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3Shape Implant Studio™

1. 1 Choose the required Lab and Template if available 2 Enter General information for the patient and other details if available 3 Upload the CBCT CT and Surface scans 4 Choose necessary teeth in the overview map with a left click 5 Specify restoration details Type Color Implant Planning and or Surgical Guide 28 a 59996_131205110 John De Q Implant Studio local BB change lab 2 A view FA Reschedule f Delete A copy General information Delivery information Patient images First Name John Last Name Doe Dentist Delauli Comments Copied from order Delivery Fatient ID CT scan v4 Upper jaw sca Lower jaw scan Choose desired construction Type ay Crown zirkon Color A Vita B3 Note The availability of the I mplant Planning and Surgical guide options depends on your license version Note In order to be able to create a surgical guide you must select the Surgical guide option in the order form Otherwise the Surgical Guide step will not be available 29 Note You must select the Implant Planning option for your order to be able to proceed to the next step TOOLS AND OPTIONS Open ae sase Allows you to place markings and annotations on the teeth Opens order details on a separate page which can be printed out Allows you to export orders to a separate folder Opens a calendar and the list showing free time slots Press the preferred date
2. 18 18 30 20 The Global transformations tool allows you to move scale and rotate the crown F e Rotate the model by clicking and A S dragging the red control points The adjacent arrows illustrate the direction of orientation e Drag the green points to change am Vv m v the shape of a whole model by moving it sidewise back forth or up down nr 60 The Morphing tool helps you shape your i f crown by dragging its parts e The net shows the direction in i which the morphing is applied saj 200 mm EN e Setup the morphing radius by dragging the bar You can also ai Y Y change the radius by holding the Shift button and scrolling the mouse wheel Use the Wax knife tool to add ea remove material to the crown or smooth its surface a w sb e Choose one of the three options and click on the model to apply the operation ea e e Select the radius and amplitude BE of the wax knife by 3 using the two slide bars or use a il eeu Shift mouse wheel and Ctrl A n mouse wheel respectively l lil Serai e The buttons numbered 1 6 contain the preset values which you can apply while using a Wax knife o 1 2 is Add material with Y different sets of the default values for radius and amplitude o 3 5 is Remove material with different sets of the default values for radius and amplitude o 6 is Smooth E aa mm am e The Undo button reverses the
3. 63 w CT visibility mm ae i Be 3 64 e Click the Reset implant position if you wish to manually change the implant s position which initially was automatically pre positioned based on the Virtual Crown placement 1 Select the Reset manually Ea button 2 Click two points in the Sagittal or Tangential views making sure that the first point you click is for the occlusal side of the implant 3 Click the Reset from crown pose button to go back to the automatic placement based on the Virtual Crown Manual implant positioning placing 2 points Manual implant positioning result e Rotate the implant around apical and occlusal ends using the handlers in the Sagittal and Tangential views 65 e Press and hold the Ctrl button on your keyboard and move your implant with a cursor up down or left right This will restrict the movement of an implant along the axis Hint To enlarge a specific 2D view for a better visualization move the cursor over the desired view and press E on your keyboard 3D MODELLING WINDOW Use the 3D modelling window to change the length and the position of your implant 66 Moving Rotating Move the cursor over the implant until it turns into Left click the red control point and drag it sideways a hand Then left click the implant and move it to rotate the implant 67 CT visibility fh T Place the implant in such a way that you view it from
4. Warning Clinicians are responsible for generating a CT scan of optimal quality using as low radiation dose as possible Warning The CT scanner should always be calibrated within the intervals outlined in the manufacturer s calibration guidelines Warning If the alignment process is not conducted on the basis of high quality scans the foundation for the implant planning procedure is not present 106 8 Information on the CBCT CT Scanning I CBCT CT SCAN INFORMATION To use 3Shape Implant Studio for implant planning a digital image of the patient is required from an external CT scanner In cooperation with the 3D optical surface scan the CT scan forms the basis for clinical diagnostics planning and evaluation of optimal implant positions To acquire the CT scan the following recommendations should be considered CBCT CT Scanner Compatibility Recommendations 3Shape Implant Studio is compatible with medical single slice CT scanners multi slice CT scanners and Cone beam CT scanners which are exporting DICOM files conforming to 3Shape DICOM Conformance Statement In addition these basic recommendations should be followed e The field of view for the jaw bone should be large enough to allow a diagnostic evaluation of the clinical situation as well as ensuring enough information for a reliable alignment to the surface scan e The voxel size should not exceed 0 5 mm in any direction e The diagnostic image qualit
5. a Order Offset from sleeve to quide 0 03 l Radial Apical distance of implant s safety zone mm adjusts the safety zone around the implant Click and drag the slider bar to change the distance from an implant to the safety zone 90 1 Radial distance 2 Apical distance Default manufacturer select from the list one of the default manufactures which has predefined minimum and maximum values for each of the settings below You can modify these settings manually Shell thickness defines the thickness of the surgical guide shell Offset from teeth to shell defines the offset distance from teeth to shell Retention amount of shell defines how tightly the surgical guide will fit on the teeth see chapter Design Surgical Guides for images Offset from sleeve to shell defines the offset distance from sleeve to shell 91 IMPLANT LIBRARY You can upload implant libraries you wish to work with into your Implant Studio 1 To check for new libraries click the Check again button 2 Select library in the list 3 Click Download The library will be added to your list of implant manufacturers Settings Implant library J Implant systems Up to date if Avinent Up to date Bego Up to date W Biodenta Up to date W Glidewell Up to date J W Sleeves Up to date Iw Avinent Up to date W Bego Up to date W Biodenta Up to date If Glidewell Up to date J Surgical trays Up
6. 40 e Region of interest Manually improve the alignment by marking with the cursor a specific area on the Surface Scan in the 3D pane to perform a regional alignment optimization for the selected areas i Add lets you mark the area of greater importance for the alignment algorithm z Remove removes only the part of the marking indicated by the cursor 5 t Clear selection clears all your previous marking e Difference Map Click the Show difference map 9 button to view the alignment result with the help of a color scale Please pay special attention to the areas marked red and blue they might require additional alignment e g with the help of the Region of interest tool 41 Difference Map You can also use 2D Cross Section to check the alignment Step 3 Confirm Alignment Approve the alignment by marking the Confirm alignment checkbox The CT and Surface panes get hidden 42 Scan alignment a g John Doe Ea e Threshold HUY 0 5 na 1500 Fi S00 E pram w Region of interest m eT i i x X F aS Ls 3 p ae _ _ _ Difference Map 9 RA l 2 3 Confirm alignment 4 Note The scans alignment must be performed in order to proceed to further steps which otherwise appear disabled The visualization tools can help you while planning implants and designing surgical guides Right click anywhere in the modeling window to open the visual
7. Color Not chasen Ww p Step 2 Choose the required Lab and Template if available Select lab Implant Studio local Implant Studio Lab Default Set up default template Step 3 Enter General information for the patient and other details if available Step 4 Select Construction details for the restoration Choose the relevant teeth in the map and specify the restoration and bridge type as well as the implant and surgical guide positions fe Step 5 Use the comment field to add special instructions or comments to the lab See chapter Order Form for details 2 2 Load CBCT CT and Surface Scans Once an order has been created press the corresponding Load buttons in the Order form to load Surface upper lower and CBCT CT scans Implant Studio Lab Change lab Be View Export a Reschedule FS Delete Copy General information Delivery information Patient images First Name John Last Name Doe Dentist Default Comments Delivery Select a date Patient ID Upper jaw scan Lower jaw scan Choose desired construction Add sr precaration scan Open color tool OOBOOLLLPBIOGA E w 2000000000000 OOO Type Wa Crown arkon wF Color Not chosen See chapters Load CBCT CT and Adjust CBCT CT Scan Visibility and Load Surface Scan and Optimize Visibility for details For the CBCT CT scans 3Shape Implant Studio supports all open DICOM dcm file formats which comply with t
8. most recent editing command lobalTrans lobalT rans e The Redo Ag button restores the lobalTrans changes back lobalT rans Cancelling any operation requires that the operations following are cancelled first Undo 4 actions 61 3 11 Apply Implant Planning Tools 5 After placing a crown go to the Implant planning step to position your implant j n i j il 4 O07 131 Po Coat Implant planning gt T AS Sy Sw f G 93973 131209155905 John Boe gs Step 1 Select implant manufacturer a Press or use the shortcut keys to select the implant x m manufacturer and implant type for the selected indications See the chapter Use the Implant Library for details Step 2 Modify your implant s position 62 2D VIEWS Use the 2D views to position your implant correctly e Enable disable the clipping planes ih in the Sagittal and Tangential views see the chapter Define Panoramic View for details e Use the Distance measurement tool to measure distances between objects Place two points and view the result Click the Delete the active measurement button to clear your measurement Click the Insert distance measurement button to start placing measurement points e Use the BF aie implant aligned plane button in the Sagittal and Tangential views to enable a plane centered around an implant When enabled you can scroll in either of the views and the planes now of different colors rotate around an implant
9. J5 Ph APM m E 2 09 4 35 Ph E Pictures gt CT_00000007 dem 2 2 Moj Una H videos s CT_00000008 dem V201 4 35 PM yi i Fea 1 i To Be CT odem POT 4 35 PM fy 18 i 7 Computer gt CT_00000020 dem 2 20 2013 435 PM Local Disk C gt CTL L dem 2 20 2013 35 PM da Local Disk De s CT 00000012 dem HAMI 4 35 PM G Marketing dehapetwo M te OT ANG eni gon i in m mI rr m m Fille name gt Step 4 Preview scans in the CBCT CT loader The CBCT CT loader will assist you with selecting the correct scan by placing the available scans into two categories Supported scans and Unsupported scans Click the scan to read additional information in the window to the right 32 Supported scans 4 acques Betqaun Os DICOM data successfully loaded Unsupported scans Confirm Step 5 Confirm the selected scan to upload it Select the supported scan you want to load and then click the Confirm button to upload the CBCT CT scan A green tick will appear in the CT scan check box after the successful upload Upper jaw scan Lower jaw scan Load CT scan ADJ UST CBCT CT SCAN VISIBILITY Hint Please use the visualization settings for the CBCT CT scan and the option to adjust the grey values in order to find the optimum for each individual scan 33 Step 1 Click the CT visibility button below the Visualization sli
10. appears on the screen gt Step 2 Read carefully and agree to the terms of the Approval of Planning form gt Step 3 View the created surgical report and a drill protocol by clicking the corresponding buttons The Surgical report file can be sent out via e mail or 3Shape Communicate See a detailed chapter below Approve Order and Generate Surgical Report and Drill Protocol for more information Warning Please make sure that the presented screenshots and information for the implant positions and implant types as well as eventually the surgical guide in the Surgical report are sufficient in order to make a clear and safe decision to approve or modify the implant or surgical guide position and design Warning Please follow the instructions in the drill protocol Hint Please check the Surgical report and Drill Protocol every time before a surgery and make sure that e the provided information is correct 25 e you ordered correct implants based on their order number e the right drills and sleeves are used for the selected implant type and manufacturer e drills and sleeves are in a good condition and ready to be used for the surgery 2 11 Send Export Data Files When you proceed to the Save Send step the software automatically sends the order to your partner via 3Shape Communicate IF two conditions are met p You configured your Implant Studio Connection settings under the Configure tab 2 You read
11. are described in detail in the corresponding chapters Load and align open format CBCT scan and surface scan Place virtual crowns Plan implant positions Design surgical guides Create restorative components in Dental System Communicate with a dentist and receive his final approval of the planned 2 The Workflow How Do I 7 This section helps you to quickly find information about specific tasks 2 1 Create New Order 2 2 Load CBCT CT and Surface Scan 2 3 Crop the CBCT CT Scan 2 4 Align CBCT CT to Surface Scan 2 5 Setup Panoramic Curve and CBCT CT Views 2 6 Define Mandibular Nerve 2 7 Place Virtual Crowns 2 8 Place and Optimize Implant Position 2 9 Create Surgical Guide 2 10 Approve Order and Create Surgical Report and Drill Protocol 2 11 Send Export Data Files 2 1 Create New Order Step 1 Open a blank order form Open a Calendar from the Service toolbar and press an empty time slot to open a new Order Form Calendar Implant Studio local E Change lab A view FF Reschedule General information Delivery information Patient images Lj First Name John Last Name Doe Dentist Default op P i Comments Copied from order Delivery J Patient ID Upper jaw scan Lower jaw scan CT scan Choose desired construction Add pre preparaton scan Open color tool gt e a G Fe i sa EN A SP SEO Type ag Temporary Crown Ww boii it Implant planning vi Surgical guide None W 3shape
12. the 2D cross section windows to determine if the selected implant is right for the case e Navigate between the Manufacturer and Implant list by clicking T in the upper left corner of the form e Click z to close the Manufacturer Implant selection form 3 13 Design Surgical Guide 4 After the implants have been planned proceed to Surgical Guide design if applicable Step 1 Press the Start new patch button This will enable the spline placing mode 73 Surgical guide ia TUEN Gude Sees Faichias miston director Set rpo WEH Sleewe 30 EON o EEDD bira eai blarutsetur r Creve AroDitvbed Wi Pima 1 me Cee fon ba WIS FS SE el IEN ma P e a aE o W am gt Step 2 Place the splines to mark the surgical guides outlines Move a cursor over the scan a green control point appears allowing you to place a Spline You can place a spline by 1 clicking points one after another or 2 drawing the spline with a cursor 74 1 2 e You can also fast edit the spline by drawing or clicking close to the spline to correct its placement Fast editing Result e To close the spline place the last control point of the spline on top of the first one or click inside the yellow zone around the point e You can create several patches of splines or create only one spline covering both neighboring teeth and a drill cylinder as illustrated below 75 Jnsa
13. the top this will visualize the red handles for rotating the implant around its axis 68 Changing length Invalid positioning Left click the green control point and drag it eS aey ZONE DAT CErE e that of another implant or a nerve the implant up down to change the length of the implant The l turns red and all the following steps will be implant diameter will not be changed disabled VI SUALI ZATI ON SLI DERS Use the Visualization sliders in the upper right corner of the window to turn the visibility of objects on the screen ON OFF see chapter Visualize Your Settings and Options for details For example e Use the Center view clipping slider A to center view around the selected implant see image below and at li the bone structure around the implant by zooming in and out in the range between 0 and 4mm 69 e Use the Implant insertion directions slider is to visualize the implant direction and sleeves 1 e Move the Drilling cylinders slider r to visualize the screw hole direction 2 3 12 Use the Implant Library On the I mplant planning step you will be using the Implant Library to choose the desired manufacturer and implant type for the selected indication You can open the library a using the shortcut keys or b using the buttons on the Implant Selection box a Shortcut keys Select the indication with a mouse click see image and use one of the following shortcut keys 70 Add
14. toolbar to start planning implants 17 Step 1 Select implant manufacturer Implant planning Press the green plus button in the Implant selection menu and select the implant manufacturer from those displayed F AVINENT Step 2 Select an implant from the manufacturer A Double click the implant to select it and close the Select implant window Once an implant is selected its model appears in the 3D and 2D views of the main window 18 Avinent Select implant Platform P Diameter mm gt Step 3 Adjust implants Adjust implants and optimize their positions using the 2D views at the bottom of the screen the main 3D modeling window and the Visualization sliders Use the apie implant aligned plane button in the Sagittal and Tangential views to enable a plane centered around an Implant Please see chapter Apply Implant Planning Tools for details 19 Implant planning gt T U Y amp 7 GC 23573 12 John Doe Warning Please assure the correct minimum size of the safety zone for the implant and mandibular nerve A collision of the implant with the nerve another implant or any other main anatomical structure like nerve or artery can cause severe damage paresthesia and complication to the patient see chapter Apply Implant Planning Tools For further information on how to change the safety zone size please see chapter General Settings Planner and Guide W
15. with others and to approve the case if the planning has been done by a 3rd party After the final case approval a drill protocol is provided listing the needed parts to be ordered for the implant surgery and summarizing the planned surgery The position of the virtual crown can be transferred to 3Shape Dental System Lab software to design the temporary or final abutment s and restoration s as indicated in the order form 1 1 Intended Use 3Shape Implant Studio is a pre operative planning software for the placement of dental implant s based on imported CT image data optionally aligned to an optical 3D surface scan The CT image data are provided from medical scanners such as a CBCT CT scanner Virtual Crowns can be used for optimized implant positioning under the prosthetic aspect Furthermore a surgical guide for use with guided surgery can be designed based on the planned implant position s The surgical guide data can be exported for manufacturing on an external system Use of the software requires that the user has the necessary medical training in implantology and surgical dentistry Warning The US Federal law restricts this device to sale by or on the order of a dentist 1 2 Indications for Use The 3Shape Implant Studio software is indicated for use as a medical front end software that can be used by medically trained people for the purpose of visualizing gray value images It is intended for use as a pre operativ
16. 3Shape Implant Studio Implant Planning and Surgical Guide Solution User Manual www 3shape com Rx only 0086 Table of Contents alt GRO CIUICHION MG eect cece ercdeiea sae Sate peace saan atae Sates eaemaueeeae EA 1 LD MGM CGO WIS Cr icc catenad Sentieas ook cueend Shaan emaaienad Aare cei napind lven cn a a 2 EZ WING CAGIONS TOW US Cr sis AEE TEN AAEE coat tien ouoa O E EA EETA 2 1 3 Software Device Performance sisi nininiia eres hidindateee aie siatialeweaaesdiwiatiedaaaieeiey ieee 2 La Tine User MAT SIT Enine aE EE AE TAE E 3 FWO KNOW OVET VIEW eresse ramen adaiemandaateeendestcusheaesnedanmeniced eeshucerianuseninareds to 6 2 The WORKTIOW HOW DO T Tois mapras E 7 2 E Create NOW Ord oerna a a e a a aa e a a Ea 7 22 Load CBCT CT and SUNACE SCAN Sirri a EEEE E E ENA 9 2 23 Crop tne C BCH CE SCA 515 a E a ees 11 ZAAI CBC GTO SUNTI CE SCA ie cistieceeanta sy ciate tines ee E eemaaanENTEGn EOE 12 2 5 Setup Panoramic Curve and CBCT VICWS ccccccccccceeeeeeee eee e eee a a a E 14 2 6 Define Mandibular NGG visiic ccuietenceve ts ie comet ieee vides caved wea ee bala cemletkeas AENEAN 14 2 7 Place Virtual Crown Saasen e oa I A E AE iay er AE E AE E 16 2 8 Place and Optimize LIMplant POSITION irera a a E a awl 17 2 9 Create S rgical GUJE caure eT ETE A AE A AEE A AAE T 21 2 10 Approve Order and Create Surgical Report and Drill Protocol ccccee cece cece eeeeeeeees 25 2D PSSM 7 EX DOR Data FES grins sssaceev
17. A S asl Europe Middle East amp Africa Sales Holmens Kanal 7 1060 Copenhagen K Denmark Representative offices 3Shape North America 3Shape Shanghai Co Ltd 3Shape Latin America North American Sales Asian Sales Latin American and Caribbean Sales Somerset Hills Corporate Center Room 906 Tower A of Eton Place Carrera 13 82 91 10 Independence Boulevard No 69 Dongfang Road Suite 150 Oficina 401 200120 Shanghai China Warren New Jersey 07059 USA 110221 Bogota Colombia 3Shape com Visit our corporate web site to learn more about 3Shape and our innovations 3shapedental com Visit our dental web site to learn what solutions 3Shape has for your clinic or lab support 3shape com Visit our Support site to download a printable version or to request to receive a printed copy of the 3Shape Implant Studio User Manual 7 Warnings and Precautions Load CBCT CT and Surface Scans Warning Make sure that the quality of the loaded CBCT CT is sufficient for planning the case and that the relevant areas in the CT for the bone analysis are adequate in order to make an accurate and sustainable implant planning and surgery Warning User needs ensure that the surface scan is of the required quality for planning the case and that the relevant areas for the implant planning and placing the surgical guide fully exist el e Align CBCT CT to Surface Scan Warning Implant Studio must not be used for alig
18. Create surgical guides X F Press the Preview button to create a surgical guide The software needs a few seconds to create the surgical guide Preview View the progress bar for status Patches 1 Femen direcion et From wimi Aveo Detect Sleever 30 PEGG Sunpcal Trp hg ERGO Harar tha lt 2 hdanuvacturer Breve Prolfivhed hal Sw iM mm S07 me EN w uE a Step 7 optional Add bars and windows 80 Surgical guide Surgical guide creation Bars and windows Settings X P n Add aam bar Preview Add viewing window Go to the Bars and windows sub step Choose to add a support bar or a viewing window from the menu Place a support bar and or a viewing window on the guide Modify the bar and the window by using the handles for rotation and size adjustment Click and drag bar window to move it Click Preview to apply the supplements Press the Preview button one more time to go back to the editing mode Adding a support bar before and after Preview 81 82 3 14 Approve Order and Generate Surgical Report and Drill Protocol jn When you proceed to the Save Send step the software automatically creates a surgical 7 report with information about the chosen implant types e Click the Show surgical report button if you want to send a pre approval copy of the Surgical report to the doctor responsible for the case so he could approve it by signin
19. Scan is working correctly to allow a secure and accurate placement of the implant during the navigated planning and surgical guide design process Hint To assure optimal scan quality please make sure that the surface scan is taken with a reliably functioning 3D scanner and the scanner has recently been calibrated Once the order has been created and scans loaded click the Workflow page button in the Main toolbar The software will automatically bring you to the first step Cropping where you can reduce the scan size by cropping the CBCT CT scan and keeping only that part of a scan that will be used for planning 59996_ 137205110951 Cropping John Doe Graphics information Cropping infonmation Graphics adaptar AMD Radeon HD 660 Cropping ragon dimension Jakaa hex ID fevbure dimension 16384 ae Memory required oz MB Original volume dimensions Sotla i TOR 2 Volume region valid 1 Axial plane 2 Coronal plane 3 Sagittal plane 4 Graphics information 5 Cropping information Please see chapter Crop the CBCT CT Scan below for details 11 2 4 Align CBCT CT to Surface Scan Once the cropping of the CBCT CT was done optional you can proceed to the Scan alignment step To align the CBCT CT and Surface scans please follow steps below Warning Implant Studio must not be used for aligning CT and 3D opt
20. a new implant for the selected indication Remove the existing implant for selected indication Change type of the currently selected implant This will L open the implant library with the previously chosen Implant system Esc Close the implant library b Implant Selection box buttons Click to add an implant to your scan Click to remove the existing implant Click 5 to change the current implant manufacturer or the type of implant fe Step 1 Select the desired manufacturer from the list Left click on a manufacturer to select their implant solution This will open the list of implants by this particular manufacturer T AVINENT Fapa Syal Step 2 Select the implant type 71 Left click on the desired implant type to select it gt Step 3 Select the relevant implant size Left click in the table to choose the necessary Length and Diameter of the implant Here you can also select a Platform type from the drop down menu Avinent Select implant Step 4 View additional information about the implant 72 After selecting an implant an illustration of the implant together with the additional information appears in the preview window to the right Avinent Select implant 4 Avinent Coral HE E Cee 4g 48 Implant length 10 mm Implant diameter 3 3 mm eE g OO EECH S e Preview the newly selected implant in the 3D modeling window and in
21. and agreed to the Approval of Planning form which appears when you enter the Save Send step After you have agreed to the Approval of Planning form the order is automatically sent If the software was not set up to send orders via 3Shape Communicate then the output files can be found in the output folder In case a surface scan was used together with a CBCT CT scan for planning Implant Studio will export send the approved implant position and surface scan as a 3Shape dcm file This file can be imported into any 3Shape dental software application See chapter Communicate and Export Import of Design Data for details 26 3 Your Tools and Settings Implant Studio offers a variety of tools and settings for your implant planning and surgical guide design See chapters below for details 3 1 Order Form OPENING THE ORDER FORM e To open the Order Form and create a new order click on the empty time field 1 in the Calendar or the 2 t Today gt Patents Monday July 29 2013 2 Choose sessior 7 See see Hide patient names Calendar Messages Configure e You can also create a new order for the existing patient through the Patients tab by clicking the New session 3 button a Add patient Edit patient Z New session Order Order details Messages Configure Comments ORDER DETAILS Fill in the provided fields with the patient s information and construction details
22. and time and then Select to reschedule the session a Reschedule 4 April 2013 Su Mo Tu We Th 2 3 4 Bt 2 3 7 FEB 9 to 14 15 16 17 18 21 22 23 24 25 28 29 30 Deletes an entire order Creates a Standard or Pre preparation copy of an order see the description for each below 30 _ Standard copy New order includes all data except ID from old order Changes in ardar Aa a atte te alae aeodar sar am are oS roer do not erect the old order and vice versa 3 2 Load CBCT CT and Adjust CBCT CT Scan Visibility UPLOAD CBCT CT SCAN fe Step 1 Click the CT scan Load button in the Order form gt Step 2 Go to the folder containing the DI COM CBCT CT scan and select a dcm scan file Step 3 Press Open 31 Implant Studio Lab EB Change lab ai View A Export Fi Reschedule fA Delete B Copy General information Delivery intormation Patient images AE es L J y e lis First Name John Last Name Doe Dentist Comments Delivery Select a date Patient ID CT scan ty Search CTE ate D Taupi T H Mo Date modified Marne Reale atar nas ns Open color too gt CT 00000000 dem 22 a Dewwniloads P CT_OO000001 dem DMS ETELE S l i L S Recent Places s CT 00000002dcm WaT A5 Phi E CT_00000003 dem VAMA a Link Faeries s CT 0000ih0id dem 2M T Documents s CT00000005 dem 2 M2013 4 35 PM a Music Ps T_00000006 dem 2 0 2009 435 PM
23. anning and Guide Design Data sasssrerrererrsrerrsrrrrerrsrrrrrrreren 97 4 2 Communicate With My Partner IPS Software sesessererrsrerrsrrrrerrrrrrrerrrrererrerrrrrrrerene 98 4 5 Sonave Dental System aeaaaee A A E E EE E 99 4A S5Mave COMMUNICALS Topera a a eee ieee el A 99 SOVS EMS eNOS ae a A A A A A A A T TAA N 101 5 41 System REQUIFEIMGIILS nesre eei e a E baw E E e E e at 101 5 2 SCtUD NEWOK nstallati Osse vol sms aie niauinpe nase ai eniepeelae tai auenens 101 6 Manutacturer INTOnMaltiOn miira a a A a aeubeoneateoauausee 102 7 WaERINGS ana PECCAULIONS errer rnani Aa i A AE A A ATTA AAA 103 Si irornmation onthe CBCT Cr Scan eee onr nnr r A E 107 1 Introduction 3Shape Implant Studio is a pre operative planning software used to plan the placement of one or more implants based on an imported and aligned Computer Tomography CT and 3D surface scan The implants are provided by a secure implant library In addition a surgical guide for a guided surgery can be designed and exported for 3rd party fabrication based on the approved implant position and a specified sleeve file defined by the manufacturer The use of the software requires having the necessary expertise in implant dentistry Implant Studio provides a method of importing medical imaging information from radiological imaging systems such as CT combined with an optional 3D surface scan to a computer Visual representations of the imaged anatomical structur
24. arning In case of collision between implant and nerve or between implants the software will disable access to further steps i e creation of report protocols as well as the surgical guide design step 20 Warning Please assure that an implant does not collide with an existing implant or tooth root channel Also assure that the implant does not penetrate the jawbone border Warning During implant placement please consider that the bone density in reality can be different than the visualized bone density displayed on the screen Please see section Load CBCT CT and Adjust CBCT CT Scan Visibility for more details Hint Please assure that the chosen implant position corresponds to the intended restoration position and the fixation mounting method for the prosthesis on the implant Warning The user must be able to recognize red and green colors to detect warnings such as Collision between implant and nerve 2 9 Create Surgical Guide lt Once implants have been placed and positioned you can press the Surgical Guide button in the Workflow toolbar in case you want to create surgical guides Step 1 Place the splines to mark the surgical guides outlines Press the Start new patch s button to enable a spline placing mode and create one or several patches you can place a few splines if necessary Make sure you select the correct manufacturer under Settings 21 x X Warning Please assure that the req
25. ation is sufficient for the planning situation and intended final solution I confirm that the design of the surgical guide was performed correctly and ensures a stable and firm sit during surgery I confirm that I will read the drill protocol before surgery and verify that the provided information corresponds with the intended planned surgery I agree to the fact that neither 3Shape nor its resellers will perform any medical or clinical review of my planning I am fully aware of the technical constraints that govern the manufacturing of the surgical guide I agree that 3Shape and its reseller do not assume any liability for damages or injuries resulting from my planning and treatment I have read and agree to all of the above Approve amp Save After you have agreed to the Approval of Planning form the order is automatically sent If the software was not set up to send orders via 3Shape Communicate then all output files and date can be found in the output folder by pressing the Open save folder button in the next window Save Siz E Vis GS Y Communicate with your partner using 3Shape Communicate access cases and communicate anywhere and at any time directly from your PC tablet or smart phone a a LES ict ek pbb pene Fi Upper jaw Jox Patuliee Freit ga hat e ica iia 98 4 3 3Shape Dental System 3Shape Dental System provides 3D scanning CAD modeling order management intraoral scann
26. automatically sends the order to your partner via 3Shape Communicate IF the following conditions are met 1 You configured your Implant Studio Connection settings under the Configure tab 2 You read and agreed to the Approval of Planning form see below which appears when you enter the Save Send step TO approve implant planning click the Approve amp Save button If you do not wish to approve the order close the Approval of Planning form by clicking on the cross in top right hand corner of the form please note that in this case the order will not be sent Show surgical report You have now completed your implant planning using the 3Shape Implant Planning software By sending the order to your Lab and or Surgical Guide partner you also approve the quality of your own planning Before sending the order please accept the following items on the checklist Approval of Planning Tam satisfied with and approve the medical and clinical aspects of my planning T approve that I performed the planning carefully chose the most appropriate implant solution and safety zone in relation to any potential existing teeth dental restorations the main anatomical structure and the intended final dental restoration solution In case it s applicable I approve that the marking of the mandibular nerve is pertormed correctly I confirm that the scan data used for the CBCT and surface scan are up to date and that their quality and visualiz
27. awScanim 4 P gt LowerlawSeanWithimplantinfo dem P gt ModelElerment 18 20 dem gt ModelElementl9 dem P gt MoelElerment30 dom P gt SurgicalGuidelovwer stl z Delete Dentist Patient ID CT scan Date medified PSL S013 1007 AM way M013 1125 AM BaN 2013 TLE AM 9 23 2013 6201 Pha TOLMIN AM 6 20 2013 10 50 AM BLL 2013 257 PM 14 2013 204 PM 6 11 2013 257 PM 6 11 2013 2 57 PM Fl m l B Change lab B Copy B A green tick will appear in the Upper Lower jaw scan check boxes after the successful upload Upper jaw scan OPTI MI ZE VISIBILITY Lower jaw scan vE CT scan VE Use the Preparation slider A y to toggle the visibility of the Surface scan Click on Slider s icon to hide the scan completely 3 4 Crop the CBCT CT Scan 35 Once the order has been created and scans loaded click the Workflow page button in the Main toolbar to start the Implant planning process The software will automatically bring you to the first step Cropping where you can reduce the scan size by cropping the CBCT CT scan and keeping only that part of a scan that will be used for planning 59396 131205110951 John Doe Cropping Graphics information Cropping information oraphics adaptar AMD Radeon HD Gad Cropping regen dimension 9G O8x71S tex 30 texture dimension 16334 Original volume dimensions 04040 Ia715 Mamory requi
28. ction plane a 2D preview window appears in the bottom left corner 46 e Move the mouse cursor over the window and scroll to zoom the sectioned area in out e Press down the mouse wheel to move the cross section in the preview window e Move the preview window within the screen by clicking and dragging the green border of a window mouse cursor changes into a hand e Change the window s size by clicking and dragging its borders mouse cursor changes into arrows e Place two points to measure the distance between objects see image above e Click the green cross button to close the 2D cross section tool Hint To enlarge the 2D cross section window move the cursor over it and press E on your keyboard 3 Setup Default Views and User Interface During implant planning you can use the visualization sliders to toggle the visibility of objects in the modeling window as well setup the default views be Step 1 Open the right click menu Right click in the modeling window to open the menu See chapter Visualize Your Settings and Options for details on the right click menu Step 2 Pin the sliders to the modeling window For easier access you can display the visualization sliders in the modeling window by clicking the _ ie Pin icon 47 gt Step 3 Use sliders to control the visibility of objects With the sliders accessible from the modeling window they can be used for turning the visibility of scans on
29. d Hint Place the 3 points in approximately the same place and same order in both scans and ensure that the area is clearly visible in both scans The optimal alignment should be reached within the area where the implant s are placed later Please use also the cross section views to check the alignment 13 Hint Please assure that the visualization of the CBCT CT and surface scans appear correct and complete 2 5 Setup Panoramic Curve and CBCT Views After aligning the two scans proceed to the next step Panoramic curve where the panoramic view for the CBCT scan can be defined Using the cursor click the points along the arch to define the panoramic curve 2 p ies Fa 4 Panoramic curve F ae i ba k 4 wr 5 1 Matched surface and CBCT CT scans 2 Green panoramic curve drawn with the cursor 3 The blue lines indicate the depth of the CT scan shown in the panoramic curve view 4 The orange line indicates the section view along the panoramic curve 5 The panoramic curve view 6 Cross section view within the blue lines called the Sagittal view 7 Section view defined by the orange line called the Tangential view 8 Visualization sliders See chapter Define Panoramic View for details 2 6 Define Mandibular Nerve 14 So cep a Nerve denntion 1 CAGE 42 3Re AOL jot tse od Lot a John Doe To define a nerve channel on the Nerve definition step use the panoramic v
30. ders fhis will open the CT Element Visibility with the sliders for Air Skin Bone and Enamel PR visibility A Step 2 Click and drag the sliders to setup the desired CBCT CT scan visibility e Move sliders to the left right to change the voxel intensity e Move handles up down to adjust the Opacity Hint Please ensure that the points representing bone skin enamel and different body parts and do not cause misinterpretation 1000 o 3000 5164 3 3 Load Surface Scan and Optimize Visibility UPLOAD SURFACE SCAN gt Step 1 Click the Load button for upper lower jaw in the Order form Step 2 Select a surface scan file from the selection window that appears stl and 3Shape dcm formats are supported gt Step 3 Click Open 34 Implant Studio Lab fi View General information Delivery information First Name John Comments Upper jaw scan Choose desired construction PS Select lower jaw scan file A Export Patient images Last Name Doe Delivery Select a date Lower jaw scan P Reschedule Se d e Orders 1505313073174049 pr p Organize New folder i a j jf m i 7 B l Wr Favorites ane K A EE Desktop di CTData gt Libraries i Downloads E Recent Places LL D Documents al Music E Pictures H ideo E Computer Er E ee Mih Pam File name d PnntableOrderForm di SavedData y di template P gt Lower
31. e can be imported into any O Open save folder 3Shape dental software application 3 15 General Settings Click the Configure button in the main toolbar to use various Implant Studio settings Configure 84 GENERAL Settings General About Software version Implant Studio 2014 Software build 2 1 6 0 159625 Dongle ID 2601772594 Site ID 59995 Expiry Gate 27 Oct 14 Next key renewal Gate 26 Dec 13 Check for upgrades Check for upgrades User interface language English English w What s new Open what s new Renew license online Open web shop 35hape support About provides information on software version dongle number etc Check for upgrades checks for software updates allowing you to keep your Implant Studio system up to date User interface language allows you to select the preferred interface language What s new opens a What s new in Implant Studio pdf Renew license online opens a web page for the online renewal of your license 3Shape support provides you with the remote support directly from 3Shape Tell 3Shape the ID and password displayed on the screen for desktop sharing 85 SYSTEM settings Log Open systern log file Free Narddisk space 42GB Auto snow On screen Keyboard 4 r Log opens system log file Free hard disk space shows the remaining space on your hard disk Sound Volume controls the system sound volume 86 SOUND Mute On screen Ke
32. e software program for simulating evaluating dental implant placement and surgical treatment options Indications of the dental implants do not change with guided surgery compared to conventional surgery Contraindications Pre operative planning with Implant Studio must only be applied if additional radiation dose from 3D radiology compared to conventional x ray can be justified 1 3 Software Device Performance Implant Studio has been developed with the intention of providing maximum safety and accuracy in regard to planning of the implant positions and the design of surgical guides The actual performance of the software is limited by the quality resolution and accuracy of its input data DICOM CBCT CT and eventual surface scan and by the user s decisions on how to define the input data s alignment The actual implant planning process and surgical guide design can only be performed within the limitations defined by the input data and their alignment The input data and alignment also defines the achievable degree of accuracy of all measurements The software does not apply any modifications compression or alterations to the input data DICOM and eventual surface scan during their upload alignment usage and or export Implant Studio DICOM Conformance Statement is available for download here http www 3shapedental com implant studio DI COM conformance statement Overall the intended use of the software is consid
33. e three smaller control points to the offset between a sleeve and an implant by adjust the supporting material around the clicking the upper control point and moving it up sleeve i e the diameter and the support below and down the sleeve fee Step 5 Configure the Surgical guide parameters 78 79 Manufacturer Dreve ProDiMed_M1lz W Thickness 2 00 mm Offset from teeth 0 075 mm Retention amount 0 000 mm Oftset from sieeve 0 030 mm the selected ones Select a manufacturer with the parameters which have been pre set in the Planner and Guide setting under the Configure tab You can manually edit these parameters here However each parameter has minimum and maximum values which you will not be able to exceed Thickness defines the thickness of the surgical guide shell Offset from teeth defines the offset distance from teeth to shell Retention amount defines how tightly the surgical guide will fit on the teeth see images below Offset from sleeve defines the offset distance from sleeve to shell Note The created surgical guide STL file is intended to be used only for production on the selected machine material and manufacturer 3Shape gives no guaranty regarding the performance of a surgical guide produced on machines and materials other than 2D cross section A distance measured from a tooth to a surgical guide 0 99 mm Retention amount 0 000 Retention amount 0 100 Step 6
34. ea while placing the three points for both CBCT CT and Surface scans Please do the same while using the Region of Interest tool Saat RO rene I Surta Er atan JLA When moving the cursor over the CT Surface panes the following buttons appear e The Clear the points if button lets you remove incorrectly placed alignment points e The Lock views scans during rotation button lets you lock and synchronize the movement of the two M D e The Switch to 2D mode button CT pane only becomes available after the scans are aligned 37 o Click the button to use a cross section plane for evaluation of the alignment o Move and rotate the plane to place it in the necessary position o Click Reset cross section plane to return the plane to its initial position o Place the measurement points on the CT and Surface scans with a mouse click to measure the distance between scans if necessary o Click the Enable Threshold highlighting Sel button to highlight with green those areas on the CT scan which are used for the base alignment between the CT and Surface scans These areas which are marked green are defined by the Threshold HU Slider see Step 2 below 38 Step 2 Check and correct the alignment if necessary e Threshold HU 39 Scan al ig nment The Threshold HU slide bar lets you adjust the Hounsfield scale for the enamel in the CT scan the effect of adjustment is shown on the Images
35. er implant or any other main anatomical structure like nerve or artery can cause severe damage paresthesia and complication to the patient see chapter Apply Implant Planning Tools For further information on how to change the safety zone size please see chapter General Settings Planner and Guide Warning In case of collision between implant and nerve or between implants the software will disable access to further steps i e creation of report protocols as well as the surgical guide design step Warning Please assure that an implant does not collide with an existing implant or tooth root channel Also assure that the implant does not penetrate the jawbone border Warning During implant placement please consider that the bone density in reality can be different than the visualized bone density displayed on the screen Please see section Load CBCT CT and Adjust CBCT CT Scan Visibility for more details 104 Warning The user must be able to recognize red and green colors to detect warnings such as Collision between implant and nerve Create Surgical Guide Warning Please assure that the required material thickness and offset parameters are applied when creating the surgical guide according to the specific material and manufacturing machine requirements you will use Warning Please check for potential collision between the sleeves the visualized drill cylinders and any existing tooth or dental restora
36. ered to be safe if used correctly and while taking the necessary precautions The medical benefits outweigh the overall residual risk 1 4 The User Interface LOGIN PAGE C noose LISer When you launch Implant Studio you need to login to start using the system Click the Default operator button to enter You can setup the default operator or create a new one on the Configure page Default operator Y HOME PAGE Implant Studio Home page displays the Calendar with sessions 1 the Service toolbar 2 with various options and settings and the Main toolbar 3 which helps you navigate through the application Today Patients f a i Calendar Thursday December 05 2013 Choose sessin z l Choose session Hide patient names TEREE EEEE amp eee mH eee wo eee ee ESEG TETEN TAREE TETEE TEESE EELEE ee em amp oe see ew E ERESSE TETEE TETEE TETEN TETEE TETEE ft ti mf ee wm S 59996 131205110250 3 John Doe ais 5 3shape gt e 1 CALENDAR Allows you to create new sessions Please see chapter Order Form for details e 2 SERVICE TOOLBAR Patents Calendar Messages Configure O O O O O Contains a list of patients their sessions and information on every order including images of scans Enter patient s name in the Search field to find his sessions Allows you to create a new order for the selected patient click the New session button to ope
37. es e g the jaw with teeth and roots are derived allowing for a three and two dimensional assessment of the patient without patient contact Implant Studio adds features for pre operative simulation of dental implant placement and surgical treatment options and allows the user to visualize the placement of dental implants and other planning objects like mandibular nerve canals and virtual crowns within the visualized 3D volume data Thus dental professionals like implantologists are able to precisely plan the positions orientations types and sizes of implants which are to be placed in the patient s mandible maxilla together with the related surgical procedures keeping the aesthetic aspect in mind Build in safety feature like collision detection and safety zone minimize the risk of harm to the patient to the highest possible degree The case planning can be used to generate an output STL file for a surgical drill guide thus transferring the virtual case planning into physical tools enabling the surgical installation according to the virtual case planning Surgical drill guides are patient specific templates which are intended to transfer the pre operatively determined positioning of the dental implants to the patient intra operatively which will assist the surgeon in placing dental implants by guiding and marking drill locations and assist during the implant insertion A surgical report allows the user to share the planning case
38. ff the Implant Studio system a confirmation dialog window appears to make sure you want to shut down Implant Studio o Cancel closes the window and returns to the Main page The Close and Help windows also contain information on the Implant Studio version you are currently using e 3 MAIN TOOLBAR The Main Toolbar provides easy access to the main software pages It can appear both at the top or bottom of the page gt ER E Home page Order form Workflow page Communicate page WORKFLOW TOOLBAR The process of implant planning is comprised of a succession of important steps which are reflected in the Workflow toolbar 59396 131705110951 Cropping John Doe Graphics information Cropping information Graphics adapter AMD Radeon HD Gan Cropping regen dimension Jamaga Max 20 texture dimension loss Original volume dimeniion A401219 Mamoy requires 252 MB Volume mgit To open the Workflow page click the corresponding button in the Main toolbar The window will open on the Cropping page t allowing you to crop the CBCT scan Note that some of the 5 steps will remain disabled until the previous step is completed gt or in case an error was made during planning e g implant nerve collision 1 5 Workflow Overview The Implant Studio typical workflow in combination with other Dental software packages is illustrated below Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 case The steps
39. g the report e Adrill protocol on the other hand will be generated only after you read and agree to the terms of the Approval of Planning form which appears when you enter the step see below TO approve implant planning click the Approve amp Save button If you do not wish to approve it close the Approval of Planning form by clicking on the cross in top right hand corner of the form note that in this case the drill protocol will NOT be created and the output file will not be saved Show surgical report You have now completed your implant planning using the 3Shape Implant Planning software By sending the order to your Lab and or Surgical Guide partner you also approve the quality of your own planning Before sending the order please accept the following items on the checklist Approval of Planning I am satisfied with and approve the medical and clinical aspects of my planning I approve that I performed the planning carefully chose the most appropriate implant solution and safety zone in relation to any potential existing teeth dental restorations the main anatomical structure and the intended final dental restoration solution In case it s applicable I approve that the marking of the mandibular nerve is performed correctly I contirm that the scan data used for the CECT and surface scan are up to date and that their quality and visualization is sufficient for the planning situation and intended final solution I c
40. gently on a bite separator like a bite pad or cotton pads Hint Non fixed metal parts in both jaws e g dentures should be removed prior to scanning unless they are needed for diagnostic reasons Avoiding potential errors e Patient positioning If the patient moves during the scanning process motion artifacts will occur and discontinuity in the anatomy or double anatomical borders will appear in the image This degrades the quality of the image data and makes the process of aligning the CT scan to the surface scan difficult or maybe even impossible e Metal artifacts Shapes and anatomy of a tooth restored using metal or ceramic materials will not be clearly reproduced in a CT scan due to metal artifacts If such teeth and also adjacent teeth are clearly impaired by metal artifacts they should not be used in the alignment process Warning If the alignment process is not conducted on the basis of high quality scans the foundation for the implant planning procedure is not present 108
41. he 3Shape DICOM Conformance Statement In case a DICOM dcm fails to load it can be due to a corrupted file structure or that the file fails to comply with the quality check during loading please see hint below for further instructions Hint In case a DICOM dcm fails to load please check the 3Shape DICOM Conformance Statement on our website or in chapter Information on the CBCT CT Scanning of the manual Alternatively please contact the original CT manufacturer for Clarification 3Shape Implant Studio allows to import open format STL files and 3shape dcm surface scans In case it fails to load please check the quality of the surface scan and the used triangulation settings Warning Make sure that the quality of the loaded CT scan is sufficient for planning the case and that the relevant areas on the image for the bone analysis are adequate in order to make an accurate and sustainable decision for implant planning and surgery Hint Please use the visualization settings for the CBCT CT scan and the ability to adjust the grey values to find the optimum for each individual scan Warning User needs to ensure that the surface scan is of the required quality for planning the case and that the relevant areas for the implant planning and placing the Surgical guide fully exist Hint Please check that the scan data are correctly and completely loaded 10 Hint Please check that the visualization of the CBCT and Surface
42. iams Serena 63080 20110906 1419 Techs Jar 2011 Preview Open Case M Wosniasi Caroline 635080 A91 10906_1407 20110906 1407 Tech OAS 9011 Close Open Case 3shape Communicate Main page 100 5 System Settings Please make sure your computer meets the minimum system requirements prior to using Implant Studio 5 1 System Requirements Item Minimum Requirements Recommended OS Windows 7 or 8 64 bit Windows 7 or 8 64 bit RAM 8GB or better 16 GB Monitor 1280x800 or similar 1920x1200 or similar Resolution Video Card 1GB GeForce 2GB GeForce Memory Available HDD 250GB 500 GB Space CPU IntelCore i5 or equivalent IntelCore i7 or equivalent Network Network Internet connection Network Internet connection Mouse With the wheel button With the wheel button Note We recommend using the software in combination with a 3DConnexion space ball Hint Please assure you have an appropriate graphic card capable of visualizing the CBCT and surface scan in the required quality and resolution according to the system Specifications 5 2 Setup Network Installation In order to import export orders and communicate with your partner your computer must be connected to the Internet through Wi Fi or cable 6 Manufacturer Information 3Shape is a global company with offices in Europe Asia and the Americas 3Shape Implant Studio is manufactured by the 3Shape Medical A S 3Shape Medical
43. ical surface scans in edentulous cases The available alignment tools are not suited for achievement of reliable and accurate alignment results Step 1 Place the alignment points Place 3 points on the Surface scan in the left pane and 3 corresponding points on CBCT CT scan in the right pane for correct alignment of the scans The scans are automatically aligned after placing the points on marking the Confirmation checkbox while the Surface and CBCT CT windows get hidden Step 2 Check and correct the alignment if necessary Use the following tools to check and improve the alignment e Region of interest tools e Difference map e 2D mode in the CT pane e 2D cross section gt Step 3 Confirm Alignment Approve the alignment by marking the Confirm alignment checkbox 12 er i J ms a E 3120511035 scan alignment T y WO S G g 597996 131205110951 John Doe Liters Threshold HU BION mere T y 5 APh Fo i Difference Map sl Confirm alignment 4 See chapter for more information Warning Before clicking the Confirm Alignment check box please assure that the CBCT CT and surface scans are well aligned particularly in the area s where the implant s will be placed Please check these also for the alignment in the 2D cross section views Note You must confirm the alignment with a click on the Confirm Alignment in order to be able to proceed to further steps which otherwise appear disable
44. ied 1 Axial view here you must place a green spline to define the Panoramic view 2 of a scan Prior to placing a spline use the adjustable plane in the 3D window to easily define the position and angle of the axial plane To move the plane up down click and drag the blue control point in the 3D window or move the cursor to the Axial view press Ctrl and scroll the mouse wheel To tilt the plane click and drag the red control points or the blue rim of the plane 50 Then place the spline by left clicking the control points along the teeth row and double click on the last point to close the spline Try to place each point in the center of the tooth I minimize window Press to hide the Axial view window Reset panoramic curve plane position Press to return the adjustable plane to its initial ai position Y fi clear Panoramic points Press to remove the spline 51 2 Panoramic view projected 2D view of the CBCT CT scan defined by the green spline in the Axis view 1 window 14 mm iy os The Height slider is used to scale the height of the Panoramic Sagittal and Tangential window views simultaneously om ie Depth slider is used to control the thickness of the visualized CBCT CT scan bias projected from the buccal to the lingual side of for the panoramic view Click the blue plane and drag it sideways to view different parts of the scan in cross section The Sagittal view 3 and the Tangentia
45. iew two cross section views and the 3D view to help you assess the CBCT CT scan from different angles and place the nerve correctly See chapter Define Nerve Channel for details 1 ji ars 15 Warning Please make sure that the nerve is correctly placed and that you have chosen the appropriate size of the nerve channel diameter to compensate for potential inaccuracies in the nerve position Warning If the nerve position is not clear due to poor CBCT CT image quality the dataset must not be used 2 Place Virtual Crowns ee Once the panoramic curve has been defined press the Anatomy design button in the Workflow toolbar to start placing virtual crowns gt Step 1 Select desired smile from the library Y Anatomy design cul F Vy SS Select smile library Selected library Allure DS1 matan Nia opty Rai ahi laksa Tor E ey Step 2 Shape virtual crowns Use the necessary Transformation Morphing and Wax Knife tools to shape the crowns as illustrated below 16 Hint Please assure that the selected crown design correlates with the intended final design nV Hint The positions of the virtual crowns need to be approximated to the intended final restoration position See chapter A O Ols for details 2 8 Place and Optimize Implant Position g Once the virtual crowns have been placed press the Implant planning button in the workflow
46. ing dentist lab communication and it interfaces hh to essentially all manufacturing equipment and materials Your implant planning and guide design can be sent directly to 3Shape Dental System installations in labs via 3Shape Communicate an advanced communication and visualization tool allowing the labs and dentists discuss patient cases while viewing their 3D models on line 4 4 3Shape Communicate 3Shape Communicate is an advanced service that lets labs and dentists share case information view 3D designs online and exchange messages 3shape hape communicate Garba r a Full Digital Process a 3 Bans eee ee j Login AE Pease enter your emal address and password Register f FE you don t have an account UserEmail dentalclinic 3shape com Password eeeee8 leaked aie og On Tforgot my password 3shape Communicate Login page Note To use 3Shape Communicate you must register your clinic or your lab on the 3Shape Communicate web site www 3shapecommunicate com and configure your Implant Studio Connections settings You can use your credentials to access your 3Shape Communicate account from any remote PC tablet or smart phone 99 eich 3shape dentist 3shape com Log Off Welcome Cases Settings Connectons ashapedental com Cases Dentist Site Patient Name Order No Delivery Date Carrew John 63080_20110907_0952_Techw 1 8 2011 Preview A j Wil
47. ization tools menu Three tools are available 1 Visualization sliders 2 Measurement tools 3 2D cross section Pav SUALI ZATION SLIDERS 43 Use the Visualization sliders to turn on off the visibility of scans bone enamel Skin Opacity contrast brightness sleeve with implant insertion direction drill diameter etc You can pin the slider to the modeling window and set up the default views see Setup Default Views Note Only sliders that are relevant for the current step will be available MEASUREMENT TOOLS Right click the 3D scan on the Implant Planning step and click one of the measurement options to let the software automatically measure the distance from implant to implant shows the shortest distance to next neighboring implant Implant to nerve shows the shortest distance from implant to nerve 44 a Implant to surface shows the shortest distance from implant to surface scan Use the cross section to create a 2D cutting plane at a position of your choice You can also use the tool to define a free definable cutting plane to inspect the implant position in the 2D format e Draw a section line across the model by holding down the left mouse button e To rotate the 2D plane click and drag a red control point or a blue rim see image below e To move the 2D plane alongside the scan click and drag a blue control point 45 After you have placed the cross se
48. l view 4 show the planes which are sagittal and tangential accordingly to the panoramic spline defined in the Axis view 52 Panocramit cure Hover the cursor over one of the views to visualize the clipping plane options Enable clipping plane cuts the scan sagittal or tangentially depending Enable clipping plane on the view you are in Click to disable the plane To move the planes sagittal or tangentially hover the cursor over one of the corresponding views and scroll the mouse wheel while pressing Ctrl 53 The Clipping Plane is ON in the Sagittal view Implant planning step 3 9 Define Nerve Channel To define a nerve channel use the 2D views to help you view the CBCT CT scan from different angles and place the nerve correctly 54 z re CADA 99965 985 i ve definition as l 7 n i rrr ASUS a lohn Doe Hint To enlarge a specific 2D view for a better visualization move the cursor over the desired view and press E on your keyboard e Use the Sagittal and Tangential views to place the nerve spline left click in the views to define the nerve Pic 1 and 2 below e To change the position of the nerve move the cursor over it until it turns blue and drag it in the desired direction Pic 3 below e To change the diameter of the nerve channel move the cursor over the Sagittal or Tangential view and scroll the mouse wheel while holding down Shift Hint If you are not sure abou
49. n the Order Form Displays a calendar with existing sessions and available time for new sessions Allows you to create a new order click on the empty time field in Calendar or the button to open the Order Form Opens a list of existing orders and allows you to search orders using various filters Opens an inbox with the incoming system and external messages When a new message s arrives a red square with a number of unread messages appears on the tab Informs you when your Implant Studio system receives an order with the Surface scan a number of newly arrived orders appear in a green square on the tab Click on the message to open the order on the Order form page The order itself is automatically stored under Cases Allows you to setup your Implant Studio system See chapter General Settings for details Online Support launches a screen sharing session for online support Training Center opens a dialog window with training videos User Manual opens Implant Studio online help Safety Guide opens Implant Studio Safety Guide Terms of Service opens the document with 3SHAPE SOFTWARE GENERAL LICENSE TERMS AND CONDITIONS Third Party Licenses displays information on the external applications used in Implant Studio Send feedback opens a form for reporting an eventual system malfunction Close closes the Help window o Logout signs the user out and displays the Login page o Shutdown turns o
50. ning CT and 3D optical surface scans in edentulous cases The available alignment tools are not suited for achievement of reliable and accurate alignment results Warning Before clicking the Confirm Alignment check box please assure that the CBCT CT and surface scans are well aligned particularly in the area s where the implant s will be placed Please check these also for the alignment in the 2D cross section views Define Mandibular Nerve Warning Please make Sure that the nerve is correctly placed and that you have chosen the appropriate size of the nerve channel diameter to compensate for potential inaccuracies in the nerve position Warning If the nerve position is not clear due to poor CBCT CT image quality the dataset must not be used Place and Optimize I mplant Position Warning Be aware that not all displayed implant systems may have regulatory clearance in all countries Please direct any questions regarding regulatory status in your country towards the implant manufacturer or reseller Warning Please make sure that the correct implant type incl platform type length and diameter is chosen according to the patient clinical situation Please consider this in particular when planning an implant case near a main anatomical feature like artery or alveolar nerve Warning Please assure the correct minimum size of the safety zone for the implant and mandibular nerve A collision of the implant with the nerve anoth
51. off controlling the brightness setting contrast etc Drag the sliders sideways or click their icons to toggle the visibility of items 48 Implant planning gt V J w i G _ iat wis scl Jonn Doe 4 Step 4 Setup the default views e The software can save the default views under the 1 2 3 buttons 1 so that when you click a number the corresponding default view is ES displayed To save the default view ee 1 Press Shift and click one of the numbers 2 Select the desired check boxes 2 to mark the sliders you want se to use for the view 3 Drag the sliders or click their icons to setup the desired visualization 4 The software will save the settings under the selected number 49 3 8 Define Panoramic View After aligning the two scans proceed to the next step where the panoramic view for the CBCT CT scan can be defined This will allow you to view the scan from different angles Panoramic curve S D 4 lt 3 TREN john Diese 1 Axial view 2 Panoramic view 3 Sagittal view blue 4 Tangential view orange e Every view is shown in its own box e The cross section plane is defined by a specific color blue for Sagittal and orange for Tangential e You can move along the axis of a view by hovering the cursor over the view and scrolling with the mouse wheel while pressing Ctrl See image above e If you scroll in any view window the zoom in out operation will be appl
52. onfirm that the design of the surgical guide was performed correctly and ensures a stable and firm sit during surgery I confirm that I will read the drill protocol before surgery and verify that the provided information corresponds with the intended planned surgery I agree to the fact that neither 3Shape nor its resellers will perform any medical or clinical review of my planning I am fully aware of the technical constraints that govern the manufacturing of the surgical guide I agree that 3Shape and its reseller do not assume any liability for damages or injuries resulting from my planning and treatment have read and agree to all of the above amp Approve amp Save After you have agreed to the Approval of Planning form it closes and you enter the following options of the Save Send step become available 83 Save Show surgical report click to open a Surgical report the Surgical report after the approval has a status Approved written inside it while the one before the approval has a status For Approval OA Show surgical report Show drill protocol click to open a Drill protocol EA Show drill protocol Show approval click to open the Approval of Planning ivi form es Open save folder click to open the output folder In case a cities ol ail surface scan was used during planning Implant Studio will create a file of the approved implant position with the surface scan as a 3Shape dcm file This fil
53. red T52 MB Volume gat 1 Axial plane 2 Coronal plane 3 Sagittal plane 4 Graphics information 5 Cropping information All three windows provide different views of the 1 Axial 2 Coronal and 3 Sagittal and each has a slide bar which you can move sideways to look through the slices of the CBCT scan and better see which part to crop Click and drag the blue cropping box inside the windows to select the part of the CBCT CT scan that you wish to work with area outside the box will be deleted In the 4 Graphical information window you can view information on your video card and the size of the original CBCT CT scan 36 The 5 Cropping information window shows the size of the new cropped scan and if it is too small the Volume region field displays Invalid and you will not be able to continue with Implant planning unless you crop the CBCT CT scan correctly in which case the field will display Valid 3 5 Align the CBCT CT and the Surface Scans n To align the CBCT CT and Surface scans please follow steps below Be Step 1 Place three corresponding points on each scan Place 3 points on the CT scan in the left 3D pane and 3 corresponding points on the Surface scan in the right 3D pane the scans will automatically align after you place the last point You can move the points in order to correct the alignment or remove the points all altogether to start over Hint Please use only the teeth ar
54. rion direction Set Fromm Wie ibo Detect Jemna 3 Anta Lured Try y aire Da S01 Manulaeturer Greve Froiivied MI o Click b to start placing another spine As a result you will have several splines one that is active green and another that is inactive grey Click on a spline to make it active o Click 3 to remove an active spline o Click 2 to clear all the splines p Step 3 Set I nsertion direction Click Set From View to define the insertion direction from the view perpendicular to the screen the blue arrow on the screen shows the direction Click Auto Detect to allow the software to automatically set the insertion direction 76 Surgical quide Alize tg VU 31 ws Ww Cereal Surgical guade creation Settinas xX Patches 1 Insertion direction Set From View Auto Detect Sleeve 18 BEGO Surgical Tray y BEA kirar Clama d Beisl Master sieeve dE hlanutacturer Dreve ProDiMed Mi w Thickness 200 mm Da farm teeth 0075 mm Retention amourtt 2000 mn Dr Torm serg 0 030 mm Step 4 Adjust the sleeve and the drill cylinder Sleeve 30 BEGO Surgical Tray vy BEGO Master Sleeve 42 Change the sleeve type if you are using a Pilot Drill Ww BEGO Surgical Tray BEGO Master Sleeve 4 3 BEGO Surgical Tray BEGO Master Sleeve 4 2 71 93974_131209155905 John Doe se CT viibi F 3 If the implant system allows it you can define Click and drag th
55. surtsy ocntasuveure EEA 26 3 YOUR TOONS ando eNOS ra a ea hie er aia er cise eet Ge a a ee Saeed e eneEees 27 Sa ba e EO eee meee ee eer nn See reer A A A A AE 27 3 2 Load CBCT CT and Adjust CBCT CT Scan Visibility anennanunnnnunnnnrrrerrrrerrrrrrrsrerrsrrrrne 31 3 3 Load Surface Scan and OPtimiZe VisSipility aynca ea a E E 34 3 4 Crop tHE CBCH CE SCA erar AA Aaa 35 3 5 Align the CBCT CT and the Surface SCANS cccccccccc cece nese E E ETAT 37 3 6 VISUAIIZE Your Settings and ODUONS iiicocivinicarinkdeeieecida pies A eden 43 3 7 Setup Default Views and User Interface cccccccccce cece eee e cece eee eeeeeeeeeeesseeeeeeeeeeenenseeaas 47 DENNE Panoramie VlGWirasssciessenwevenhcus dteabecwa EE EN NE 50 5 9 Detine Nerve CNI NNE eea a a aee aaa aA 54 S TO Apply Virtual Clown TOONS nira n E AA A Re ee eee A 57 3211 ADDY implant Planning TOOS x j lt cscrnineteccnanemeunanpn erat ener aen eenienma a aee Ee 62 3412 Use The MpIant LIDlany errr pveiartawciis se ents nieeernie sa eres ee nearv erate emer Roe 70 3 3 DESIGN Surgical GUAE eater ia Rea oie evade pany sudo pauein pia hes Sot a peeled ones 73 3 14 Approve Order and Generate Surgical Report and Drill Protocol c cece cece eee eeeeeees 83 3215 GEN Ela SeN ainn a aera ney oan Sand Mean Stag ae Bead a eo eS 84 4 Communicate and Export Import Design Data ccc ccceee eee eeee cece eeeeeeeeeeeeeennennnegs 97 4 1 Export Import Your Pl
56. t the correct nerve position enlarge the diameter of the nerve channel to create a larger safety zone 55 e Inthe Panoramic view drag the blue plane sideways to move along the scan and find the best angle to view the channel e Use the clipping plane b to cut the scan sagittal or tangentially depending on the view you are in Pic 4 below See more in chapter Define Panoramic View e Click ii to clear the nerve spline Pic 1 Defining the nerve channel Sagittal view Pic 2 Defining the nerve channel Tangential view Pic 4 Tangential view of the nerve channel with clipping plane ON Pic 3 Changing the position of the nerve 56 3 10 Apply Virtual Crown Tools i After you have aligned both scans and defined a nerve channel you can place your virtual crown Step 1 Click the Choose smile library button Anatomy design Step 2 Choose the required library in the Select smile library window 57 Anatomy design Selected library 35 Default ih y Je abaini 7 anan p Step 3 Click the relevant place on the scan to position the crown The scan needs to be rotated in such a way that you could place the crown looking from the top 58 Step 4 Modify your crown using the provided tools Select the crown you wish to modify by clicking the corresponding tooth number at the top and choose the desired tool 59 eee re i hi Anatomy design ia sa E vy ss as amp
57. tails 3Shape Implant Studio will create an open STL file ready for export after approval This surgical guide STL file is intended to be used only for production of the guide and not supposed to be modified in any 3rd party solution Warning Before you start using a surgical guide from a new supplier or machine for the first time we strongly recommend that you validate the physical and functional quality plus the accuracy of the surgical guide It is the responsibility of the guide manufacturer to ensure that the equipment used is capable of producing surgical guides Suitable for guided surgery Hint We recommend that you or your supplier apply a 3D inspection solution and the 3Shape protocol Implant Studio Validation Procedure to Approve Surgical Guides in order to validate the printed surgical guides We recommend that you do so both before you or your supplier start manufacturing and also at frequent intervals during the production run In this connection we advise you to use the 3Shape Convince Quality Control System 24 e When you proceed to the Save Send step the software automatically creates a Surgical report which is intended to be used for the review and approval procedures e A drill protocol however will be generated only after you read and agree to the terms of the Approval of Planning form which appears when you enter the step gt Step 1 Go to the Save Send step The Approval of Planning form
58. tion and consider the consequences for the intended treatment procedure Note that in case of the sleeve collision all further steps will be disabled Warning The surgical guide should sit stably and firmly on the teeth and it must not move during surgery This is to ensure optimal guidance for the drills and implants during surgery Do not use the surgical guide unless you judge the fit to be optimal safe and completely correct Warning Before you start using a surgical guide from a new supplier or machine for the first time we strongly recommend that you validate the physical and functional quality plus the accuracy of the surgical guide It is the responsibility of the guide manufacturer to ensure that the equipment used is capable of producing surgical guides suitable for guided surgery Note The created surgical guide STL file is intended to be used only for production on the selected machine material and manufacturer 3Shape gives no guaranty regarding the performance of a surgical guide produced on machines and materials other than the selected ones 105 Warning Please make sure that the presented screenshots and information for the implant positions and implant types as well as eventually the surgical guide in the Surgical report are sufficient in order to make a clear and safe decision to approve or modify the implant or surgical guide position and design Warning Please follow the instructions in the drill protocol
59. to date If Full combinations Upto date RI Lad Connections SE i ah Mba iiss A oe 4 i 2 Order Inbo p Woe oad Cc Wit ssc Check again Download 92 LAB CONNECTIONS Settings Lab Connections Genera tcia External Connection Method Communicate Ww System r 9 Sound Y Operator Pae Connection g Pianner and Guide Implant library 93 Operator _OMNECTON E Planner and Guide Implant library Dentist address Tooth numbering system Color system Remember last indication settings Calendar Time interval between orders in minutes Workday start Workday end Patient names privacy 94 ORDER INBOX Settings Order Inbox Direct Connect Folder VADevelopment Direct Connect Username triosorder Direct Connect Password PT TIiIiiiilt Test Direct Connect Check for new orders 95 MESSAGES Messages Delete messages older than Month Ww Delete only read messages wf 96 4 Communicate and Export Import Design Data Exchange data with dentists or labs and discuss cases online See chapters below for information Note To be able to send receive orders and communicate with your partners you must first configure your Connection settings under the Configure tab 4 1 Export Import Your Planning and Guide Design Data When you proceed to the Save Send step the software
60. uired material thickness and offset parameters are applied when creating the surgical guide according to the specific material and manufacturing machine requirements you will use Warning Please check for potential collision between the sleeves the visualized drill cylinders and any existing tooth or dental restoration and consider the consequences for the intended treatment procedure Note that in case of the sleeve collision all further steps will be disabled Warning The surgical guide should sit stably and firmly on the teeth and it must not move during surgery This is to ensure optimal guidance for the drills and implants during surgery Do not use the surgical guide unless you judge the fit to be optimal safe and completely correct 22 Hint Please design the surgical guide in such a way that sharp edges are avoided Hint As you design the surgical guide ensure that there is sufficient Support and connection between the main structure and the support for the sleeves Step 2 Create a surgical guide Press the Preview button to create the surgical guide Surgical guide i EEE r Gy AEAEE an Ld a be John Doe ae gads or i Seng i x aaa a al sat m iE yag Step 3 optional Add bars and windows 23 Surgical guide Surgical guide creation Bars and windows Settings A Add support bar N Add viewing window Preview See chapter Design Surgical Guides for de
61. y should be adequate for clinicians to appropriately read the CT image data Warning Clinicians are responsible for generating a CT scan of optimal quality using as low radiation dose as possible Warning The CT scanner should always be calibrated within the intervals outlined in the manufacturer s calibration guidelines Il SCAN PARAMETERS 1 Single slice and Multi slice CT a Patient scan settings The correct settings for tube voltage and effective tube current depend on the CT type the anatomy and the intended scan of the patient e Spiral CT e No gantry tilt Hint For optimal settings of tube voltage kV and effective tube current mAs consult the manufacturer of the CT scanner to obtain settings optimal for dental CT scanning b Reconstruction settings e Reconstruction interval 0 5 mm or half detector width typically 0 5 mm or smaller e Reconstruction kernel A sharp bone filter is preferred 2 Cone beam CT scan settings a Patient scan settings e The voxel size should not exceed 0 5 mm in any direction b Reconstruction settings e Tilting of axial slices should not be allowed Ill SCANNING PROCESS Scanning and positioning of the patient should always be conducted according to the guidelines provided by the manufacturer of the CT scanner Hint Do not scan the patient with a closed bite Instead stabilize the mandible relative a to the maxilla e g by instructing the patient to bite
62. yboard 87 OPERATOR Settings Operator Add new Modity Is administrator Automatically login Proto Add new creates new Implant Studio operator Modify lets you edit the operator settings Delete removes the selected operator from the list Name operator s name Password operator s password If you do not want to have a password leave this field blank E mail address operator s e mail address Is administrator allows you to add delete users when enabled The first Implant Studio operator is always an administrator by default Automatically login automatically logs in the Implant Studio operator Import photo allows you to upload your personal photo in png or jpg formats User photos appear next to the operators names in the Choose user login screen Clear photo removes the photo 88 Save saves the photo Cancel removes the photo CONNECTION Settings Connection Fi Pa 4y O a M QO F T5 F m ia a Remote screen taDdlet scanning Operator ET at aTa amo EO P anner al icl WWIGge Im p ant WOorar Y Lab Connections PS r l r Tl LAL 89 PLANNER AND GUIDE Settings Planner and Guide Implant safety zone Radial distance 150 E Apical distance 2 00 m Us Surgical quide settings Default manufacturer Guide thickness F Offset from teeth to guide 0 075 Retention amount 0 la

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