📖 Workflow

Upon data assignment, users proceed to the Data Editing step, where they can trim unnecessary parts, fill mesh holes, or sculpt data to optimize the simulation outcome.

Check data for any excessive gingiva data or missing tooth data and make any necessary modifications. When done, click the next step icon at the top of the screen or the “Next” button in the bottom right corner.

 

How to Trim Data

1. Choose one of the selection tools to designate what part of the data you want to remove.

	Smart Teeth Selection	Automatically select all teeth of the arch, leaving out gingiva parts.
	Brush Selection	Select all entities on a freehand-drawn path on the screen. Only the front face is selected. The brush comes in three sizes.
	Smart Single Tooth Selection	Automatically select the area of a single tooth, leaving out gingiva parts. Click and drag the mouse on the tooth.
	Polyline Selection	Select all entities within a polyline shape drawn on the screen.

 

2. If needed, modify the selected area using the following tool options.

	Autofill Selected Area	Automatically fill in entities of the selected area.
	Shrink Selected Area	Reduce the selected area each time you press the button.
	Expand Selected Area	Expand the selected area each time you press the button.
	Invert Selected Area	Invert the selection.

• You can also turn on “Deselection Mode” to modify selection manually or use “Clear All Selection” to automatically deselect everything.

 

3. To complete the trim, click “Delete Selected Area.”

 

How to Fill Holes

1. Locate any missing data areas and adjust the "Maximum Perimeter of a Hole." If the "Use Neighboring Colors for Filled Holes" option is on, the program will use the matching color palette to fill the area; otherwise, it is filled in grey.

 

2. Click “Apply” to fill the hole with the new mesh.

 

How to Sculpt Data

Find the area that needs modifications and, using the tools below, add, remove, smooth or morph its parts.

	Add	Use the mouse to add on part of the data. Hotkey: 1
	Remove	Use the mouse to remove parts of the data. Hotkey: 2
	Smooth	Use the mouse to smooth parts of the data. Hotkey: 3
	Morph	Use the mouse to morph parts of the data. Hotkey: 4

 

 

The second step of the workflow focuses on determining the position of the grinding surfaces based on the lower arch (the occlusal table). This involves aligning the mandible scan data to a plane using four specified points. By default, this alignment process is automated for the user’s convenience.

 

1. First, check the automatic data alignment by viewing it on Multi-View or rotating it with the "View Cube.”

2. If you want to check the occlusal relationship, click the maxilla icon in the Data Tree on the left to show it and view together with the mandible data.

3. If realignment is necessary, click the “Detach Data” tool at the bottom and manually align data by setting 4 parallel points on the maxilla. As shown below, two are on the distobuccal cusps of the first molars, and two are on the buccal cusps of the first premolars.

4. When done, click the next step icon at the top of the screen or the “Next” button in the bottom right corner.

 

 

Tooth Identification is a step in which users create a detailed dental chart for the current project. Here, users need to verify tooth numbering on the right and record dentition details on the left. All provided details in this step will be considered when generating the teeth movement later on.

 

1. Start by checking the automatic tooth numbering on the right to ensure that all teeth were identified and numbered correctly.

• If the tooth numbering is incorrect, click on it to reassign.
  
  
• If a tooth is not identified, it will appear as missing in the chart on the left (colored in grey). To manually identify it, click on it in the chart and choose the “Find Teeth” option. This will enable you to select the tooth data on the scan manually.
  
  

• Ensure that data for each tooth is selected accurately and precisely, covering the entire tooth without any gum data. This will ensure a higher level of detail in each tooth movement later on.
  To adjust or correct the selection, click the tooth number and choose “Edit.”
  
  
• Next, you have to document details about the patient’s current dentition or any planned treatment in the chart on the left. All added information will change the simulation according to the provided chart details. To add information for a specific tooth, click on it; to remove it - right-click.
  Below is the list of details and actions that are applicable to existing teeth (white) and missing teeth (grey).

Existing Tooth	Missing Tooth
Planned Extraction	Planned Prosthesis
Planned Prosthesis	Unerupted Tooth
Primary Tooth	Find Teeth
Partially Erupted Tooth
Pin the Tooth

 

• When a tooth is set to Planned Prosthesis, the simulation will use data from the opposing tooth if available, or otherwise from the teeth library. If a tooth was originally marked as Missing Tooth and is then changed to Planned Prosthesis, the change takes effect at the final staging step shown in the Output Overview. If the tooth was marked as No Info and is changed to Planned Prosthesis, the change applies from the beginning of the aligner staging process.

 

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.

 

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

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

 

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

 

4. Click “Done” in the bottom right corner when done to save changes and return to charting.

 

 

The Ceph Tracing step will be available only if ceph data was imported during the data assignment. Its goal is to create a digitally traced cephalogram. The program will automatically outline the bone and tissue structures on the imported X-ray and place some of the main landmarks.

1. First, examine the result of automatic tracing. Ensure that the outlines have no sharp angles and that all 13 key points are correctly placed.

The app must identify the following points and landmarks: A Point, B Point, Gnathion (Gn), Condylion (Con), Upper Molar, Lower Molar, Incision Superius (Is), Incision Inferius (Ii), Nasion (N), Sella (S), Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), and Gonion (Go).

 

2. If adjustments are needed, click “Edit” and drag the control points. Hover over the red points to see the guide on where the point must be placed.

Click “Edit” again to save the made changes.

3. You can always restore the results of automatic tracing by clicking “Reset.”

 

4. When done, click “Next.“

 

 

This step is only accessible if ceph data is included in the case. Here, the scan data is automatically aligned with the traced cephalogram, enabling users to examine the relationship between teeth and bone structures.

 

1. Check the automatic overlay results. If adjustments are necessary, detach the data from the cephalogram using the "Detach Data" option at the bottom.

2. To manually realign, place two points at the same spot on both the scan data and cephalogram: one at the tip of the front incisor and one at the molar cusp, as shown below.

3. Then, check the results of skeletal and dental assessment across a number of criteria provided in the widget below. All values are automatically calculated and are displayed with a color-coded mark indicating the potential difficulty of treating the case. Click on the question mark in the box to view more details.

4. When done, click “Next.“

 

 

The next step is Arch Form Selection, which entails choosing an arch form template that closely matches the patient's actual arch shape and size.

 

1. Select a template for both the maxilla and mandible from the dropdown menus below each. Choose the one that closely matches the actual shape and size.

 

2. If needed, reposition the selected template using your mouse: left-click and drag to move, and right-click and drag to rotate.

 

3. Make sure that the arch form is oriented symmetrically on the scan data. Use the perpendicular lines to assess the symmetry; the blue line can be moved with a mouse.

4. When done, click “Next.“

 

 

Bite Classification is the final step before simulating teeth movement. Its primary objective is to determine the bite class based on the relationship of posterior teeth. This step is automatic, but users can adjust the detected class if needed or in case there are missing teeth.

 

1. Verify that the alignment stripes were placed correctly: one on the mesiobuccal cusp tip of the upper 1st molar and the other on the buccal grooves of the lower 1st molar. If the 1st molars are missing, you can use canines instead.

If the automatically detected class is incorrect, choose the correct one from the options provided in the box at the bottom of the screen.

 

2. The distance between molars is measured automatically and used to estimate treatment difficulty.

 

3. The traffic light icon next to the Treatment Difficulty option displays different colors based on the level of difficulty. Green indicates easy, yellow represents moderate, and red signifies hard.

4. When finished, click “Next.“

 

 

The Simulations Preview step involves generating simulations of teeth movement based on the information provided in previous steps. The main goal here is to assess potential treatment scenarios and determine the best course of treatment. Additionally, these simulations can be employed during patient consultations to visually illustrate the treatment process and expected outcomes, thereby increasing the patient’s understanding of future procedures.

 

1. First, compare the original scan data and the simulation for scenario 1.1. Click the Info Box to hide it and use the View Cube or viewing tools in the Side Toolbar to help with the visual examination.

• Check for any poor teeth alignment in this simulation. If any is present, adjust it using the “Tooth Orientation” tool, where each tooth can be individually reoriented. Read more on how to use this tool at the end of the current chapter.
  
• When comparing between scenarios, check the general summary for the case below the workflow steps. It presents overview of the treatment difficulty through traffic light colors. This summary provides a quick diagnostic summary of skeletal and dental relationships, showing categories like Skeletal AP, Vertical, Incisor Inclination, and Bite Classification.
  
  

 

2. To explore additional treatment options for the current case, open the scenario list under the original scan data or simulation 1.1. Click on any of the available scenarios to preview its simulation. Each scenario in the list also indicates what type of appliance options are possible for treatment.

 

 

3. Change between scenarios on both sides of the screen to compare different treatment simulations side-by-side. Utilize the following tools in the Side Toolbar to assist you: Animation, Superimposition, Ceph Overlay Comparison, and Occlusal Relationship.

• Use "Animation" to visualize the movement of teeth for the selected scenario.
  
  
• Use "Superimposition" to assess the anticipated movement of each tooth from start to end, with the start point depicted in purple. Superimposed data is animated for your convenience.
  
  
• Use “Ceph Overlay Comparison” to see the post-treatment dentition in relation to the bone structure. For example, by examining the area highlighted in the green circle in the image on the right and comparing it to the image on the left, you can easily see the movement of the teeth.
  
  
• Use “Occlusal Relationship” to analyze the occlusal contact for the post-treatment dentition, referring to the color bar on the left for color interpretations.
  
  

 

4. Once you have made a decision on the final treatment, confirm choosing your preferred treatment scenario by clicking its check located in the center of the screen.

• Applicable treatment types (aligner, bracket) for each scenario are shown next to the scenario title in the list.
  
  

 

5. Click “Next” to go to the final step. If your chosen scenario can be treated using both aligners and brackets, you will be asked to choose one before proceeding to the final step. Note that you will not be able to move to the next step if the original scan data is marked as chosen.

How to Use Tooth Orientation

Tooth Orientation is used to ensure that the software is accurately identifying the orientation of each tooth in the following planes:

• Amount and direction of rotation relative to the chosen arch form to be maintained.
• Degree of angulation or tip from the occlusal table.
• Degree of inclination or torque from the occlusal table.

Errors in tooth orientation detection can be caused by misshapen teeth, teeth with worn or uneven edges, blocked-out or crowded teeth, poor scan quality, or other complications. These errors can be detected when reviewing simulation 1.1 in comparison to the original scan data by viewing any tooth that appears to not have been leveled, aligned, or out of position in some direction. This tool displays the orientation using simulation 1.1, which is after all teeth have been leveled and aligned to the chosen arch form.

Changes made to orientation are applied to how the software identifies the current position of each tooth, and thus, changes will be applied to all scenarios automatically.

 

1. Click on any desired tooth to start adjusting its orientation; by default, the “Rotation” tool is activated first. The chosen tooth will be shown on the right, with the rotation defined by the blue line with green control points on each end. To adjust the rotation, drag by one of the points so that the blue line accurately identifies your perceived rotation of each tooth.

 

2. To edit the degree of angulation or tip from the occlusal table, click "Angulation (Tip)." Then, choose a tooth and start adjusting by dragging the control points to change positioning. The occlusal plane is displayed at the incisal edge of the blue line for your reference.

 

3. To edit the degree of inclination or torque from the occlusal table, click "Inclination (Torque)." Then, choose a tooth and start adjusting by dragging the control points.

 

4. If you want to reset back to the initially identified tooth orientation, click “Reset” in the toolbox below.

 

5. Click “Done” in the bottom right corner to return to the simulations preview and comparison.

 

 

Output Overview is the last step in the workflow. Here, users can take a closer look at the selected treatment scenario before proceeding to appliance fabrication or ordering. The purpose and features of this step will vary based on the appliance option chosen earlier - aligners or brackets.

 

Aligners

If the “Aligners Self-Setup“ option was chosen in the previous step, user is presented with the model of the treatment simulation and features for it refinement as well as the aligner staging set-up options.

 

1. Start by reviewing the suggested staging for aligner creation. In the staging navigation box at the bottom of the screen, you’ll see how the software has divided the entire treatment into stages. The upper line represents the staging for the maxilla, and the bottom line for the mandible. Each stage corresponds to one aligner to be created.

You can use the play button to animate the full treatment sequence, or click on any stage to review it in details.

 

 

2. If needed, you can adjust the staging speed by clicking the gear icon in the top-right corner of the staging navigation box and opening “Staging Settings.”

 

3. You can choose to include or exclude attachments for your aligners by toggling the “Include Attachments” option in the navigation box.

 

4. Use the tools in the Side Toolbar to view a detailed analysis of tooth movement and the Bolton ratio.

 

5. You can also open and read a step-by-step detailed treatment plan provided for your treatment scenario.

 

6. If needed, you can improve the generated treatment simulation using the “Treatment Refinement” feature. You’ll find more details on how to use it later in this chapter.

 

7. When all done, click the “Complete“ button to either save the project or export files for aligners.
When exporting files you will be able to customize your export: choose what stages to export, in what format and how.

 

How to Use Treatment Refinement

This feature allows users to enhance the generated treatment by manually adjusting tooth movements, arch form, IPR values, and default attachments. When entering this mode, the tooth movement adjustment tool is selected by default.

	Move Teeth	Manually adjust each tooth's final position in the simulation.
	Edit IPR & Spacing	Adjust and manage interproximal reduction (IPR) and tooth spacing.
	Edit Attachments	Change the shape, size, and position of the default attachments.
	Edit Arch Form	Adjust the shape of the arch form.

 

Move Teeth

Start by selecting the type of movement you want to perform using the Movement Controls on the right. Then, adjust the target teeth using your mouse. Alternatively, you can use the left and right arrows in the movement widget for more precise adjustments.

Tooth movement can be performed by the tooth crown, center of resistance, or root apex. Select desired in the Movement Controls widget.

Any tooth in the simulation can be returned to the pre-treatment positioning with the “Back to Initial Position“ option. Right-click a tooth to use it.

 

Edit IPR & Spacing

Click the circle located between the teeth where you want to add spacing or IPR.

Then, adjust the value as needed to set the desired amount of spacing or IPR—blue values represent IPR, while yellow values indicate spacing.

To remove the spacing/IPR, simply click the circle again.

Edit Attachments

You can delete default attachments individually by right-clicking on them, or remove all at once using the “Remove Attachments” option in the bottom-left corner.

To add a new attachment, click on a tooth. Attachments are available in four shapes: horizontal, vertical, cross, and L-shape.

Right-click an attachment to adjust its size, and drag it with your mouse to reposition it freely.

Edit Arch Form

Note that adjusting the arch form will affect tooth movement. To prevent unwanted changes, you can lock a tooth’s position by right-clicking on it before you begin.

 

Then, use the control arrows to make adjustments to the arch form.

 

Resetting Changes

You can undo a recent change using the “Undo” button in the bottom-left corner, or use the “Reset” options to reverse multiple changes—either all treatment refinement changes, only attachment adjustments, or all modifications related to tooth movement (IPR, spacing, manual teeth movement, and arch form adjustments).

 

When finished, click “Done“ in the bottom right corner to save treatment refinements and return to Output Overview.

 

Brackets

If the “Order Brackets“ option was chosen in the previous step, user is presented with the detailed table of the appliances that will be required for treatment.

 

1. Check the generated brackets information, including archwires, bands, and torque prescription, as it will be further sent to SmileStream to complete the order process.

 

2. Open and read a step-by-step detailed treatment plan provided for your chosen scenario.

 

3. Once you're finished, click "Complete" in the bottom right corner to finalize and save your project. You have two choices: save the project and move to SmileStream to complete the order process, or close the program and save the case progress as a project file in Medit Link for ordering later.

 

4. If you choose to order the appliance immediately, all information required for the bracket order will be shared with SmileStream, and you will be redirected to the below page. Check the automatically filled information once again. All information can be changed right in the SmileStream before placing an order but it will not be updated in app.