. Previous Situation.

Figure 28. New Situation.

XXVII. Welcome screen

The difference between open file and import CT was not very intuitive in SimPlant 9, especially

to new users. If the difference was understood, there were still difficulties finding the correct

icons.

SimPlant 10 will welcome you with the screen in Figure 29. The screen invites you to open an

existing SimPlant file, or to read images from a CT scanner. The icons have been restyled for

more difference between open file and import CT images.

Figure 29. The SimPlant Pro Welcome screen.

XXVIII. Overall improvements

Performance

Depending on the computer you are using, you may notice that SimPlant 10 is noticeably faster

than SimPlant 9.2 in a number of operations. One of the speed improvements is in the import:

general improvement of about 25% is estimated for the global import process. Smaller

improvements for the first (loading of images) and second (convert) steps are expected. Scrolling

through images has become much faster, especially in segmentation mode but also for some

specific cases such as scrolling through panoramic images when there are density

measurements, when there are several implants, loaded 3D objects, etc.

Remember Shades in volume and Masks toolbar

When you change the settings of the shades in the Volume or Masks toolbar, SimPlant will

remember those settings on opening SimPlant again. SimPlant will also show the toolbar if you

had the toolbar open when you have used SimPlant for the last time.

Mask Toolbar

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

SimPlant Master

XXIX. Dicom Print Control Software

SimPlant 10 has Print Control software for printing towards dicom printers directly. Master

customers are no longer required to use e-Film or another third party software to print from

SimPlant to film. A dicom conformance statement will be available on the website. This feature is

implemented as a separate commercial module.

XXX. 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 of having to go to the

preferences)

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

PPU licence is a licence

For PPU clients, paper print, film print and editing were authorised, yet the screen showed "no

license".

DIA remembers images folder

The Dicom Input Application (for Masters and Pro users) now remembers the images folder from

previous installation. This is time saving at installation.

Include Images in subfolders

SimPlant provides you with a checkbox "Include images in subfolders" in the import dialog (like

the "Search in subfolders" button in the open project dialog). When this option is checked on, all

images in all subfolders of the selected folder are shown in the file list and are "imported" when

the next button 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

So when processing is done, the user has to go back to "pick up" the scout if 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!

Known Problems: When saving a file in the SimPlant 10, it will be possible to open it in SimPlant 9 in all cases. It will

even open in SimPlant 8.33, except when it has 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 a

SimPlant 8 customer. There are two solutions:

o Not place any text comments or virtual teeth o Upgrade to SimPlant 10

SimPlant ViewSimPlant PlannerPlanning has never been so easyDr. James

Who is this Dr. James?How to call Dr JamesAutomatic Implant Match and SpecifyPrecise implant movementImplant RotationImproved schematical representationOther improvementsMore correct Implant-Nerve collisionMesiodistal and Buccolingual angleImproved nerve drawingDouble-click on object opens properties dialogEscapeImproved Implant Preview

Advanced PlanningVirtual Teeth

What are virtual teeth?How do I place virtual teeth?How do I manipulate virtual teeth?Lekholm & ZarbRealistic Abutments

SimPlant makes full use of the third dimensionDirect 3D RenderingPlace an implant in 3DInstant PreviewPoint renderingClip+scrollNew clipping features

SimPlant is your communication tool!AnnotationsDistribute to viewImprovements to the Movie Tool

Installation and PasswordsPlanner vs Pro licenseUpdate installer

Overall changesXP lookNew Keyboard shortcutsEmbrace CBCTImplant VersionNew organisation of the preferences

SimPlant PRODiscard small partsWelcome screenOverall improvementsPerformanceRemember Shades in volume and Masks toolbarMask Toolbar

SimPlant MasterDicom Print Control SoftwareOther ImprovementsFOVRemember Printer settingsPPU licence is a licenceDIA remembers images folderInclude Images in subfolders

Known Problems: