📖 [Ortho Simulation] Workflow

The workflow in Medit Ortho Simulation consists of 7 stages, which must be followed in a specific sequence. However, after completing the "Advanced Adjustments" stage, users can return to the "Simulation Preview" stage to compare the modified scenarios with the original model.

	Data Alignment	Align scan data to the occlusal table.
	Model Settings	Set the model midline and clean the data.
	Simulation Settings	Adjust settings for the simulation by defining missing teeth, planned extractions, and prostheses.
	Simulation Preview	Preview simulation results alongside the original model to compare the before and after.
	Advanced Adjustments	Adjust the position of each tooth manually.
	Animation View	View the animated tooth movement for each simulation.
	Complete	Finish work on the project and save results to the Medit Link case.

Data Alignment

The primary task of the first stage is to align the scan data to the occlusal plane. This step is mandatory for users who imported scan data acquired with third-party software. However, if the scan data comes from Medit Scan for Clinics or Medit Scan for Labs, this stage will be automatically skipped.

1. You can align data to the plane by three or four points. Choose the corresponding tool below and then select points on the data. The scan data will be aligned to the occlusal plane automatically. Use the "Delete Point" feature if the point was placed incorrectly.

2. Once the data is aligned, use the Multi-View on the right to check data positioning and make more precise adjustments.

3. If realignment is necessary, click "Detach Data" at the bottom to start over.

4. When done, click "Confirm" in the bottom right corner or click the icon of the next stage at the top of the screen.

Model Settings

In this stage, users must adjust the orientation of the arches by defining midline points on both the maxilla and mandible.

1. Set the midline on both arches by dragging the green points; place them between the two central incisors.

2. Before proceeding to the next stage, check your scans for any excessive gum data (anything past the mucogingival junction). This will ensure smoother work of the program in the following stages. 
If any is present, the unnecessary soft tissue data can be removed using the "Polyline Trimming" tool provided on the right. Click and drag (or click in several spots) to select the area, then right-click to delete it. Click the tool icon again to exit the tool.

3. When done, click "Confirm" in the bottom right corner.

Simulation Settings

This is the most important stage in the simulation generation process. The user must complete two tasks here: create and set up simulation scenarios and segment the teeth data. The simulation will be generated in the next stage based on the input of provided here.

Creating Simulation Scenarios

To create a simulation, the user must set up a scenario to visualize potential tooth alignment changes by providing details on the patient's dentition and user-defined inputs. This is done on the left side of the screen.

1. Start by checking your scenario list in the guide panel on the left. You can create up to 3 scenarios by either adding one with an empty form or cloning an existing one. Here, scenarios can also be renamed or deleted.
The "Auto Simulation" toggle is on by default for each scenario. If you toggle it off, the teeth positions in the original and simulation data will remain the same, requiring you to move each tooth manually in the following stages.

2. Next, check the form information on the right and edit it for each scenario to visualize different scenarios.
The first click on a tooth number will set it as 'Planned Extraction,' and the second will change it to 'Planned Prosthesis.' Information on missing teeth is updated automatically based on the teeth numbering and data selection on the right side of the screen.

• When "Auto Simulation" is enabled, you can use the "Manual Movement Only" feature to pin specific teeth in the form. The pinned teeth will remain in their original position after generating the simulation.

Segmenting Teeth Data

The teeth data is automatically segmented, and the results are displayed on the right side of the screen. Users must review the teeth numbering and data selection for accuracy.

1. First, check the teeth numbering. If a tooth was incorrectly identified, click its number to reassign it.

2. Next, review the data selection to ensure each tooth is accurately selected. The entire surface of the tooth must be selected, excluding any gum data. If the data selection needs editing, click the tooth number and choose "Edit" to manually reselect tooth data on the scan.

3. Teeth numbers with no corresponding data will be automatically marked as missing in the form on the left. If that needs correction, hover over the missing tooth and choose "Tooth Area Selection" to manually select the data of that tooth on the scan.

How to select tooth data

Selection editing mode is prompted if users need to manually select data for a non-identified tooth or correct the existing data selection.

• Use the “Smart Tooth Selection” tool to automatically select an area of an entire tooth with a click and drag.

• To make the data selection more precise, adjust it using “Brush Selection” or “Brush Deselection.”

• To clear all selection and start over, use “Clear Selection.”
  

• Click “Confirm” in the bottom right corner when done to save changes.

When all work in this stage is done, click "Confirm" in the bottom right corner.

Simulation Preview

In this stage, users can preview automatically generated simulations alongside the original data model. The "Simulation Preview" stage serves two main purposes: facilitating patient consultations and supporting visual review of the simulated scenarios.

Patient Consultation

This stage allows users to preview dental models showing initial dentition and a visualized potential outcome. These visual aids can be beneficial during patient consultations.

Here are some helpful features available in the Side Toolbar on the right that can be used.

1. Model Display Mode

If the realistic model display makes your patient uncomfortable, you can change to a simplified two-color study display mode.

2. Scenario Comparison Mode

You can compare each scenario's simulation individually with the original model by switching between them in the top right corner. Alternatively, you can use "Scenario Comparison Mode" to simultaneously view all scenarios alongside the original model.

3. Show/Hide Reference Data

You can preview simulations with the reference data: midline, arch line, and face scan data. Click the feature icon in the Side Toolbar and choose what data you want to see.
If needed, the midline and arch line can be adjusted in the next stage.

4. Grid Settings

Click this feature in the Side Toolbar multiple times to show, overlay, and hide the grid. The grid utilizes millimeters as a measurement unit.

Simulation Analysis

This stage offers three features for visually reviewing and comparing the simulated scenarios: Bolton Ratio, Teeth Movements Data, and Sculpting.

1. Bolton Ratio

The Bolton Ratio is calculated automatically, and the results for the currently selected scenario are displayed in the top right corner. You can expand the widget to see the results for all scenarios.

2. Teeth Movements Data

This feature is located in the Toolbox at the bottom of the screen. It shows the calculations for tooth movements in the simulation, allowing you to check the feasibility of the proposed scenario. This data is also helpful when comparing different visualization scenarios, including cases with user-defined assumptions such as extractions, and supporting patient consultations.

3. Sculpting

The "Sculpting" tool in the Toolbox at the bottom lets you modify gum and teeth data. Changes made to either the original or simulation data are automatically mirrored on the other.
Note that sculpting does not affect the results for the Bolton Ratio.

With this tool, you can add, remove, morph, and smooth data. Adjust the brush size and strength for more control, and use the Data Tree to hide data from the view for greater comfort.

When you're done, click the next stage icon at the top of the screen.

Advanced Adjustments

"Advanced Adjustments" is the stage where users can manually readjust the generated teeth movements. This stage allows users to edit simulations created with the "Auto Simulation" option enabled or move teeth in scenarios where the option was disabled. Additionally, users can export generated data from this stage after adjusting teeth movement in the simulations.

1. Choose a scenario in the top right corner. Here, you can also manage your scenario list without returning to the "Simulation Settings" stage.

2. Using the "Tooth Movement Controls," you can adjust each tooth individually or select multiple teeth to move them simultaneously. The "Move Freely" option is selected by default, but you can choose other options that allow movement along only one set direction. Note that the gum data will adjust automatically once the teeth are moved.

Move Freely (* use Ctrl to rotate	Move along the Occlusal Direction	Move along Mesial/Distal Direction	Move along Lingual/Buccal Direction	Rotate around Occlusal Direction	Rotate around Lingual/Buccal or Mesial/Distal Direction

• Use "Deselect All" to remove selection from all teeth and return to moving them individually.

3. Turn on "Show/Hide Occlusal Intersection" if you want to reference the changes in occlusal relationship while moving teeth.

• You can change the scale of the deviation display between all data and the contact area only by clicking "Switch Deviation Display Area." The scale resolution can be adjusted using the small icon at the top of the color bar on the left or by entering different values for the bold numbers.

• The split screen with the occlusal view of the data on the left can be turned off if you click "Occlusion Multi-View."

4. Teeth can also be moved by adjusting the midline and arch line. To do this, choose the "Adjust Guide Lines" tool at the bottom, then modify the guide lines on the model by dragging their control points. Once the guide lines are adjusted, click "Align to Guide Lines" to update the model according to changes.

5. The "Preview IPR" feature lets you see a visualized outcome based on a hypothetical interproximal spacing assumption on your current simulation model. First, define a spacing value by moving the slider below. Then, select the circles representing the interproximal areas where reduction is expected. The preview will be available immediately.

• If you want to apply the previewed IPR to the final simulation model, click "Apply" before deactivating the "Preview IPR" feature.

6. The "Selected Simulation" feature lets you check the animated tooth movement for specific teeth. Click on the teeth you're interested in, then drag the slider below to see the progression of their movement.

• If you want to apply the current position of the teeth from the replay to the final simulation, click "Apply" before deactivating the "Selected Simulation" feature.

7. Similar to the previous stage, you can review the details of teeth movements calculated and organized in a table for each arch using the "Teeth Movements Data" feature.

8. This stage also provides a feature for exporting your simulation data. Select a simulation scenario in the top right corner and click "Export to Medit Link" to customize your data export.

You can export data as a library file for further use in Medit ClinicCAD or just as segmented teeth data (open or closed). If you export data as a library, it will be automatically added to your Medit ClinicCAD upon the next app launch. Enter the name for the export file, review the data, and click "Confirm." All exported files will be added to your current Medit Link case.

9. When all work in this stage is completed, click the next stage icon at the top of the screen.

Animation View

This stage provides animated simulations for each scenario, serving as an additional visual aid for consultation or visual review of the simulated scenario. Users can also export teeth data from a specific step of the animation if required.

1. Start by choosing a scenario in the top right corner for which you want to view the animated teeth movement. Then, click play (or hit the space key) to start the animation. Click on the model at any moment of the animation replay to pause it. If you click and hold, you can compare the current state of the teeth with the original model.
Use the view control buttons or "Show/Hide Reference Data" in the Side Toolbar for assistance.

2. Click "Splint Animation into Steps" in the Toolbox at the bottom to automatically divide the animation into even steps. You can set the number of steps, up to 20. Each step will then be marked with a pin.

• Steps can also be manually created by clicking the little pin icon above the seek bar.

• Right-click a pin to delete it, or use "Delete All Pins" to remove them all at once.

3. If needed, you can export teeth data from a specific step by customizing the export options in the "Export to Medit Link" feature at the bottom. You can export the current step only, all steps, or select specific steps.

4. When all work in this stage is completed, click the final stage icon at the top of the screen.

Complete

Use "Complete" when you have finished working on the simulation project. This stage allows users to save the result files for the current project to the Medit Link case.

Choose which scenarios you want to save; you can select multiple scenarios. By default, the program will save the following results from your project:

• project file

• capture images of the simulation with project information (also referred to as Ortho Simulation Report)
• video of the animated simulation
• a CSV file with teeth movement data (optional)

For the Ortho Simulation Report, check what patient and case information you want to add to the capture images of the simulation. The report will be available for review in Medit Link.