Exoplan.2.3.User Manual en

English
2021–02–26
User Manual
exoplan
Rx Only
exocad.com 2797
User Manual by exocad GmbH
© 2017-2021 exocad GmbH
exocad GmbH
Julius-Reiber-Str. 37
64293 Darmstadt
Germany
phone: +49-6151-629489-0
fax: +49-6151-629489-9
info@exocad.com
exocad.com
Document version
exoplan.2.3_User_Manual_en, 2021-02-26
Product version
exoplan 2.3 Matera
exoplan — User Manual
Content
1 General Information 6
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.2 Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.3 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.4 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.5 Units and Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.6 Hardware Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.7 Software Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.8 Software Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.9 Software Activation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.10 Input Data and Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.11 Color Scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2 Launching exoplan 12
3 Loading a Scene/Project/Scan 13
3.1 Loading a Scene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.2 Loading a Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.3 Loading a Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.4 Importing an Implant Planning Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4 Selecting a DICOM Series 15

4.1 Step 1: Open the DICOM Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4.2 Step 2: Select a DICOM Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4.3 Result: DICOM Series Loaded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4.4 Loading Implant Planning Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
5 DICOM Control 18
5.1 Data Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
5.2 View Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
5.3 Surface Generation Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
6 Defining Density References 27

6.1 Interface Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
6.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
7 Defining Axial and View Direction 31

7.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
8 Aligning CT Data 34
8.2 3-Point Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
8.3 Best Fit Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
8.4 Options to Improve the Best Fit Alignment Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
8.5 Transformation of Objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
9 Defining the Panoramic Curve 50

9.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
© 2017-2021 exocad GmbH page 3/176

10 Defining the Mandibular Canal 59

10.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
11 Initial Placement of Tooth Models (Backward Planning) 68

11.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
11.3 Placing Multiple Bridges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
11.4 Selecting a Tooth Library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
11.5 Deleting Bridges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
12 Precise Placement of Tooth Models (Backward Planning) 75

12.2 Step-by-Step: Simple Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
12.3 Step-by-Step: Chain Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
13 Defining the Density Threshold Value 85

13.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
14 Implant Positioning 88
14.2 Selecting Implant Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
14.3 Initially Positioning an Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
14.4 Moving/Rotating an Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
14.5 Implant Positioning Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
15 Sleeve Placement 99
15.2 Selecting a Sleeve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
15.3 Positioning a Sleeve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
16 Deleting Implants 103
17 Deleting Constructed Parts (Tooth Models, Mandibular Canals, Drilling Sleeves) 104
17.1 Delete all tooth models / mandibular canals / drilling sleeves . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
17.2 Delete individual tooth models / mandibular canals / drilling sleeves . . . . . . . . . . . . . . . . . . . . . . . 105
18 Selecting Implant Types 106
19 Generating Planning Result Files 107

19.1 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
19.2 Aborting the Planning Result Files Generation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
19.3 Generating Provisional Planning Result Files for Individual Implants . . . . . . . . . . . . . . . . . . . . . . . . 111
19.4 Errors During Planning Result Files Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
20 Creating Surgical Guides 112

20.1 Initiating Surgical Guide Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
20.2 Drilling Sleeve Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
20.3 Designing the Sleeve Mounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
20.4 Designing the Surgical Guide’s Bottom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
20.5 Designing the Surgical Guide’s Top . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
20.6 Adding Window/Support/Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
20.7 Merging and Saving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
20.8 Free-Forming the Merged Surgical Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

20.9 Generating the Surgical Guide Result Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
21 Saving a Scene / Closing a Project 127

21.1 Saving a Scene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
21.2 Closing a Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
22 Wizard Mode vs Expert Mode 128

22.1 Expert Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
22.2 Expert Window vs Wizard Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
22.3 Wizard Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
23 Views 133
23.1 Main View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
23.2 Secondary Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
23.3 Axis-oriented Views: Axial, Saggital, Coronal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
23.4 Panoramic Curve-Based Views: Curve Cut, Curve Tangent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
23.5 Panoramic View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
23.6 Implant-based Views: Implant Cross, Implant Axial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
23.7 View Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
24 Menus 149
24.1 Main Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
24.2 Expert Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
24.3 Context Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
25 Controls 151
25.1 Group Selector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
25.2 Implant Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
25.3 DICOM Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
26 Tools 155
26.1 Measurement Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
26.2 Add/Remove Mesh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
26.3 Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
26.4 Show Project in Explorer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
26.5 Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
26.6 About . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
27 Appendix 163
27.1 System Exceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
27.2 DICOM Control: Information in Data Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
27.3 Axial and View Direction Purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
27.4 Tooth Libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
27.5 Implant Libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

27.6 Drilling Sleeve Libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
27.7 Collisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
27.8 Implant Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
27.9 Planning Result Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
27.10 Mesh Types for Loading in exoplan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
27.11 Saving Meshes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
27.12 Shortcuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
27.13 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
27.14 Safety Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

1 General Information
WARNING
Federal Law (USA) restricts the sale of this device to or on the order of a physician, dentist, or li-
censed practitioner.
1.0.1 Typographic Conventions

In this user manual the following terms and corresponding symbols are used as described here:
WARNING
A warning alerts the user to a potential harm or a potentially hazardous situation and may provide
control measures.
HINT
A hint provides a general suggestion for performing a workflow step or solving a potentially prob-
lematic situation.
NOTE
A note is a brief comment on a particular workflow step or an explanation of accuracy.
1.1 Introduction
exoplan is a pre-operative software application for planning the position of one or more implants based on imported and
aligned CT data and 3D surface scans. exoplan output data can be used for creating surgical guides (third-party fabrication),
or be imported into other software (e.g. exocad DentalCAD) for designing virtual restorations. Using exoplan requires the
necessary expertise in implant dentistry.

exoplan allows the visualization of implants and other planning objects (such as mandibular canals and tooth models) within
the visualized 3D volume data and in various 2D views, allowing dental professionals (e.g. implantologists), to precisely plan
positions, orientations, types, and sizes of implants. Safety features, such as collision detection, density visualization, and
safety distance, reduce the risk of harm to the patient to the lowest possible degree.
1.2 Intended Use

exoplan is a medical software, intended to support the pre-operative planning of dental implants using the visualization of the
implant placement within images of the patient’s anatomy. The process is based on CT/CBCT data sets originating from other
medical devices, and can be supported by optical scan(s) of the patient’s anatomy as well as a virtual prosthetic proposal.

exoplan allows the design of surgical guides to support the placement of endosseous dental implants in guided surgery. The
design of surgical guides is based on 3D surface data representing the preoperative situation and approved implant positions.
The software exports the planning and design results as geometrical data and a digital 3D model of the surgical guide to
support the manufacture of a separate physical product.
exoplan does not extend or change indications of dental implants. Usage of a surgical guide designed with the software does
not change the necessary due diligence required compared to conventional (non-guided) surgery.
The software is intended to be used only by dental professionals with sufficient medical training in dental implantology and
surgical dentistry in office environments suitable for reading diagnostic dental DICOM data sets. exoplan shall not be used
for any purpose other than planning dental implant placement or design of surgical guides.
1.3 Indications and Contraindications

1.3.1 Indications
exoplan is indicated to be used as a medical front-end, pre-operative software program by medically trained persons for sim-
ulating/evaluating the placement of implants and surgical treatment options.
The indications of dental implants do not change with guided surgery compared to conventional surgery.
1.3.2 Contraindications
exoplan is not for diagnostic purposes.
exoplan is not intended for planning treatments of edentulous patients or patients with insufficient dentition that does not
allow a stable fit of a tooth-retained surgical guide.
exoplan only supports the planning of treatments for adults.
This version of exoplan does not support the planning with implants with an angled prosthetic platform connection, including
zygomatic implants.
1.4 Safety Information
WARNING
exoplan must only be used by qualified professionals. Using exoplan and Surgical Guide de-
sign and its features as well as the manufacturing of surgical guides without the necessary
medical knowledge in dentistry and professional diligence can lead to serious injuries of the
patient during the surgical implanting process, such as a permanent injury of the mandibular
nerve, a vessel, sinus, or healthy teeth.
exoplan must not be used by users with a physical handicap in color perception (e.g. color-
blind). exoplan users must be physically able to distinguish colors used for the display of ob-
jects (e.g. colors used for collisions and bone densities).
1.5 Units and Conventions

This document uses the FDI tooth numbering system.
Measurements in the exoplan software and in this document are in cm/mm or in degree.
1.5.1 Measurement Accuracy

The following statements regarding measurement accuracy refer to

measurements calculated and displayed during distance/angle measurement,

the color scale for evaluating the CT data alignment result, and
measurements in collision detection (such as collisions between two implants or collisions between implants and the
mandibular canal).
Measurement accuracy depends on the accuracy of the input data and their alignment, in particular the spatial resolution
of the CT data. The input data can contain artifacts which do not represent the patient’s actual physical anatomy.
When measuring distances/angles, results can also be influenced by contrast and brightness settings, and density threshold
settings (in the visualization mode Isosurfaces).
1.6 Hardware Requirements

Full workstation configuration:
CPU: Intel Core-i7 - 2600 (Socket 1155)
RAM: 8GB
Graphics: Nvidia or AMD Radeon dedicated GPU with at least 2 GB video RAM or better, OpenGL 4, DirectX 11.1, Shader
Model 5 and a graphics driver dated August 2017 or newer
Screen resolution: 1080p (1920x1080, or higher)
Minimum hardware configuration:
CPU: Quad-Core and 2.8 Ghz
RAM: 8GB
Graphics: Nvidia or AMD Radeon dedicated GPU with at least 2 GB video RAM or better, OpenGL 4, DirectX 11.1, Shader
Model 5 and a graphics driver dated August 2017 or newer
Screen resolution: 1080p (1920x1080, or higher)
Peripherals/Human Interface devices (HID):
Standard computer keyboard required
Standard computer mouse required
Multitouch screen optional/supported
3D mouse (3D connexion) optional/supported
Please see here for supported 3D mice: http://www.3dconnexion.com/products/spacemouse.html. Any special LED/display-
powered 3D mouse macros/buttons are not supported.
A free USB slot is required to connect the USB license copy protection dongle (HID device).
Please verify the display quality of your monitor before using exoplan, e.g. by using the SMPTE test image.
WARNING
Ensure to use only the recommended hardware, drivers, operating system, and software applica-
tions (e.g. PDF reader), such as graphics adapter, and that your graphics and monitor settings as
well as the light conditions of your work environment are configured in an optimal way.
1.7 Software Requirements

A PDF reader (Adobe Acrobat Reader) must be installed to view PDF files generated by exoplan.

1.8 Software Installation

Step 1: Download Framework2015(.exe)¹ and install following the installation instructions.
Step 2: Insert the dongle you received from exocad.
Step 3: Download the exoplan zip file to a directory of your choice.
Step 4: Unpack the zip file.
WARNING
Do not apply modifications to the installed system. In particular, do not update drivers for the
graphics adapter. To avoid system modifications due to automatic updates, deactivate automatic
software and driver updates. Modification and/or corruption of the software installation may lead
to dangerous results in the implant planning process and the design of a surgical guide with haz-
ardous impact for the surgical implanting process.
Take appropriate measures to protect the exoplan software installation, and the patient data included, from unauthorized
access and malware or viruses. Ensure that backups of all relevant/critical data are available.
Choose an appropriate dpi scaling. The dpi scaling is a setting of the Windows Control Panel. It generally influences the size
of windows and icons. Choose a dpi scaling that displays exoplan menus and controls in a comprehensible size, so that they
do not cover essential parts of the main view.
1.9 Software Activation

An internet connection is required for using exoplan. When using the software for the first time, it is activated online. If you
do not use exoplan for a minimum of two weeks, exoplan is reactivated online.
1.10 Input Data and Requirements

1.10.1 CT Image Data (DICOM Data)
WARNING
Ensure that the DICOM series has a sufficient spatial resolution, an acceptable accuracy, and is not
blurred (e.g. due to patient movement during acquisition).
WARNING
The relevant anatomical structures must be sufficiently visible in the 3D CT data to proceed with
implant planning. E.g. the mandibular nerve must be visible in the mandible. In maxillae, the
anterior palatine nerve and the maxillary sinus floor must be visible. Insufficiently visible anatom-
ical structures in the 3D CT data may lead to an erroneous planning process and thus may cause
permanent injury of the patient.
¹http://www.exocad.com/a3c368e82b36/exocadFramework2015.exe

HINT
If loading the DICOM data fails, please examine the DICOM data requirements listed below and
make sure that the input data meets these requirements.
exoplan uses volumetric DICOM data for a visual representation of the dentomaxillofacial region.
The following requirements must be met:
The DICOM dataset must contain at least one study.
The study within one DICOM dataset must contain at least one image series.
A DICOM series must contain at least two images.
The slices in a DICOM series must be equidistant.
The distance deviation between two neighboring DICOM images must be not greater than 0.001 mm.
Data with gantry tilt cannot be used in exoplan.
The SOP Class UID of the DICOM series must be Enhanced CT Image Storage or CT Image Storage. This means only CT or
conebeam CT data can be used. Loading of other DICOM modalities, e.g. MRI is not possible.
exoplan will refuse to load the data if any of these requirements is not met and the user will be informed in a dialog that the
DICOM data cannot be loaded and therefore cannot be used for the implant planning process.
The following additional requirement is recommended but not mandatory:
The size of a voxel (as per DICOM tag Pixel Spacing and the calculated distance of neighboring images) in the DI-
COM series should not be larger than 0.6 mm in any of the dimensions. If this requirement is not met, the user will
be informed in a dialog that the resolution of the DICOM data is too low. The user can choose to load the DICOM data
anyway.
The following recommendations should be considered when acquiring the patient’s DICOM data:
During CT data acquisition, focus on achieving the highest possible resolution with as less artifacts as possible. Try to
reduce the potential noise caused by metal artifacts or scattering by e.g. scanning the patient in a tilted position.
Ensure that the complete patient anatomy and structures at risk (e.g. nerves or sinus cavity) necessary for the implant-
planning process are visible in the resulting DICOM series.
exocad recommends to scan the patient in not completely closed jaw position. This is helpful in the CT data alignment
step (see Chapter 8).
1.10.2 Scan Data
WARNING
When loading a DICOM series and an optical scan, ensure that the series and the scan belong
to the same and current patient.
Ensure that the data quality of optical scans used in exoplan is sufficient for implant planning.
An optical scan used in the implant planning process must cover all relevant areas, such as remaining teeth.
exocad recommends to use a recently produced optical scan, so that it shows the current tooth situation of the patient.
If you are loading a scan (antagonist scan, waxup, etc.), verify that you have loaded the correct scan.

1.11 Color Scheme

Please note that the user interface of the software may differ (especially in color) from the screenshots shown in this user
manual if the distributor of the software adapted the user interface to match the corporate identity of his company. Func-
tionality and behaviour remain unchanged.

2 Launching exoplan
Launch exoplan either by running the ImplantPlanning.exe file in your exoplan installation folder, or via an external
software (e.g. exocad DentalDB).
Using the main toolbar (see Chapter 24.1) or the context menu (see Chapter 24.3), you can load a scene, a project , or a scan
(see Chapter 3). You can also open the DICOM Control to visualize a DICOM series (see Chapter 4).
1}
m 2}
m
Figure 2.1: exoplan startup screen
1}
mMain view
2}
mMain toolbar (see Chapter 24.1)

3 Loading a Scene/Project/Scan
The options to load a scene/project/scan are only available if no project/scene is currently loaded in exoplan.
3.1 Loading a Scene

Step 1: Click Load in the main toolbar (see Chapter 24.1) or right-click the background in the main view to access the
context menu (see Chapter 24.3).
Step 2: Select Load Scene.
Step 3: In the appearing explorer window, navigate to the desired folder and select the desired scene file.
You can load scene files saved by a previous version of exoplan. Scene files saved by a future version of exoplan will not be
loadable.
3.2 Loading a Project

Step 2: Select Load Project.
Step 3: In the appearing explorer window, navigate to the desired folder and select the desired project file.
SHORTCUT
CTRL + L: Open explorer window to load a project
If scene files exist for the project you have selected, exoplan prompts you to decide if you want to load a scene file (select
from the list) or to start the planning from scratch.
Figure 3.1: Loading a project with existing scene files
If there is no scan file related to the project (e.g. a jaw scan), exoplan asks you if you want to load a scan file.
You can still load a project after you have visualized a DICOM series using the DICOM Control (see Chapter 4).

3.3 Loading a Scan

Step 2: Select Load scan data.
Step 3: In the appearing explorer window, navigate to the desired folder and select the desired scan file.
WARNING
Make sure that the optical scan is based on a recent physical model and/or was recorded recently.
Scans based on outdated information may not fit the patient’s anatomical situation or lead to in-
juries, complications, or additional surgery.
3.4 Importing an Implant Planning Result

You can import a previously created implant planning result using the implant planning info file (*.implantPlanningInfo).
This file is automatically created as a planning result file (see Chapter 27.9). If you load an implant planning project and an
implant planning info file exists for this project, exoplan will prompt you to decide whether you want to import this file. If
one or more scene files exist for the selected project, you must decide not to load a scene file before exoplan prompts you to
decide if you want to import the implant planning info file. The purpose of importing an *.implantPlanningInfo file is
to be able to design surgical guides based on the planning stored in the file.

4 Selecting a DICOM Series
As basis of the implant planning process, you select and visualize a DICOM series recorded for your patient (see Chapter 1.10.1
for DICOM series requirements).
4.1 Step 1: Open the DICOM Control

With help of the DICOM Control you can load a DICOM series and define visualization settings.
To open the DICOM Control:
Click DICOM Control in the main toolbar (see Chapter 24.1), or
Click Tools in the main toolbar and select DICOM Control.
In wizard mode (see Chapter 22.3), loading the DICOM series is the first wizard step and the DICOM Control opens automat-
ically.
4.2 Step 2: Select a DICOM Series

1. Click Select file set to open the DICOM Series Selection Dialog (see Figure 4.2).
Figure 4.1: DICOM Control with no DICOM series selected/loaded
3}
m
1}
m
2}
m
Figure 4.2: DICOM series selection dialog

If you have loaded a project file containing the patient name, the dialog’s title will display it (see Figure 4.3).
Figure 4.3: DICOM series selection dialog with patient name

2. Select the directory which contains the DICOM series you want to visualize:
Browse the directory in the navigation section 1}
m, or
drag a folder from a separate explorer window to the CT data analysis section 2}
m, or
paste the directory’s path into the navigation line 3}
m.
exoplan automatically analyzes the selected file directory for existing CT data. The content of subfolders is not considered
in this analysis.
Figure 4.4: Analysis section: Figure 4.5: Analysis section:

no CT data available CT data available
Ideally, the information in the CT data analysis section contains all items to clearly identify a patient, which is the patient’s
name (name and surname), the patient’s gender, the patient’s birth date and the date by when study and series were recorded.
However, the information depends on the availability of the corresponding DICOM tags in the selected data.
The CT data analysis section can provide less information about the CT dataset than the Data tab in the DICOM Control (see
Chapter 5.1). If the CT data analysis section does not provide a specific information you are looking for, check if you find it in
the Data tab of the DICOM Control after loading a series.
3. Select a DICOM series in the analysis section (selecting a study/patient is not possible). Click OK. The DICOM series is being
loaded (see Figure 4.6). You can abort the loading process by clicking Cancel loading.
Figure 4.6: DICOM Control while loading a DICOM series

4.3 Result: DICOM Series Loaded

The loaded DICOM series is visualized in the main view.
3}
m
2}
m
1}
m
Figure 4.7: exoplan screen with DICOM series visualization
1}
mMain view: DICOM series visualization (for view functions see Chapter 23.1.1)
2}
mDICOM Control (see Chapter 5)
3}
mGroup Selector (see Chapter 25.1) with CT data group
Once you have loaded a project file, loaded a DICOM series and continue in the exoplan workflow, you cannot return to
the DICOM series selection step and thus cannot retrospectively select another series for the current planning.
If the project definition includes implants in both jaws, exoplan prompts you to select one jaw for planning when you proceed
to the next workflow step.
4.4 Loading Implant Planning Settings

After you have loaded a project and the corresponding DICOM series, the
button Load Implant Planning Settings is available in the expert toolbar
if density references and/or a density threshold value have already been
defined for the project. Clicking this button loads these existing implant
planning settings.
Figure 4.8: Load Implant Planning Settings option

in expert toolbar

5 DICOM Control
You can modify the visualization of the DICOM series using the options and settings in the DICOM Control. To show/hide the
DICOM Control, click DICOM Control in the main toolbar (see Chapter 24.1).
WARNING
Wrong visualization settings for the DICOM series may lead to undesired results of the implant
planning process with the consequence of seriously injuring the patient (mandibular nerve, sinus,
healthy tooth) in the surgical implanting procedure.
HINT
We recommend to define the density references as described in chapter 6. Subsequently, use the
buttons for Soft tissue, Bone and Enamel to quickly set the corresponding density value for the
current visualization.
Figure 5.1: DICOM Control
DICOM Control tabs:

Data: CT dataset information (see Chapter 5.1)
View: visualization parameters and options (see Chapter 5.2)
Surface Generation: options to generate surfaces from the isosurface visualization (see Chapter 5.3)
You can reduce/extend the DICOM Control window using the icon v/> on the right.
Figure 5.2: DICOM Control - reduced window

5.1 Data Tab

The Data tab shows all available information about the visualized CT dataset (exoplan extracts this information from the
dataset, not from the project file).
1}
m
2}
m
Figure 5.3: Data tab
1}
mStructure of the CT dataset (patient, studies, series)
2}
mPatient/study/series information (depending on left-side selection)
For details on patient/study/series information, see Chapter 27.2.
5.1.1 Functions
Function Description
Select file set Open the DICOM Series Selection Dialog, for selecting a different series to load.
Load series Load the series currently selected in the CT dataset structure (left side).
Discard series Discard the currently loaded series.
Table 5.1: Data tab functions
Once you continue in the workflow, these functions will not be available anymore.
5.2 View Tab

The View tab provides options and settings for visualizing the DICOM series.
Figure 5.4: View tab

Mode Description
Isosurfaces Visualizes the DICOM series as a surface generated from the CT data and containing precisely
Chapter 5.2.1 those voxels with a density value equal to a selected surface threshold value.
X-ray Visualizes the DICOM series in a way that simulates a conventional X-ray exposure, considering
Chapter 5.2.2 only those voxels with a density value higher than a given noise threshold value.
Solid The DICOM series is rendered as a solid cube. Each voxel on its face is grayscale-colored
Chapter 5.2.3 according to the local density value. You can cut the cube to visualize the area of interest.
Solid (natural) As with Solid mode, the DICOM series is visualized as a solid cube, but colored according to
Chapter 5.2.4 different density ranges. These ranges are defined as density references (see Chapter 6). Each
range has a different color. Additionally, you can set an edge contrast enhancement value.
Table 5.2: View tab functions
Select a visualization mode by clicking the corresponding button at the top of the tab. Modifications for visualization param-
eters and options will be rendered in real-time in the main view.
5.2.1 Isosurfaces
Figure 5.5: Isosurfaces visualization

Figure 5.6: Isosurfaces parameters and options

Option Description
Surface threshold Use this slider or type in a value to define the density value of the anatomical structure
displayed as a surface.
Soft Tissue, Bone, Enamel These buttons are deactivated as long as density reference values have not been defined
in the density references definition step (see Chapter 6). As soon as you have defined
density references, you can visualize the corresponding surfaces using these buttons.
Add second surface Add a second surface.
Table 5.3: Isosurfaces parameters and options
Adding a Second Surface
You can add a second surface, for example to visualize an opaque bone structure as primary surface and a semi-transparent
soft tissue structure as secondary surface. If Semi-transparency is activated in the Options section, you cannot add a second
surface.
To add a second surface:
Step 1: Click Add second surface.
Step 2: Use the sliders Second surface threshold and Second surface transparency or type in values to define
the second surface threshold and opacity. You cannot define a second surface threshold value higher than the
primary surface threshold value.
Figure 5.7: Isosurfaces - second surface
To remove the second surface, click Remove second surface.

5.2.2 X-ray
Figure 5.8: X-ray visualization
Figure 5.9: X-ray parameters and options
Use the Noise threshold slider or type in a value to define which voxels are displayed in the X-ray visualization. Voxel data
lower than the specified value is not taken into account. This setting determines the contrast. It also applies to the X-ray
visualization mode of the panoramic view (see Chapter 23.5) and determines the image contrast in the planning report PDF.
5.2.3 Solid
Figure 5.10: Solid visualization

Figure 5.11: Solid parameters and options
Option Description
Activate solid highlighting By default, solid highlighting is deactivated. Check Activate solid highlighting to
activate the Highlight density slider.
Highlight density Use this slider to define a threshold value that determines which parts of the visible
anatomic structure are highlighted in red. All data values higher than the defined value
are highlighted. This coloring is also used in the planning report PDF’s images.
Solid Options: Hard to soft Use this slider to smooth the border between highlighted and unhighlighted regions
when solid highlighting is activated.
Table 5.4: Solid parameters and options
The solid highlighting settings also apply to the secondary views (see Chapter 23).
5.2.4 Solid (Natural)

Figure 5.12: Solid (natural) visualization

Figure 5.13: Solid (natural) parameters and options
Use the slider Edge Contrast Enhancement to change the edge contrast in the visible anatomical structure. The lower the
value, the lower the edge contrast.
5.2.5 General Options for All Visualization Modes

Options
Figure 5.14: Options section
Using the Current CT data window slider, you can define the range of data used for the visualization. These settings influ-
ence contrast and brightness in the Solid visualization mode and in secondary views (see Chapter 23.2.5). Using the triangle
icon, you can choose from available CT data window presets. Available presets are defined in the DICOM dataset. <Full
Range> is always available, which extends the CT data window to the full range of available data values.
Available checkboxes:
Semi-transparency: Set the DICOM series visualization to half transparent. Deactivates the Add second surface
button in visualization mode Isosurfaces (see Chapter 5.2.1).
Use preview mode: Activated by default. In preview mode, the accuracy is reduced during camera movements or vi-
sualization parameter adjustments. If your PC is high-performative, you can deactivate the preview mode to maintain
highest possible accuracy during camera movements and slider adjustment.

Clip
Figure 5.15: Clip section
You can cut away a section of the DICOM series visualization in three directions from both sides by using the corresponding
range sliders or entering values.
5.3 Surface Generation Tab

The Surface Generation tab is only available in visualization mode Isosurfaces. It enables you to create surface meshes
from the currently visible isosurface.
Figure 5.16: Surface Generation tab
To create a surface mesh, follow these steps:

Step 1: Define the surface you want to create a mesh for using the surface threshold slider in the View tab while in
visualization mode Isosurfaces (see Chapter 5.2.1). For example, to create a mesh representing the bone structure,
define a threshold value where the bone structure is visible.

Step 2: Select the Surface Generation tab.

Step 3: Click Generate Surface. A triangle mesh is now created from the currently displayed view.
After loading a scene or project and generating a mesh, it appears in the Group Selector as CT surfaces group.
To create further surfaces, repeat steps 1 to 3. Each created surface will be displayed in an own color.
As soon as you have generated at least one surface, the following functions are available at the bottom of the Surface Gen-
eration tab, each affecting only the last generated surface mesh:
Delete surface Delete the last generated surface.
Flip surface Change the surface’s orientation (back and front).
Toggle look through Display only the front side of the surface.
Table 5.5: Surface generation tab functions


6 Defining Density References
In this optional step, you can define density

reference values for soft tissue, bone, and NAVIGATION
enamel. Using these references you can quickly
Expert toolbar / context menu:
change the DICOM series visualization to the
Define Density References
particular structure type. Furthermore, the
density references serve as initial values in This step is part of the guided
later worksteps, which would require man- wizard workflow (see Chapter 22.3)
ual adjustment if you have not defined them.
exocad recommends to at least define the bone density reference.
3}
m
2}
m
1}
m
4}
m
Figure 6.1: Density references definition screen
1}
mMain view (see Chapter 6.1.1)
2}
mDICOM Control (see Chapter 6.1.2)
3}
mGroup Selector (see Chapter 6.1.3)
4}
mDefine Density References window (see Chapter 6.1.4)
6.1 Interface Elements

6.1.1 Main View
The main view displays the DICOM series visualization. For available navigation functions, see Chapter 23.1.

6.1.2 DICOM Control

The only available visualization mode is Isosurfaces. See Chapter 5 for a detailed description of the DICOM Control.
6.1.3 Group Selector

During this step, no elements will be added. See Chapter 25.1 for a detailed description of the Group Selector.
6.1.4 Define Density References Window

This window provides controls and explanations for defining the density references.
Figure 6.2: Define Density References window
Surface threshold Slider for defining the surface threshold for the isosurface visualization. It has the same
function as the corresponding slider in the DICOM Control (see Chapter 5.2.1). You can
use either slider for defining density references.
Soft tissue, Bone, Enamel Buttons for defining density references (see Chapter 6.2).
OK Complete the step, save all your settings and close the window.
Cancel Abort the step and close the window. All changes made since you entered the density
references definition step will be discarded.
Table 6.1: Define Density References window functions

6.2 Step-by-Step
Step 1: Define the density threshold for soft tissue / bone / enamel using the Surface threshold slider in the Define
Density References window or in the DICOM Control, so that the corresponding surface is visualized in the main
view. exoplan will suggest values based on previous projects.
Step 2: Click Soft tissue / Bone / Enamel in the Define Density References window or in the DICOM Control.
Alternatively, right-click the corresponding button in the DICOM Control and select the appearing context menu
option. The DICOM Control buttons allow you to quickly switch between the defined surfaces, also in subsequent
workflow steps.
If you are working with a CT dataset, you can also enter the default values for the density references based on the Hounsfield
scale in the Define Density References window.
(a) Soft tissue defined

(b) Soft tissue and bone defined

(c) Soft tissue, bone and enamel defined
Ensure that the density reference values are proportionate. You will not be able
to continue in the workflow with unproportionate values. For instance, do not de-
fine a higher value for the soft tissue than for the bone structure. If you define
such values, a warning section at the bottom of the Define Density References
window prompts you to check the values.
When you have defined at least one density reference and confirm by clicking OK, an .implantPlanningDensityReferences
file is created in the project directory, containing the threshold value(s) you have specified. When you load this project again,
the density reference values you defined previously will be reloaded from this file.
The density reference file is only valid for the DICOM series related to the saved scene. If you open the project with a
different series, the density references will not be loaded automatically and you must define them again.

7 Defining Axial and View Direction
In this step, you specify the patient’s axial

and view direction to define the basic orien- NAVIGATION
tation of the DICOM series. If the patient’s
head was scanned in a slanted position lead-
Axial and View Direction
ing to an incorrectly defined view axis in
exoplan, you can correct this here. exoplan This step is part of the guided
uses this basic orientation for the creation wizard workflow (see Chapter 22.3)
of secondary views, for the alignment of the
DICOM series visualization in certain worksteps, and in the planning result files.
The patient’s axial direction is not necessarily equal to the occlusal direction.
3}
m
2}
m
1}
m
4}
m
Figure 7.1: Axial and view direction definition screen

1}
2}
3}
mGroup selector (see Chapter 7.1.3)
4}
mAxial and View Direction window (see Chapter 7.1.4)


7.1.1 Main View
The main view shows the DICOM series visualization cut from the top. On the section plane, a coordinate system with two
axes Axial direction and View Direction is displayed. A light round area around the DICOM series visualization indicates
the currently defined section plane.
For available view-related functions in the main view, see Chapter 23.1.
7.1.2 DICOM Control

By default, the visualization mode in the axial and view direction definition step is Isosurfaces. All other visualization modes
are available. See Chapter 5 for a detailed description of the DICOM Control and the available visualization modes.

7.1.4 Axial and View Direction Window

The Axial and View Direction window provides controls and explanations for defining the axial and view direction.
Figure 7.2: Axial and View Direction window

Reset axial and view Reset axial and view direction to the initial positions.
direction
Cancel Abort the step and close the window. All changes made since you entered the axial and
view definition step will be discarded.
Table 7.1: Axial and View Direction window functions

7.2 Step-by-Step
If the suggested directions do not match the actual situation in your DICOM series, adjust the axial and view direction using
the control elements displayed in the main view. The section plane slider and origin position point are only visual indicators
to help you determine the correct view and axial direction. Their positions will not be saved.
1}
m
4}
m
3}
m
2}
m
Figure 7.3: CT data visualization with control elements
To change the axial direction, click and drag the marker at the top of the Axial Direction arrow 1}
m. This will tilt the
section plane.
To change the view direction, click and drag the marker at the top of the View Direction arrow 2}
m. This will rotate the
view direction axis around the axial direction axis.
Drag the marker in the section plane slider 3m
}to change the section plane’s position in vertical direction.
Drag the origin position point 4}
mto change the coordinate system’s location on the section plane.

8 Aligning CT Data
In this optional step, you can align the CT

data to an alignment object. Typically, this NAVIGATION
object is an optical jaw scan, but you can also
use a different alignment object. If the CT
CT Data Alignment
data has already been aligned to an align-
ment object externally, you can skip this step. This step is part of the guided
wizard workflow (see Chapter 22.3)
WARNING
When alignment with the CT data is done using a particular alignment object which is not the jaw
scan, the user is responsible for assuring that the jaw scan used for surgical guide design is in cor-
rect relative geometrical position to the used alignment object.
With aligning the CT data to a jaw scan, you can include a high-quality surface scan that shows the (occlusion) surface and
shapes of teeth in the construction of surgical guides. Use the same jaw scan for the alignment which will be used for con-
structing the surgical guide.
Aligning the CT data consists of two steps:
3-point alignment (see Chapter 8.2)
Best fit alignment (see Chapter 8.3)
WARNING
Aligning CT data is a sensitive process which must be performed accurately. This process includes
appropriate isosurface value settings, the accurate placement of points during the 3-point align-
ment step (see Chapter 8.2), and, if applicable, appropriate cropping of the CT mesh (see Chapter
8.4.1) and appropriate marking of feature regions (see Chapter 8.4.2). The alignment accuracy is
directly connected to the accuracy of surgical guides created from the jaw scan.
HINT
Choose a density value of the isosurface visualization that represents the surface of the teeth in the
DICOM data (the predefined Bone value should be closest to this). Perform the 3-point Alignment
and Best Fit Alignment. Afterwards, carefully check the accuracy of the alignment by using the
color scale. If you are not sastisfied with the alignment, you can choose another density value and
use the cropping and brush selection functionality to select a region of interest for re-aligning the
data.

NOTE
If the input data is optimal, the achievable accuracy of the combined 3-Point Alignment and Best
Fit Alignment is 0.2mm. The achievable accuracy is additionally limited by half of the maximum
voxel size of the DICOM data (e.g. if the maximum voxel size is 0.6mm, the achievable accuracy is
0.3mm. If the maximum voxel size is 0.2mm, the achievable accuracy is 0.2mm.
Input data is considered optimal if the DICOM data and the optical scan have been optimally ac-
quired while the density value has been selected so that the relevant areas of the DICOM data and
the optical scan represent the same surfaces.
3}
m 2}
m
1}
m
4}
m
Figure 8.1: CT data alignment screen
1}
mMain view - split screen (see Chapter 8.1.1)
2}
3}
4}
mCT Data Alignment window (see Chapter 8.1.4)

8.1.1 Main View
The main view is a split screen, showing the CT data on the left side and the alignment object on the right side. As long as no
alignment has been performed, you can modify the views separately using the main view navigation functions (see Chapter
23.1.1).
You can access the context menu (see Chapter 24.3) only in the left screen.
If you have defined a density reference for bone (see Chapter 6), the CT data is displayed accordingly.

8.1.2 DICOM Control

In this step, the only available visualization mode is Isosurfaces. See Chapter 5 for a detailed description of the DICOM Con-
trol.

During the CT data alignment step, no elements will be added. Showing/hiding elements will only affect the left screen in
the main view. See Chapter 25.1 for a detailed description of the Group Selector.
8.1.4 CT Data Alignment Window

The CT Data Alignment window provides controls and explanations for aligning the CT data. It provides different functions
in the 3-point alignment and the best fit alignment step (see Chapters 8.2 and 8.3).
8.2 3-Point Alignment

Before you start aligning, make sure that the isosurface visualization of the CT data (left screen) shows properly the corre-
sponding structures of the alignment object (e.g. teeth if you use a jaw scan). If necessary, adjust the surface threshold using
the DICOM Control (see
Chapter 5.2.1).
WARNING
If you perform the CT data alignment step after annotations have been added or collision objects
have been loaded, you must decide if these should be transformed (see Chapter 8.5).
The CT Data Alignment window shown in Figure 8.2 consists of two tabs. The Align tab provides options and explanations
for performing the 3-point alignment, the Evaluation tab is for evaluating the 3-point alignment result (see Chapter 8.2.1).
Figure 8.2: CT Data Alignment window - Align tab

Three buttons for pairs of These buttons are highlighted during the point placement, indicating which pair of
points (red, green, blue) points you are currently defining.
Lock symbol Active when all point positions are defined.
Clear Markers Clear all defined points.
Start 3-Point Alignment Start the 3-point alignment (all points defined).
OK Only available when selecting specific options in the Evaluation tab, see Chapter 8.2.1.
Cancel Abort the CT data alignment step. All changes made since you entered the CT data
alignment step will be discarded.
Table 8.1: CT Data Alignment window - Align tab functions
If you have loaded multiple objects that can be used for the alignment (e.g. via the Add/Remove Mesh tool, see Chapter 26.2),
a dropdown menu listing the available alignment objects is also part of the window.
Click alternating the CT data and the alignment object to define three pairs of points, each pair consisting of one point on the
CT data and one corresponding point on the alignment object.
Figure 8.3: Correctly defined points for 3-point alignment
To reposition points, drag and drop the points. Alternatively, select the button for the corresponding pair of points and define
new positions by clicking the CT data / alignment object. To delete all defined points, click Clear Markers.
In order for the algorithms to work accurately, choose point positions which are not collinear-aligned and not too close to
each other. The better you distribute your points, the better the results of the matching algorithms and the alignment result.
It helps if the CT data shows the patient with not fully closed jaws, as it will enable you to set points more precisely. It also
means the results of the subsequent best fit alignment will be more precise, due to a larger tooth surface being available
compared to fully closed jaw position.
Once you have positioned all points, click Start 3-Point Alignment. The CT data is now aligned to the alignment object.
Once done, the alignment object is displayed together with the CT data in the left screen.

Figure 8.4: CT data and jaw scan after 3-point alignment

The two sides of the split screen are now synchronized. All view-related actions will affect both screens.
Use the left screen to evaluate the 3-point alignment result. If the alignment object matches the CT data visualization prop-
erly and no larger deviations are visible (rotate the view to check all areas), the 3-point alignment result can be considered
precise enough to achieve an accurate result during best fit alignment (see Chapter 8.3).
8.2.1 Evaluation Tab

By selecting one of the options provided in the Evaluate tab, you can evaluate the CT data alignment before the 3-point
alignment. If you select an option, the CT data alignment step will be closed (3-point and best-fit alignment will be skipped).

Figure 8.5: CT Data Alignment window - Evaluation tab
Acceptable (external) alignment: Choose this option if the CT data and the selected alignment object are already
aligned, e.g. externally.
No acceptable alignment: Choose this option if the CT data and the selected alignment object are not aligned, but
an alignment is not relevant for further processing.

8.3 Best Fit Alignment

After you have performed the 3-point alignment, the best fit alignment functions are displayed in the CT Data Alignment
window (see Figure 8.6).
Figure 8.6: CT Data Alignment window for best fit alignment
Start Best Fit Alignment Start the best fit alignment.
Discard Alignment Discard the complete alignment, return to the 3-point alignment step.
OK Active once you have performed and evaluated the best fit alignment. Completes the CT
data alignment step an saves all your changes.
Cancel Abort the CT data alignment step. All changes made since you entered the CT data
alignment step will be discarded. If you have already performed an alignment before,
the previous alignment result will be restored.
Table 8.2: CT Data Alignment window for best fit alignment
Click Start Best Fit Alignment. exoplan refines the fitting of the CT data with the jaw scan. This process may take several
minutes.
Before starting the best fit alignment, you can improve the alignment accuracy using the second tab Impr. Accuracy (see
Chapter 8.4).
When the best fit alignment is complete, the alignment object is displayed with colors (see Figure 8.7). The colors illustrate
the deviation of the alignment object to the currently displayed Isosurfaces visualization of the CT data. The color legend is

displayed in the CT Data Alignment window (see Figure 8.8).
Figure 8.7: Best fit alignment result
Use the colors to evaluate the accuracy of the alignment result: If the areas which are clearly captured in both the CT data
and the alignment object (bone, teeth if you align to a jaw scan) appear blue (as in Figure 8.7), this is an indicator for the
alignment being accurate.
If gingiva areas in a jaw scan appear purple (deviation > 1 mm), that does not mean that the alignment result is not accurate.
The reason for this behavior is that the jaw scan shows the gingiva very precisely, and the CT data does not properly display
gingiva areas.
8.3.1 Evaluating/Discarding the Best Fit Alignment Result

Once the best fit alignment is completed, the CT Data Alignment window provides options for evaluating the alignment
result.
Figure 8.8: Options for evaluating the alignment result
The term ”acceptable” refers to the accuracy of the alignment result. The less the deviation of the CT data to the alignment
object at the common areas, the more accurate is the alignment result. You can check the accuracy of your alignment using
the color scale displayed on the alignment object after the best fit alignment.

If you want to discard the best fit alignment result, select the Discard tab. You can undo the last best fit alignment or discard
the complete alignment (3-point and best fit).
Figure 8.9: Options for discarding the alignment result
8.3.2 Performing Best Fit Alignment With Changed Surface Threshold

If you change the surface threshold value in the DICOM Control (see Chapter 5.2.1) after performing a best fit alignment, the
dialog shown in Figure 8.10 appears:
Figure 8.10: Dialog - Changed surface threshold
If you cannot identify one single threshold value in the isosurfaces visualization that represents the alignment object features
sufficiently, you can accumulate several best fit alignment results by using different surface thresholds and choosing the first
option always.

8.4 Options to Improve the Best Fit Alignment Accuracy

The Impr. Accuracy tab in the CT Data Alignment window for best fit alignment provides tools for improving the best fit
alignment accuracy.
1}
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Figure 8.11: Impr. Accuracy tab
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mCrop CT Mesh (see Chapter 8.4.1)
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mReset Mesh: Reset the CT mesh to its initial state (undoes all cropping actions)
8.4.1 Cropping the CT Mesh
During best fit alignment, exoplan generates

a mesh from the Isosurfaces visualization

of the CT data around the area of interest
(see Figure 8.12). You can crop this mesh,
e.g. to remove noisy surface areas created by
metallic artifacts.
Figure 8.12: Mesh generated during best fit alignment

Click Crop CT Mesh in the Impr. Accuracy tab (see Figure 8.11) to open the CT Mesh Editor window (see
Figure 8.13).
Figure 8.13: CT Mesh Editor window
Select one of three marking modes to define which parts of the mesh will be marked:
Select through and through: markings on visible mesh areas will also mark hidden mesh areas behind.
Select only surface: markings will only appear on visible mesh areas.
Select by click on surface: click to mark all parts of the mesh connected to the clicked point.
There are two methods to mark areas on the CT mesh for cropping actions:
Method A: by defining a straight line on the screen that goes straight through the mesh. The area on the side pointed
to by an arrow defines the marking area on the mesh.
Method B: by defining a closed contour on the screen over the mesh. The enclosed part of the contour defines the
marking area on the mesh.
Method A: Marking Mesh Areas by Defining a Straight Line
Step 1: Click a position at the height of the line you want

to draw. A green point appears. When you move

your mouse away from this point, an orange solid
line is displayed between the green point and
the mouse cursor position. A dotted line extends
outwards from this line in both directions. An
orange arrow indicates the marking direction. To
change the direction, rotate the line around the
green point by dragging your mouse.

Step 2: Double-click to set the line at the selected

position. The area you have defined for marking
is displayed in orange.
Method B: Marking Mesh Areas by Defining a Closed Contour
Step 1: Hold the left mouse button and draw a line

by dragging the mouse. A green dotted line
appears. An orange dotted line indicates how
the shape will be closed.
Alternatively, set single points by left-clicking.
These points are connected with a straight green
line. A solid orange line indicates how the shape
would continue.
You can also combine the two drawing
techniques in one contour.
Step 2: Double-click to close the shape. The marked shape is displayed in orange.

To demark areas in a marked zone, use the same techniques as described in Method A and B while holding SHIFT.
When you have marked a region on the mesh, all functions become active in the CT Mesh Editor window.
Figure 8.14: CT Mesh Editor window
All Mark the complete mesh.
None Unmark the complete mesh, remove all existing markings.
Invert Invert the markings (unmarked areas become marked, marked areas become
unmarked).
Delete Delete the part of the mesh you have marked.
Crop Delete the part of the mesh which is not marked.
Undo/Redo Undo/redo cropping/deletion actions.
OK Confirm the cropping result, close the CT Mesh Editor window.
Cancel Close the CT Mesh Editor window, discard all cropping actions.
Table 8.3: CT Mesh Editor window functions
8.4.2 Marking Feature Regions

Usually, the best fit alignment results are optimal if the entire alignment object surface is considered. If you are not satisfied
with the best fit alignment result’s accuracy, you can mark feature regions on the alignment object which will be exclusively
considered (not considered) during best fit alignment (if you do not mark specific areas, the entire object will be considered).
For example, you can mark bone areas (including teeth) in a jaw scan, since these are also clearly captured in the CT data,
whereas the gingiva captured in the jaw scan is not captured properly in the CT data. Thus the gingiva should not be consid-
ered in the best fit alignment process and this area shall remain unmarked in the jaw scan.

Click Mark Feature Regions to open the Surface Marker Tool window (see Figure 8.15).
1}
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Figure 8.15: Surface Marker Tool window
1}
mMark All: mark the entire alignment object
2}
mInvert Markings: marked regions become unmarked, unmarked regions become marked
3}
mDelete All Markings: delete all markings
4}
mBrush Size: change brush tool size
5}
mOK: confirm the marking result, close the Surface Marker Tool window
6}
mCancel: close the Surface Marker Tool window, discard all marking actions
Hold the left mouse button to draw the feature region on the alignment object. Adjust the brush size using the corresponding
slider, or by holding SHIFT and scrolling the mouse wheel. Hold SHIFT to invert the brush (the brush region will turn red).
(a) Marking mode (b) Demarking mode

Figure 8.16: Brush tool in marking and demarking mode
8.5 Transformation of Objects

If you have positioned certain objects in the current or at a later stage of the implant-planning workflow and perform or
change the CT data alignment, you must decide if you want to transform the objects along with the changing position of the
CT data.
Objects which require transformation decisions:
Tooth models (decide once for all tooth models)

Annotations (decide for each annotation)

Collision objects (decide for each collision object)
You must make the transformation decision(s) for any change in the current CT data position, which can be
performing the inital 3-point / best fit alignment,
undoing the last best fit alignment,
undoing the complete alignment (best fit and 3-point), or
performing a best fit alignment if you have only performed 3-point alignment so far.
If you decide to change the CT data alignment and choose the corresponding function in the CT data alignment window, a
dialog will appear, prompting you to decide if you want to transform the existing objects. While making the transformation
decisions, the main view zooms to the affected tooth model(s) / annotation / collision and highlights them. Your decision will
be applied to all actions in the current CT data alignment step, until you complete it. If you open the CT data alignment step
again, you will have to make the transformation decision(s) again.
Figure 8.17 shows the dialogs for transforming tooth models, annotations, and collision objects.
(a) Tooth model(s)


(b) Annotation
(c) Collision object

Figure 8.17: Transformation dialogs

9 Defining the Panoramic Curve
In this step, you define the panoramic curve

by drawing a line along the jaw ridge. Defin- NAVIGATION
ing the panoramic curve is necessary for gen-
erating the panoramic view (see Chapter 23.5).
Define Panoramic Curve
This step is part of the guided
3}
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Figure 9.1: Panoramic curve definition screen
1}
2}
mPanoramic view (see Chapter 9.1.2)
3}
4}
mDefine Panoramic Curve window (see Chapter 9.1.4)


9.1.1 Main View
The main view shows a sectional view of the DICOM series, cut across the axial plane, determined by the axial/view direction
you have defined in the axial and view direction definition step (see Chapter 7).
In the DICOM series visualization, an initial panoramic curve with markers is displayed (see Figure 9.2).
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 125 130 135 140 145 150
115 115
110 110
105 105
100 100
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90 90
85 85
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Figure 9.2: Main view - DICOM data with inital panoramic curve
1}
mPanoramic curve
2}
mDepth indication lines
3}
mDrag point for moving the panoramic curve (see Chapter 9.2)
4}
mOrientation indicators (patient perspective: R = right, L = left)
You cannot move or zoom the view.

By scrolling the mouse wheel or by holding the right-mouse button and moving the mouse, you can move through the DICOM
series visualization in axial direction to find an appropriate cut position.

9.1.2 Panoramic View

This secondary view shows the panoramic image resulting from your settings in the main view. (see Chapter 9.2) The panoramic
view reflects changes of the panoramic curve in real-time.
The panoramic view only displays the CT data range between the panoramic depth indication lines (see Figure 9.2).
3}
m 2}
m
1}
m
Figure 9.3: Panoramic view
The cut position line 1}

mindicates the current cut position. It automatically moves up and down when you scroll through the
DICOM series visualization in the main view.
The green sphere 2}
mindicates the start point of the panoramic curve, the red sphere 3}
mindicates the end point.
For more details on the panoramic view and available navigation functions see Chapter 23.5.
9.1.3 DICOM Control

In this step, the only available visualization modes are Solid and Solid (natural). See Chapter 5 for a detailed description of
the DICOM Control and the available visualization modes.

9.1.4 Define Panoramic Curve Window

The Define Panoramic Curve window provides functions and explanations for defining the panoramic curve.
Figure 9.4: Define Panoramic Curve window
Flip Perspective Flip the perspective upside down.
Reset Panoramic Curve Reset the curve to the initial state.
X-Ray Noise Threshold Change the noise threshold value for the X-ray visualization of the panoramic view.
Undo/Redo Undo/redo previous actions in panoramic curve definition.
Cancel Abort the step, close the window. All changes made since you entered the panoramic
curve definition step will be discarded.
Table 9.1: Define Panoramic Curve window functions



In this step, the Group Selector is not part of the initial screen. Click Show/Hide Groups in the main toolbar to show the
Group Selector.
During the panoramic curve definition step, two subelements are added to the Implant planning elements group:
Panoramic curve
Panoramic curve helpers (drag point, depth indication lines, orientation indicators, oral/vestibular inscriptions)
See Chapter 25.1 for a detailed description of the Group Selector.
9.2 Step-by-Step
You can define the panoramic curve for the whole jaw ridge (see Chapter 9.2.1) or only for parts of the jaw ridge (see
Chapter 9.2.2). However, ensure that all case-relevant areas of the jaw are covered by the panoramic curve. Ensure that the
labels vestibular and oral fit the orientation of the patient’s jaw correctly.
If the depth indication lines are not entirely smooth and

show angles or loops (e.g. as in Figure 9.5), this does not
necessarily mean that you have not defined the panoramic
curve correctly. Check the panoramic curve in such cases,
and if it is correct, continue in the workflow.
Figure 9.5: Depth indication lines with angles/loops
9.2.1 Defining the Panoramic Curve for the Whole Jaw Ridge
Step 1: In the main view, move along the axial axis through the CT data (scrolling the mouse wheel, or holding the
right-mouse button and moving the mouse) until you can clearly see the jaw ridge of the jaw you are planning the
implant(s) for.

Step 2: Move the curve to the jaw ridge by clicking and dragging the drag point.
Step 3: Define start and end point. Adjust the curve so that it fits the jaw ridge. Add points to the curve as needed by
clicking it. Drag and drop points to the desired positions.
To delete a point, right-click it while holding it with the left mouse button. You can delete all points except for three: start
point, end point, and one point on the curve.
As result, the panoramic image shows a complete view of the patient’s dental situation (see Figure 9.6).

Figure 9.6: Panoramic curve and image for the whole jaw ridge
9.2.2 Defining the Panoramic Curve for Parts of the Jaw Ridge
You can define the panoramic curve only for a limited part of the jaw ridge. For example, only for one side of the jaw or only
for the relevant tooth area. Figure 9.7 shows the panoramic curve definition for these examples.
To define the panoramic curve for a part of the jaw ridge only, set the start and end point accordingly. Then adjust the curve
by setting points as described in Chapter 9.2.1.

(a) Panoramic curve for one jaw side

(b) Panoramic curve for tooth area
Figure 9.7: Partial panoramic curve definition examples

9.2.3 Defining the Panoramic Curve in Partial Head Scans

If defining the panoramic curve for a partial head scan, ensure that the ´´oral” and ´´vestibular” markers point to the correct
direction. The direction varies with the orientation of the tooth bow in the DICOM series.
Figure 9.8 shows the correct definition of a panoramic curve for a partial head scan where tooth 36 will be implanted.
Figure 9.8: Correctly defined panoramic curve for partial head scan

10 Defining the Mandibular Canal
This step is only available when planning im-

plants for tooth numbers in immediate vicin- NAVIGATION
ity of the mandibular nerve. Defining the
mandibular canal is important to avoid dam-
Define Mandibular Canal
aging the nerve when drilling channels for
implants into the patient’s jaw bone. When This step is part of the guided
positioning implants (see Chapter 14), a col- wizard workflow (see Chapter 22.3)
lision will be detected if you move an implant
too close to the defined mandibular canal. It is not possible to finish the implant planning process until you resolve the col-
lision (see Chapter 27.7 for details on collisions).
WARNING
An incorrect definition of the mandibular nerve can cause a permanent injury of the patient during
the surgical implanting procedure.
HINT
Use one of the methods described in the chapters 10.2.2 and 10.2.3 to locate and define the mandibu-
lar nerve. If in doubt, increase the diameter of the mandibular canal to fully encapsulate the pa-
tient’s nerve.
Since the thickness and structure of the mandibular nerve can vary, you define a “tube” that must encapsulate the entire
nerve and possible nerve branches. Complicated cases of nerve structures might require increasing the tube size (see Chap-
ter 10.1.7) or creating multiple slopes during the channel definition to cover all areas at risk.
If you define the mandibular canal distant to the data range shown by the depth indication lines displayed during the panoramic
curve definition step (see Figure 9.2), this can cause distortion effects in the panoramic view (see Chapter 9 for details on how
to create the panoramic view; see Chapter 23.5 for details on the panoramic view).

5}
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Figure 10.1: Mandibular canal definition screen
1}
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mSecondary view: curve cut view (see Chapter 10.1.2)
3}
mSecondary view: panoramic view (see Chapter 10.1.3)
4}
5}
6}
mView presets (see Chapter 10.1.6)
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mDefine Mandibular Canal window (see Chapter 10.1.7)
Clicking in a sectional view (e.g. curve cut, panoramic view in cut mode) directly sets a point for the mandibular canal.
See Chapter 10.2.1 for details.

exoplan automatically suggests the described preset of main view and secondary views. You can change the preset using the
Implant Control (see Chapter 25.2) or the view preset buttons (see Chapter 10.1.6).
10.1.1 Main View

The main view displays the DICOM series visualization. For available view-related functions in the main view, see Chapter
23.1. View indicators (colored frames) indicate positions of active secondary views. See Chapter 23.1.2 for details on view
indicators.
Clicking in the main view focuses all sectional views to this position (this only happens in this step). You cannot define the
mandibular canal in the main view.

10.1.2 Secondary View: Curve Cut

This secondary view shows a cross-section view of the DICOM series oriented orthogonally to the panoramic curve. See
Chapter 23.4 for a detailed description of the curve cut view.
10.1.3 Secondary View: Panoramic View

This secondary view shows the panoramic image you have defined in the panoramic curve definition step (see Chapter 9).
See Chapter 23.5 for a detailed description of the panoramic view. You can only define the mandibular canal in cut mode.
10.1.4 DICOM Control

Use the DICOM Control for modifying the DICOM series visualization in the main view. All visualization modes are available.
See Chapter 5 for a detailed description of the DICOM Control and the available visualization modes.

During this step, the group Mandibular nerves will be added. If you define both mandibular nerves, the elements Left/Right
mandibular nerve will be added. See Chapter 25.1 for a detailed description of the Group Selector.
10.1.6 View Presets

Special view presets are available in this step. Select a view preset by clicking the corresponding icon. See Chapter 23.7 for a
detailed description of view presets.
10.1.7 Define Mandibular Canal Window

The Define Mandibular Canal window provides functions and explanations for defining the mandibular canal.

Figure 10.2: Define Mandibular Canal window (both nerves)
If your project definition requires to define only one nerve, only buttons for the corresponding jaw side will be displayed.
Right / Left Nerve Toggle between right and left nerve.
Clear Clears any existing definition for the corresponding mandibular canal.
Lock Nerve / Nerves Lock the defined mandibular canal(s). This can be helpful when you are using other
tools during this step (e.g. the Measurement Tool, see Chapter 26.1) and want to avoid
unintended changes in your mandibular canal definition.
Nerve Diameter Define the nerve tube’s diameter. Choose a diameter covering the complete extent of
the mandibular nerve at any point.
Undo/Redo Undo/redo previous actions. If you define canals on both sides, these buttons
undo/redo the last action on the currently selected side.
OK Complete the mandibular canal definition step, save all your settings and close the
window.
Cancel Abort the mandibular canal definition step, close the window. All changes made since
you entered the step will be discarded.
Table 10.1: Define Mandibular Canal window functions
10.2 Step-by-Step
This chapter describes three possible methods for defining the mandibular canal:
Method A: Using the curve cut view (see Chapter 10.2.2)
Method B: Using the panoramic view (see Chapter 10.2.3)
Combining method A and method B (see Chapter 10.2.4)
There are also other methods for defining the mandibular canal. However, these three common methods are the most effi-
cient ways to define the nerve properly.
10.2.1 Placing Points Along the Mandibular Canal

Define the mandibular canal by setting a sequence of points in the sectional views.
To set the first point, click where you want to begin defining
the nerve channel. The point appears gray. All other views
are automatically focused to the latest point.

To set additional points, click the desired position on the

mandibular canal. All points will be connected with a solid
line and appear in yellow (left nerve) or blue (right nerve).
Drag and drop a point to change its position.

Delete a point by holding it with the left mouse button and clicking the right-mouse button.
Add a point to the sequence by clicking the line.
Each time you click or drag a point in a point sequence, all views focus this point.
Your defined mandibular canal will be visualized in all views, regardless of the sectional views you used to set your points.
Clicking a sectional view while in the mandibular canal definition step adds a new point to the currently defined mandibular
canal. You can avoid this behavior by activating Lock Nerve in the Define Mandibular Canal window (see Chapter 10.1.7).
This can be helpful if you want to use other tools, e.g. the Measurement Tool (see Chapter 26.1).

10.2.2 Method A: Using the Curve Cut View

For this method, exocad recommends using a view arrangement with the curve cut view as focus window (see Figure 10.1 for
a possible arrangement).
Step 1: Click the mental foramen in the main view. This will focus all views to this position.
Step 2: Set the first point in the curve cut view. If possible, position the first point where the nerve enters the jawbone.
Step 3: Set additional points in the curve cut view until the nerve channel continues backwards from your perspective.
When setting the point from which the channel will continue backwards, hold SHIFT. This shortcut moves the
curve cut view automatically a little further back along the panoramic curve after you set a point.

Step 4: Continue setting points while holding SHIFT until you have sufficiently covered the region of interest for your
case. You can check the progress and result of your nerve channel definition, for instance, in the panoramic view
and in the main view (see Figure 10.3).
(a) Main view (semi-transparent)


(b) Panoramic view
Figure 10.3: Mandibular canal definition
You can view the point sequence in the curve cut view by holding the right-mouse button and dragging the mouse left or
right. This will move the curve cut view along the panoramic curve (see Chapter 23.4. For a detailed description of view-
related functions in the curve cut view see Chapter 23.4.1).
10.2.3 Method B: Using the Panoramic View

For this method, exocad recommends using a view arrangement with the panoramic view as focus view. Ensure that the
panoramic view is in cut mode. You cannot set points in X-ray mode.
Step 1: Move the cut position in the panoramic view by holding the right-mouse button and dragging the mouse to
visualize the mandibular canal.
Step 2: Starting from either end, place points along the course of the mandibular canal until you have sufficiently covered
the region of interest. If necessary, adjust the cut position during point placement.

In the panoramic view, the depth position of points may be hard to identify. Sometimes a point appears correctly set in the
panoramic view, but is actually not inside the nerve channel because the depth position is off. To check if the depth position
of a point is correct, use the curve cut view as a reference and activate Show View Intersection Marker in the secondary
view visualization settings (see Chapter 23.2.3). An orange line then indicates the current position of the panoramic view,
allowing you to see the depth position of points.
10.2.4 Combining Method A and B

Combining method A and method B is an efficient way to define the mandibular canal’s entry into the jawbone via the mental
foramen and its path inside the jawbone.
Step 1: In the curve cut view, set points as described in Method A, Steps 1 - 3. Do not hold SHIFT while setting the point
from where the nerve channel continues backwards.
Step 2: In the panoramic view (cut mode), set the remaining points as described in Method B, Steps 1 - 2.
Figure 10.4: Mandibular canal defined in curve cut view and panoramic view
You do not have to complete the mandibular curve definition in any way (e.g. with a double-click). Once you have set all points
for the mandibular canal, you can leave the mandibular canal definition step and proceed in the workflow.
If needed, you can delete previously defined mandibular canals at a later point in the workflow using the Delete Constructed
Parts option in the context menu / expert toolbar (see Chapter 17).

11 Initial Placement of Tooth Models (Backward Planning)
In this optional step, you can place library

teeth to simulate the result of your final restora- NAVIGATION
tion. You cannot access this step (and the
subsequent precise placement step) if you
Place Model Teeth for Backward
have loaded a waxup scan. If you have loaded
Planning
an optical jaw scan for your project, exocad
highly recommends to perform the CT data This step is part of the guided
alignment step (see Chapter 8) before plac- wizard workflow (see Chapter 22.3)
ing tooth models.
The tooth placement consists of two steps:
1. Initial placement (see this chapter)
2. Precise placement (see Chapter 12)
During initial placement, do not worry if the tooth position is not exact or optimal. You can modify the tooth positions further
in the precise placement step.
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Figure 11.1: Initial placement startup screen
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mPlace Model Teeth window (see Chapter 11.1.4)


11.1.1 Main View
If you have loaded a jaw scan in your current project, this scan will be displayed in the main view. If you do not have a jaw scan,
the DICOM series visualization will be displayed instead. You can place tooth models both in the jaw scan and in the DICOM
series visualization. However, exocad recommends using the jaw scan, because scan data usually contains more relevant
details (e.g. the gingiva) and less surface artifacts compared to the DICOM series visualization.
For available view-related functions in the main view, see Chapter 23.1.

In this step, the only available visualization mode is Isosurfaces. See Chapter 5 for a detailed description of the DICOM Control
and the available visualization mode.

During this step, the group Full Anatomic will be added. If you position multiple tooth models, an element Library Model
with corresponding tooth number will be added for each model. See Chapter 25.1 for a detailed description of the Group
Selector.
11.1.4 Place Model Teeth Window

The Place Model Teeth window as shown in Figure 11.2 provides controls and explanations for the initial tooth model place-
ment. The top of the window shows the tooth/teeth you are currently editing.
Figure 11.2: Place Model Teeth window

Mesial Contact of Tooth Define the mesial contact point for the tooth/teeth in the bridge.
Distal Contact of Tooth Define the distal contact point for the tooth/teeth in the bridge.
Position on Gingiva for Define a position on the gingiva for the tooth/teeth in the bridge.
Tooth
Delete Contact Points Delete the defined contact points.
OK Complete the initial placement step, save all your settings and close the window.
Cancel Abort the initial placement step, close the window. All changes made since you entered
the step will be discarded.
Table 11.1: Place Model Teeth window functions
If you are placing a bridge including the front teeth, the first two buttons will both be called Distal Contact of Tooth.
11.2 Step-by-Step
This chapter provides instructions for the following scenarios:
1. Placing a bridge for a single tooth with two adjacents: Chapter 11.2.1
2. Placing a bridge for a single tooth with one adjacent (usually last molars on distal side): Chapter 11.2.2
3. Placing a bridge consisting of multiple teeth: Chapter 11.2.3
11.2.1 Single Tooth, Two Adjacents

Define mesial and distal contact for the tooth model by clicking the jaw scan. You can toggle between the points by activating
Mesial Contact of Tooth and Distal Contact of Tooth in the Place Model Teeth window.
After placing the first contact point (mesial or distal), the tooth model becomes semi-transparent and the button for the
opposite contact will be active in the Place Model Teeth window.
Figure 11.3: Single tooth model with mesial and distal contact

After setting both contact points, you can still modify their positions. This will be explained in Chapter 11.2.4.
11.2.2 Single Tooth, One Adjacent

Define a mesial contact and a position on the gingiva for the tooth model by clicking the jaw scan. You can toggle between
the points by activating Mesial Contact of Tooth and Position on Gingiva for Tooth in the Place Model Teeth window.
You can use either of the gingiva position buttons.
Figure 11.4: Single tooth model with mesial contact and gingiva position
After setting both contact points, you can still modify their positions. This will be explained in Chapter 11.2.4.
For tooth numbers 7, exoplan automatically activates the gingiva position button in the Place Model Teeth window after
the mesial contact point has been defined, even if this tooth is not the last molar on the distal side. If your project includes
tooth 8, select the button for placing the distal contact manually.
11.2.3 Multi-Tooth Bridges

In a multi-tooth bridge, you place all included tooth models simultaneously.
As for a single-tooth bridge, you define contact points / gingiva positions on the adjacents to position the tooth models (see
Chapters 11.2.1) and 11.2.2).

If you define a bridge including the front teeth, you define two distal contact points. The Place Model Teeth window then
contains only buttons for these distal contact points.
Figure 11.5 shows examples for the placement of multi-tooth bridges.

(a)
(b)
Figure 11.5: Placement of multi-tooth bridges
11.2.4 Modifying Contact Point Positions

Use one of the following methods to change the positions of contact points on adjacent teeth or the gingiva:
Click and drag a point to the desired position.

When you move the mouse over the jaw scan in the area around the tooth gap, a sphere is displayed. Its color indicates
which point you are currently defining, depending on which contact is closer to the mouse position. Click to set the
indicated contact.
Activate the corresponding button in the Place Model Teeth window and click the desired position for the contact.
To swap contact points, activate the button for one of the points in the Place Model Teeth window and click the other point
in the jaw scan.

Contact Point Restrictions
Once you have defined the first contact, you can set the next contact position only in a limited area around the first
point to prevent overscaling of the bridge.
You cannot place two contacts too close to each other. A minimum space will be kept to avoid underscaling of the
bridge.
11.3 Placing Multiple Bridges

If your project includes multiple bridges, you must place tooth models for each bridge separately.
Each time you have defined the tooth model position/s for a bridge, click OK (save position/s and to the Place Model Teeth
window). Next time you open the initial placement step, exoplan opens the Place Model Teeth window for the next bridge
(which has not yet been set).
11.3.1 Skipping Bridges

To skip the initial tooth placement for a bridge in expert mode, click OK in the Place Model Teeth window without placing
any tooth models. A dialog will ask you to confirm that you want to skip the tooth model placement for this bridge. You may
skip each bridge individually (Skip) or choose to skip the current and all subsequent bridges. (Skip All)
To skip the initial tooth placement for a bridge in wizard mode, click Next without placing any tooth models. A dialog will ask
you to confirm that you want to skip the tooth model placement for this bridge. You may skip each bridge individually (Skip)
or choose to skip the current and all subsequent bridges. (Skip All)
11.4 Selecting a Tooth Library

Select a tooth library in the Choose Library section of the Place Model Teeth window (see Figure 11.6).
Figure 11.6: Tooth library selection

To select a tooth library:

Select a library from the dropdown list, or
Use the arrow buttons to select the next/previous library in the list, or
Hold CTRL and scroll the mouse wheel to switch libraries.
After you have selected a library, the tooth models will be directly used in the main view during the current placement. You
do not have to start the placement again from scratch.
Libraries are deactivated for selection if they do not contain one or more tooth models required for the bridge or if they are
locked. See Chapter 27.4 for details on available tooth libraries.
11.5 Deleting Bridges

To delete a bridge, click Delete Contact Points in the Place Model Teeth window. You can delete a bridge or single tooth
models while not in the initial placement step using the Delete Constructed Parts option (see Chapter 17).
If you have positioned a multi-tooth bridge consisting of at least three tooth models, deleted one or more of these models
using the Delete Constructed Parts option, and opened the initial placement step again, exoplan will prompt you to decide if
the gaps in the bridge should be filled with tooth models.

12 Precise Placement of Tooth Models (Backward Planning)
The precise placement step is only available

if you have placed tooth models in the initial NAVIGATION
placement step (see Chapter 11). It allows
you to refine the initial tooth placement by
Correct Model Tooth Placement
moving, rotating, and scaling the tooth mod-
els. This step is part of the guided
2}
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1}
m
3}
m
4}
m
Figure 12.1: Precise placement startup screen
1}
2}
3}
mSecondary views ( see Chapter 12.1.3)
4}
mTooth Placement window (see Chapter 12.1.4)


12.1.1 Main View
The main view shows the jaw scan / DICOM series visualization with the initially placed tooth models. For available view-
related functions in the main view, see Chapter 23.1.

In this step, the only available visualization mode is Isosurfaces. See Chapter 5 for a detailed description of the DICOM
Control.
12.1.3 Secondary Views

When accessing this step, three secondary views are displayed by default: coronal view, curve cut view, and curve tangent
view. See Chapter 23.2 for detailed descriptions of secondary views.
12.1.4 Tooth Placement Window

The Tooth Placement window provides controls and explanations for the precise tooth placement. Two tabs are available,
the Simple tab and the Chain Mode tab (see Figure 12.2). You can move/scale/rotate tooth models in any view (main view
and secondary views).
(a) Simple tab (b) Chain Mode tab
Figure 12.2: Tooth Placement window

Simple Tab Functions
Move, Rotate, Scale Move/rotate/scale tooth models.
Radio buttons Restrict movement/rotation/scaling to certain directions.
Move all Simultaneously Active when at least two tooth models are present. Move/rotate/scale all tooth models
simultaneously.
Undo/Redo Undo/redo the last action.
OK Complete the precise placement step, save all your settings and close the window.
Cancel Abort the precise placement step, close the window. All changes made since you
entered the step will be discarded.
Table 12.1: Tooth Placement window Simple tab functions
See Chapter 12.2 for precise tooth model placement using the Simple mode.
Chain Mode Tab Functions
Chain, Single, Tube Modes within the chain mode.
Symmetry/Reset Symmetry/reset options.
Checkboxes Activate/deactivate chain mode behaviors.
OK Complete the precise placement step, save all your settings and close the window.
Cancel Abort the precise placement step, close the window. All changes made since you
entered the step will be discarded.
Table 12.2: Tooth Placement window Chain Mode tab functions
See Chapter 12.3 for precise tooth model placement using the chain mode.
12.2 Step-by-Step: Simple Mode

Figure 12.3: Action buttons in Tooth Placement window

12.2.1 Moving Tooth Models

Step 1: Activate Move.
Step 2: Click the tooth model you want to move.
Step 3: Drag the tooth to the desired position.
To restrict movement to certain directions, activate a corresponding radio button.
SHORTCUTS
Hold CTRL: Rotate a tooth
Hold SHIFT: Scale a tooth
Hold CTRL + SHIFT: Perform direction-based scaling
12.2.2 Rotating Tooth Models

Step 1: Activate Rotate or use the shortcut in Move mode.
Step 2: Click the tooth model you want to rotate.
Step 3: Hold the mouse button and drag. Rotation center is the tooth model’s center.
To restrict rotation to certain directions, activate a corresponding radio button.
12.2.3 Scaling Tooth Models

Step 1: Activate Scale or use the shortcut in Move mode.
Step 2: Click the tooth model you want to scale.
Step 3: Hold the mouse button and drag the mouse to scale the tooth. A green arrow indicates the scaling direction. To
perform direction-based scaling, hold CTRL and SHIFT.
To restrict scaling to certain directions, activate a corresponding radio button.
12.3 Step-by-Step: Chain Mode

The chain mode is a useful function to arrange tooth models in multi-tooth bridges.
Chain controls are displayed in the main view (see Figure 12.4).

2}
m
1}
m
3}
m
Figure 12.4: Chain controls
The tube 1}
mindicates the tooth chain. Placement discs 2}
mmark the ends of the tooth chain.
By clicking the control points 3}
m, which are present for every tooth model and the placement discs, you can pin positions of
teeth and placement discs. When pinned, the control point appears in red and the tooth / placement disc will not be affected
by movement/rotation/scaling actions. Clicking a red control point will unpin the tooth / placement disc again.
There are three chain modes, represented by the three top buttons in the Chain Mode tab:
Chain: transforms all teeth in a chain (see Chapter 12.3.1)
Single: transforms a single tooth (see Chapter 12.3.2)
Tube: transforms all teeth on a fixed bow (see Chapter 12.3.3)

12.3.1 Chain Mode

Move, scale and rotate tooth models in a chain using the same functions as in the Simple tab when in Move mode (see Chapter
12.2):
To move the tooth chain, click a tooth model in the chain and drag.
To rotate the tooth chain, click a tooth model in the chain where you want to apply rotation. Drag in the desired rotation
direction while holding CTRL. The greater the distance to the point you selected, the lesser the rotation influence.
To scale the tooth chain, click a tooth model in the chain and drag in the desired scaling direction while holding SHIFT.

You can also move, rotate and scale placement discs. When you click a placement disc, both discs will be fixed in their posi-
tions. This allows you to move one end of the chain while the other end remains fix. Once you let the disc off, both placement
discs will be unpinned again.
The following checkboxes are available in chain mode:
Teeth Scalable If a chain transformation is too big, the teeth will be scaled. Uncheck to deactivate.
Keep in Contact By default, the teeth remain in contact. Uncheck to deactivate. This will allow gaps and
intersections between teeth. When activated again, contacts will be re-established.
Show Chain Controls Uncheck to hide the tube and the control points.
Limit Rotation to Check to limit rotation to buccal/lingual tilt.

Buccal/Lingual Tilt
Table 12.3: Tooth Placement window Chain Mode checkboxes
12.3.2 Single Mode

To move, rotate, and scale an individual tooth, use the same functions as in the Simple tab when in Move mode (see Chapter
12.2):
To move a tooth, click it and drag.
To rotate a tooth, click it and drag in the desired rotation direction while holding CTRL.
To scale a tooth, click it and drag in the desired scaling direction while holding SHIFT. Use CTRL and SHIFT for direction-
based scaling.
Moving, rotating, and scaling a single tooth will affect the entire chain to some extent when the checkbox Keep in Contact
is activated.
The checkboxes Teeth Scalable, Keep in Contact, and Show Chain Controls are available, with the same functions as in
chain mode (see Chapter12.3.1).
12.3.3 Tube Mode

In this mode, you can move, scale, and rotate teeth in a chain along a fixed bow, indicated by a red tube extending the ends
of the main tube (see Figure 12.5).

Figure 12.5: Tube mode - Main and red tube
Move the teeth along this bow by dragging your mouse. Rotation and scaling behavior are the same as in Chain mode (see
Chapter 12.3.1).
The checkbox Keep in contact is not available, as the teeth always stay in contact. Available checkboxes are Teeth Scalable,
Show Chain Controls and Limit Rotation to Buccal/Lingual Tilt, with the same functions as in Chain and Single mode
(see Chapter 12.3.1).
12.3.4 Symmetry Option
In the Options section of the Chain Mode tab, the Symmetry but-
ton is activated if you place tooth models on both jaw sides at op-
posing positions. You can use the symmetry function to create a
symmetry for the right and left jaw side.
Figure 12.6: Chain mode options

The Symmetry button actually consists of four buttons. Hovering over one of these buttons displays blue symmetry indica-
tors in the main view, indicating the symmetry plane, considered teeth (blue control points), and the symmetry direction.
Figures 12.7 to 12.10 show the symmetry button functions.
Figure 12.7: Overall symmetry from right to left


Figure 12.8: Overall symmetry from left to right
Figure 12.9: Front teeth symmetry from right to left

Figure 12.10: Front teeth symmetry from left to right

Define a symmetry by clicking one of the four buttons. The entire Symmetry button will appear activated. Any movement/rotation/
scaling action on one jaw side will be mirrored to the other side along the symmetry plane.
To deactivate the symmetry function, click Symmetry again.
Symmetry Plane Control
The symmetry plane control is a sphere with two arrows (see Figure 12.11). The arrows indicate which teeth are used as
reference for the plane orientation. The reference teeth are locked (red control points).
Figure 12.11: Symmetry plane control
To change the reference teeth, click the control point of a tooth on either jaw side. The symmetry plane control will jump to
the new position and the control points of both reference teeth will appear red (see Figure 12.11).
To pin the symmetry plane, click the sphere between the arrows.

12.3.5 Reset Options

Clicking Reset in the Options section of the Chain Mode tab (see Figure 12.6) displays available reset options you can select
from.
Figure 12.12: Chain mode reset options
Reset (keep red) Restores the original position of unpinned teeth (green control points), but keeps the
current position of pinned teeth (red control points).
Reset Keeps changes made in the Simple tab, discards all other changes.
Global Reset Restores the original position of all teeth, discards all changes.
Cancel Keeps all current tooth positions.
Table 12.4: Chain mode reset options


13 Defining the Density Threshold Value
In this optional step, you define a threshold

value for visually separating hard bone ar- NAVIGATION
eas from softer areas. Areas above the de-
fined value will be displayed in blue, areas
Define Density Threshold
below the defined value will be displayed in
red (see Figure 13.1). In the implant position- This step is part of the guided
ing step (see Chapter 14), the colors will help wizard workflow (see Chapter 22.3)
you to avoid positioning an implant in an area
which may be of insufficient density.
WARNING
An incorrect density threshold value definition can impede the recognition of suboptimal implant
positions.
HINT
The density threshold value and the deduced visualization are only visual helpers for the implant
placement. Choose a conservative value (i.e. higher, more red than blue) if in doubt.
3}
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1}
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4}
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Figure 13.1: Density threshold definition startup screen
1}
2}

3}
mGroup Selector ( see Chapter 13.1.3)
4}
mDefine Density Threshold window (see Chapter 13.1.4)

13.1.1 Main View
The main view shows a cut view of the DICOM series, colored blue and red according to the defined threshold value. For
available view-related functions in the main view, see Chapter 23.1.

In this step, the DICOM Control is fully extended, and the Clip tab is active, allowing you to directly adjust the cut position in
the main view if necessary. See Chapter 5 for a detailed description of the DICOM Control.

13.1.4 Define Density Threshold Window

The Define Density Threshold window provides controls and explanations for defining the density threshold.
Figure 13.2: Define Density Threshold window
Threshold Define the density threshold value. You can change the slider range using the context
menu (see Chapter 24.3).
Reset View and Reset the view and visualization to the initial orientation.
Visualization
OK Complete the density threshold definition step, save all your settings and close the
window.

Cancel Abort the density threshold definition step, close the window. All changes made since
you entered the step will be discarded.
Table 13.1: Define Density Threshold window functions
13.2 Step-by-Step
Define the density threshold value by moving the Threshold slider or by entering a value. Voxels above the defined value
are displayed in blue, voxels below the defined value are displayed in red.
Define a value that leads to all bone and denser areas being blue. Figure 13.3 shows an example for the DICOM series visual-
ization with correctly defined density threshold. Bone and denser areas appear blue, all other areas appear red.
Figure 13.3: Visualization of correctly defined density threshold
Ensure all blue areas are always bone areas. Red areas can be bone areas, blue areas must be bone areas.
The density threshold value you define in this step affects how implants
are displayed in the implant positioning step (see Chapter 14). In certain
views, the implant will be colored blue and red, as shown in Figure 13.4.
The coloring illustrates the density area at the current implant position.
Be aware that the colors are just indicators. If the implant is displayed
in blue, this does not mean that it is in a completely dense area and if
the implant is displayed in red, this does not mean that it is in a an area
of low density.
Figure 13.4: Implant with colors

When confirming your density threshold settings by clicking OK, the value will be saved to an ImplantPlanningThreshold
file and reused when you work on the project again. If an ImplantPlanningThreshold file exists for your current project,
you will not be able to return to the density threshold definition step in wizard mode, but you can change the density thresh-
old value in expert mode.

14 Implant Positioning
WARNING
exoplan does not verify if you have placed an implant at an eligible position for the selected
tooth number.
When selecting an implant for a particular tooth location make sure that the intended use/the
indications of the implant allows the usage for the respective tooth and purpose.
HINT
Use the secondary views Implant cross and Implant axial to verify the eligibility of the implant
position: Click the right mouse button and drag to analyze the surroundings of the placed implant.
Ensure that implant type, implant diameter, and implant length are chosen correctly according to
the patient’s clinical situation. In the maxillae region, ensure that no critical anatomical structures
(e.g. the floor of the maxillary sinus, the piriform foramen, and the anterior palatine nerve) will
be injured. (See chapter 14.4 for more information on placing an implant. See chapter 23.6 for a
detailed description of the implant-based secondary views.)
In this step, you define the implant position.

It consists of three parts: NAVIGATION
1. Selecting implant parts (see Expert toolbar / context menu:

Chapter 14.2) Implant Positioning
2. Initial positioning of the selected This step is part of the guided
implant (see Chapter 14.3) wizard workflow (see Chapter 22.3)
3. Refining the implant position by
moving and/or rotating the implant
(see Chapter 14.4)

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3}
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m
Figure 14.1: Implant placement startup screen
1}
2}
3}
mCurve cut view (see Chapter 14.1.3)
4}
mCurve tangent view (see Chapter 14.1.4)
5}
6}
7}
mImplant Positioning window (see Chapter 14.1.7)

14.1.1 Main View
The main view shows the DICOM series visualization, the jaw scan, and view indicators. For available view-related functions
in the main view, see Chapter 23.1.

The panoramic view shows the panoramic image you defined in the panoramic curve definition step (see Chapter 9). See
Chapter 23.5 for a detailed description of the panoramic view.
If you position implants distant to the data range shown by the depth indication lines in the panoramic curve definition screen
(see Figure 9.2), this can cause distortion effects in the panoramic view.

14.1.3 Curve Cut View

The curve cut view shows a cross-section view of the DICOM series oriented orthogonally to the panoramic curve. See Chap-
ter 23.4 for a detailed description of the curve cut view.
14.1.4 Curve Tangent View

The curve tangent view shows a cross-section view of the DICOM series oriented tangentially to the panoramic curve. See
Chapter 23.4 for a detailed description of the curve tangent view.

If the implant for the currently selected tooth is not positioned yet, the only available visualization mode is Isosurfaces. The
surface threshold value is set to bone, if you have defined this density reference in the density references definition step (see
Chapter 6). While moving/rotating an implant (see Chapter 14.4), all visualization modes are available. See Chapter 5 for a
detailed description of the DICOM Control.

During this step, the groups Implant parts and, if applicable, Abutment parts will be added. As elements, all positioned
implants/abutments are listed. Which groups/elements are available for individual implants/abutments depends on the
library settings of the selected implant/abutment. See Chapter 25.1 for a detailed description of the Group Selector.

14.1.7 Implant Positioning Window

The Implant Positioning window provides controls and explanations for selecting and positioning implants.
Figure 14.2: Implant Positioning window
If you are planning multiple implants, select the tooth number in the dropdown menu at the top to select and position the
corresponding implant.
Three tabs are available:
Select: functions for selecting an implant and attachable parts (see Chapter 14.2).
Align: functions for moving and rotating the implant and all attached parts (see Chapter 14.4).
Settings: implant settings (see Chapter 14.5).
Click OK to complete the implant positioning step, save all your settings, and close the window. Click Cancel to abort the
implant positioning step and close the window. All changes made since you entered the step will be discarded.
You cannot complete the implant positioning step if there is a collision between an implant and another object. Resolve
collisions by repositioning implants or by changing the safety distance around implants (see Chapter 14.5.3). See
Chapter 27.7 for details on collisions.

14.2 Selecting Implant Parts

Select implant parts using the functions in the Select tab. Implant parts are all parts of one implant construction (e.g. im-
plant, stock abutment). The shapes of these parts are stored in implant libraries.
1}
m
2}
m
3}
m
4}
m
Figure 14.3: Implant selection functions
Step 1: Activate one of the implant part buttons 1}

m. The available buttons depend on the tooth’s implant type (see
Chapter 27.8).
Step 2: Select the library for the implant part using the library dropdown menu 2} m . Alternatively, type text into the
menu field. If you position multiple implants, an implant part library based on the already positioned implant
models will be preselected in the library list.
Click the star symbol next to a library entry to define this library as a favorite. Favorites will be displayed on top of
the library list and will also persist when you restart exoplan.
Step 3: Select specific parts using the drop-down menus 3}

mbelow the implant library drop-down menu.
Possible implant part combinations depend on compatibility settings defined by the library provider. See Chapter 27.5 for
details on implant libraries.

WARNING
Please ensure that the correct implant type including platform type / platform length and diame-
ter is selected according to the clinical situation of the patient. Please pay particular attention to
this when planning an implant case near a major anatomical feature such as arteries or alveolar
nerve.
The preview section 4}m shows the selected implant parts. All parts will be displayed together and connected.
Preview section functions:
Hold the right mouse button and drag to rotate the preview.
Scroll the mouse wheel to zoom the preview.
When moving your mouse over an implant part, information about this part is displayed in an information box (the displayed
information depends on the implant library settings defined by the library provider).
Figure 14.4: Information box example

14.3 Initially Positioning an Implant

To initially position the implant (and attached parts), move your mouse over any view and click at the desired position. The
implant is displayed in yellow as a preview before you click the position. In the panoramic view, you can only initially position
the implant in cut mode. The implant parts will be displayed in all views (see Figure 14.6). In panoramic view, the implant will
be displayed without attached parts.
Figure 14.5: Before initial implant positioning

Figure 14.6: After implant positioning

After you have positioned an implant,

the implant is displayed in all views, with safety distance indicator (view-dependent). You can hide the safety distance
indicator using the Group Selector.
the Implant Positioning window changes to the Align tab. Using this tab, you can move and rotate implants (see
Chapter 14.4). You can still select any tab of the Implant Positioning window, for example to choose different parts
for a positioned implant in the Select tab (see Chapter 14.2).
the view preset changes. As secondary views, implant-centered views (Implant cross and Implant axial) are set, in ad-
dition to the panoramic view. See Chapter 23.7 for details on view presets.
If you have positioned multiple implants, select an implant for modification by double-clicking it in any view or by choosing
its tooth number in the Implant Positioning window (see Chapter 14.1.7). You can do this at any point during the implant
positioning process. If you change implant parts in the Select tab, these changes will be applied directly.
SHORTCUTS
While the mouse cursor is above an implant preview or a positioned implant: CTRL / SHIFT +
mouse wheel to change the type/subtype inside the currently selected implant library.
14.4 Moving/Rotating an Implant

Move and rotate an implant using the functions in the Align tab. This tab is only available if you have already positioned the
implant for the selected tooth (see Chapter 14.3).
Figure 14.7: Implant alignment functions
To move/rotate an implant, select the corresponding tooth number in the Implant Positioning window or double-click the
implant in a view. All attached parts will be moved/rotated together with the selected implant.
To move the implant, select Move Implant, click the implant and drag it to the desired position. You can select to move
the implant freely, along the implant axis or in the implant’s axial plane.
To rotate the implant, select Rotate Implant, click the implant and drag it in the desired rotation direction. You can
select to move the implant around it’s center, around the implant axis or around the ends.

SHORTCUT
Hold CTRL in Move Implant mode: Rotate the implant according to the rotation option currently
selected in Rotate Implant mode.
In addition to using the move/rotate function, you may use the widgets that are displayed in the main view to move and
rotate the implant or adjust the length of the implant. All movement/rotation actions are displayed simultaneously in all
views, regardless in which view you applied them. In certain views, some rotation and movement actions are restricted or
not possible.
Click Undo/Redo to undo/redo movement/rotation actions. These functions only apply to the currently selected implant.
You cannot undo/redo implant part changes performed in the Select tab (see Chapter 14.2).
If you position multiple implants, choose Show/Hide Inactives to show/hide currently not selected implants in all views.
WARNING
During implant positioning, ensure the feasibility of the surgery for the particular implant position.
Consider the existing dentition and study the insertion channels for the respective implant.
HINT
Before you proceed, make sure that with your choice of implant position no structures at risk (e.g.
sinus cavity) will be damaged. You have to visually inspect the vicinity of the chosen implant posi-
tion.
In the secondary view parallel to the implant axis (dark blue framed view): Press and hold the
right mouse button and move the mouse left or right to rotate the view around the implant
axis. Visually inspect the surrounding anatomical structures while rotating the view.
In the secondary view perpendicular to the implant axis (dark red framed view): Press and
hold the right mouse button and move the mouse up and down to move the view along the
implant axis. Visually inspect the surrounding anatomical structure while moving the view.
During the visual inspection you can use the visualization of the insertion channel (yellow)
and the visual representation of the minimum safety distance around the implant to visually
assess the distances to anatomical structures.
14.5 Implant Positioning Settings

Changes in the implant positioning settings affect all implants (not only the currently selected implant).
In the Settings tab of the Implant Positioning window, you can
change the implant type (see Chapter 14.5.1),
define implant visualization settings (see Chapter 14.5.2),
change the safety distance around implants (see Chapter 14.5.3).

Figure 14.8: Implant settings tab
14.5.1 Changing the Implant Type

Clicking Edit Implant Setup opens the Change Implant Type window (see Figure 14.9).
Figure 14.9: Change Implant Type window

Using the functions in this window, you can change implant types, define additional implants, and delete implants. See
Chapter 18 for detailed instructions on how to change the implant setup.
To apply a change in the implant setup, click Apply settings.¹ If you have already positioned implants for the affected teeth,
a dialog informs you that the implant and all its parts will be deleted if you change the implant type. Click OK to confirm.
In expert mode, you can edit the implant setup at any point using the Select Implant Type option (Chapter 18).
14.5.2 Implant Visualization Settings

If you have defined a density threshold value in the density threshold definition step (see Chapter 13), the implant of the
currently selected tooth is displayed by default in blue and red according to the densities in its current position. If you have
not defined a density threshold value, it is colored in standard visualization. Currently not selected implants are displayed in
light-green.
Visualization Modes:
Standard: sets the implant visualization to yellow.
Natural Texturing: sets the implant visualization to solid (natural) color scheme (see Chapter 5.2.4).
Threshold Visualization: sets the implant visualization to blue/red according to density threshold definition (only
available if you have defined a density threshold value).
14.5.3 Changing the Safety Distance

Use the Safety distance slider or type in a value to define the safety distance around implants. By default, this is the value
defined in the exoplan settings (see Chapter 26.5). If you define a distance lower than the default safety distance value,
exoplan informs you.
WARNING
A safety distance below 1.5 mm should only be used in exceptional cases with particular care.
The safety distance indicator appears red if there is a collision. When checking for collisions between two implants, the safety
distance is doubled. For example, if you have defined a safety distance of 2.0 mm around implants, a collision will be detected
if the distance between two implants is below 4.0 mm (safety zones overlap).
See Chapter 27.7 for details on collisions.
Figure 14.10: Implant with safety distance

visualization
¹You must click Apply settings for each individual change.

15 Sleeve Placement
In this step, you can select and position a

drilling sleeve. This serves to design a sur- NAVIGATION
gical guide for use in guided surgery. Please
note that exoplan uses the term sleeve in-
Sleeve Placement
stead of drilling sleeve in the user interface.
This step is part of the guided
6}
m 5}
m
2}
m
1}
m
3}
m
7}
m 4}
m
Figure 15.1: Sleeve placement startup screen

1}
2}
3}
mImplant cross view (see Chapter 15.1.3)
4}
mImplant axial view (see Chapter 15.1.4)
5}
6}
7}
mSleeve Placement window (see Chapter 15.1.7)


15.1.1 Main View
The main view shows the DICOM series visualization, the jaw scan, the positioned implants and view indicators. For available
view-related functions in the main view, see Chapter 23.1.

The panoramic view shows the panoramic image you have defined in the panoramic curve definition step (see Chapter 9).
See Chapter 23.5 for a detailed description of the panoramic view.
15.1.3 Implant Cross View

The Implant cross view shows a sectional view of the DICOM series along the implant axis. See Chapter 23.6 for a detailed
description of the Implant cross view.
15.1.4 Implant Axial View

The Implant axial view shows a sectional view of the DICOM series orthogonal to the implant axis. See Chapter 23.6 for a
detailed description of the Implant axial view.

By default, the visualization mode in the drilling sleeve placement step is Isosurfaces. All other visualization modes are avail-
able. See Chapter 5 for a detailed description of the DICOM Control and the available visualization modes.

During this step, the group Sleeve parts will be added. Which groups/elements are available for individual sleeves depends
on the library settings of the selected sleeve. See Chapter 25.1 for a detailed description of the Group Selector.
15.1.7 Sleeve Placement Window

The Sleeve Placement window provides controls and explanations for selecting drilling sleeves and surgical kits (surgical
kits include drills, handles, and other tools for guided surgery). Please note that hereafter the composition of a surgical kit is
no longer mentioned in detail.
At the top of the window, the implant you have selected in the implant positioning step with type and subtype information
is displayed. You can only select sleeves compatible with the selected implant.
Click OK to complete the drilling sleeve placement step, save all your settings, and close the window. Click Cancel to abort
the drilling sleeve placement step and close the window. All changes made since you entered the step will be discarded.
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15.2 Selecting a Sleeve
1}
m 4}
m
2}
m
3}
m
5}
m
Select a drilling sleeve library using the top dropdown menu 1} m . Only drilling sleeve libraries compatible with the selected
implant are available for selection. Select the desired drilling sleeve type and subtype using the two dropdown menus 2} m
m
}
below. Select a surgical kit using the third dropdown menu 3 . Only surgical kits compatible with the selected drilling sleeve
are available for selection.
To clear your selection, click the brush icon 4}
m. Clicking Show additional information 5}
mwill open the Implant Control
in the Sleeve Information tab (see Chapter 25.2.3).
15.3 Positioning a Sleeve

When you move the mouse over the drilling sleeve in the main view, planes indicating height positions and relevant measure
indications appear.
Figure 15.2: Sleeve in main view
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Using the green rotation handle, you can rotate the drilling sleeve. By clicking the green spheres along the implant axis, you
can set the drilling sleeve to the available height positions. Please note that the spheres are not available for every drilling
sleeve type. Alternatively, you can drag the drilling sleeve up/down. Some drilling sleeve types can be moved freely along the
implant axis (dependent on drilling sleeve library configuration). Please note that depending on the selected drilling sleeve,
the text beeing displayed next to the dark arrows may be different from the one in figure 15.2.
WARNING
When you have selected a freely positionable drilling sleeve, exoplan does not automatically
select a compatible surgical kit and respective tools. This responsibility fully remains with
the user.
The displayed drill depth is approximated from the geometric mesh provided by the manu-
facturer of the respective implant.
NOTE
The accuracy of drilling sleeve placement for fixed predefined positions is 0.01mm measured from
the drilling sleeve’s upper part to the implant’s apical point and the implant’s reference point (the
insertion point of the prosthetic device).
NOTE
For drilling sleeves without predefined fixed height values, the accuracy of displaying the drilling
sleeve’s distance to the virtual implant’s apical point is 0.01mm.
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16 Deleting Implants
You can delete positioned implants and their

attached parts in expert mode. NAVIGATION

Delete Implant
Step 1: Select the implant you want to delete by clicking it in the main view. To select more implants for deletion, hold
CTRL while clicking additional implants. If you do not select specific implants, all implants will be selected for
deletion.
Step 2: Click Delete Implant in the expert toolbar or the context menu. This opens the implant deletion dialog (see
Figure 16.1) which lists the tooth numbers for the implants you are about to delete. In the main view, the listed
implants will be highlighted in yellow.
Step 3: Click OK to confirm.
Figure 16.1: Implant deletion dialog
If you delete an implant, the attached parts will also be deleted.
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17 Deleting Constructed Parts (Tooth Models, Mandibular

Canals, Drilling Sleeves)
Using this function, you can delete tooth mod-

els, mandibular canals and drilling sleeves NAVIGATION
in expert mode.
Delete Constructed Parts
17.1 Delete all tooth models / mandibular canals / drilling sleeves

Step 1: Click Delete Constructed Parts in the expert toolbar or the context menu. This opens the Delete
Reconstructions window (see Figure 17.1).
Figure 17.1: Delete Reconstructions window
Step 2: Select the parts to delete from the Delete: dropdown menu (Mandibular Canals / Tooth Models / Drilling Sleeves
/ All). The Parts to delete section lists the parts which will be deleted. You cannot select individual items in the
list.
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17.2 Delete individual tooth models / mandibular canals / drilling sleeves

Step 1: Select the model/s, canal/s or drilling sleeves ¹ by clicking them in the main view while in expert mode.
To select multiple parts, hold CTRL and click the parts.
To select multiple neighboring parts in a row (tooth models in a multi-tooth bridge), click the first part you want to
delete and hold SHIFT while clicking the last part in the row.
Step 2: Right-click one of the selected parts.
Step 3: Select Delete Constructed Parts from the context menu. The Parts to delete list of the Delete
Reconstructions window now lists only the parts you have selected for deletion.
¹Deleting drilling sleeves separately is only possible if the Surgical Guide Module is activated
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18 Selecting Implant Types
Using this option, you can edit the implant

setup. The option is also available in the im- NAVIGATION
plant positioning step (see Chapter 14.5).
Select Implant Type
This step is part of the guided wizard
workflow if no implants have been defined in
your project.
Clicking Select Implant Type in the expert toolbar / context menu opens the Select Implant Type window (see Figure 18.1).
Figure 18.1: Select Implant Type window

To change the implant type for a tooth:
Step 1: Select a tooth by clicking it in the tooth bow. The selected tooth turns red. If available, reconstruction and implant
type details for this tooth are displayed at the bottom of the window.
Step 2: Select an implant type from the Implant type drop-down menu (see Chapter 27.8 for details on implant types).
To remove a tooth, select the desired tooth and click Remove tooth.
To confirm all your changes in the implant setup and close the Select Implant Type window, click OK. Clicking Cancel dis-
cards all changes and closes the window. If you have added an implant for a tooth which is near the mandibular canal region,
and you have not yet defined the canal, the mandibular canal definition step (see Chapter 10) will appear in the further work-
flow (again).
Changes in the implant setup will not change the project file definition, but the updated setup will be saved in the planning
result files. Changing the implant setup possibly deletes already placed tooth models and/or implant parts. The reconstruc-
tion type for a tooth automatically changes when you add/remove an implant.
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19 Generating Planning Result Files
In this final step of the implant-planning work-

flow, you generate the planning result files. NAVIGATION
These files contain all information on the fi-
nal implant planning state and can be used
Generate Planning Result Files
for creating surgical guides, or for designing
restorations in another software (e.g. exo- This step is part of the guided
cad DentalCAD). The planning result files gen- wizard workflow (see Chapter 22.3)
eration step is available if you have positioned
all implants defined for your project in the implant positioning step (see Chapter 14). For creating provisional result files be-
fore you have positioned all implants, see Chapter 19.3.
For details on planning result files, see Chapter 27.9.
Figure 19.1: Planning result files generation screen

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19.1 Step-by-Step
To generate planning result files, you must first approve the planning result in the Approval of Planning dialog (see
Figure 19.2).
Figure 19.2: Approval of Planning dialog

This dialog consists of two sections:
Patient information section: patient information specified in the CT data and in the project file, for ensuring you are
using the correct CT data for the patient.
Approval content section: planning approval statements you confirm by approving the implant planning result.
Read the statements in the dialog carefully and confirm only if you agree with all listed items.
To generate the planning result files, click the approval checkbox to confirm you have read the statements and will handle the
planning result files carefully. This activates the button I agree. Click I agree to confirm your planning result and to initiate
the planning result files generation process.
Alternatively, click Cancel to close the Approval of Planning dialog. You can check the planning result in the views and
modify the result, if necessary. To initiate the planning result files generation, click Generate Output in the Generate Plan-
ning Result Files dialog (see Figure 19.3).
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Figure 19.3: Generate Planning Result Files window
Generating the implant planning result files can take some time. The duration of this process depends on the size of loaded
meshes and the number of implants. When the process is complete, the Generate Planning Result Files window is up-
dated (see Figure 19.4).
Figure 19.4: Generate planning result files window after completed files generation process
The window now provides the following functions:

Show Report Open the implant planning report (PDF file).
Open Output Directory Open the project directory where exoplan saves the planning result files.
OK Close the Generate Planning Result Files dialog, keep the planning result files.
Cancel Close the Generate Planning Result Files dialog. exoplan prompts you to
decide if you want to delete the previously generated planning result files from
the project directory.
Table 19.1: Generate planning result files window functions
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If you change implant positions or settings in exoplan and save the result, existing planning result files will not be updated.
If you change your implant planning result (e.g. by removing tooth models, deleting the mandibular canal, remove/add im-
plants), existing planning result files for the current project and jaw will be deleted in the project directory, and you must
regenerate them. All files with implantplan in the filename will also be deleted, even if they are not planning result files.
The project directory only contains the last generated set of planning result files (or no planning result files, if they were
deleted). You can access previous planning result files in the archive directory. See Chapter 27.9 for more information.
19.2 Aborting the Planning Result Files Generation Process

During generation of the planning result files, the Generate Planning Result Files window as shown in Figure 19.5 is dis-
played.
Figure 19.5: Generate planning result files window during files generation
Click Abort Writing to abort the files generation process. This opens the Abort Output Writing dialog shown in
Figure 19.6.
Figure 19.6: Abort Output Writing dialog
To confirm, click Abort. Planning result files already generated during this process will be deleted. To continue the planning
result files generation process, click Resume.
Clicking Cancel in the Generate planning result files window during files generation also aborts the process and opens
the Abort Output Writing dialog, but closes the Generate planning result files window.
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19.3 Generating Provisional Planning Result Files for Individual Implants

In expert mode, you can generate provisional planning result files for individual implants, even if you have not yet positioned
all implants:
Step 1: In expert mode, click one of the positioned implants in the main view while no workstep is open. To select
multiple implants, hold CTRL while clicking the desired implants.
Step 2: Select Generate Planning Result Files in the expert toolbar. This opens the Approval of Planning dialog (see
Figure 19.2).
Step 3: Approve your planning result. exoplan will generate planning result files for all positioned implants. The planning
result files will be marked as provisional, indicating that not all implants are considered.
19.4 Errors During Planning Result Files Generation

If errors occur during planning result files generation, all planning result files which have already been created in this gener-
ation process will be deleted. In the appearing dialog (see Figure 19.7), you can try to generate the planning result files again
by clicking the corresponding button. exoplan saves a file with the error messages to the project directory. Additionally, its
content is copied to the clipboard, so you can send it to your support partner.
Figure 19.7: Dialog planning result files generation errors

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20 Creating Surgical Guides
You can create surgical guides with exoplan if the Surgical Guide add-on module is activated on your exoplan dongle. For
information regarding add-on modules and purchase/installation, please contact your exoplan reseller.
This chapter describes how to create a surgical guide using the wizard workflow. You can select the worksteps individually
using the expert mode. See Chapter 22 for details on the wizard/expert mode.
WARNING
Please note that manufactured surgical guides for endosseous dental implant placement are clas-
sified as medical devices by the FDA, regulated under 21 CFR 872.3980. As such, they are subject to
legal requirements such as registration and listing as a manufacturer of medical devices, validation
of production equipment/processes and quality system regulations.
WARNING
Verify the surgical guide manufacturing process and the surgical guide before using it for the
treatment of patients.
When the surgical guide bridges over multiple missing teeth, make sure that the solid fit of the
surgical guide is still ensured and that it does not bend under load. In particular, this applies
for multiple canine and incisors.
HINT
Produce surgical guides for testing and ensure that they fit firmly on a corresponding model and
that the implants are placed in the correct position. Ensure that no relevant deviations exist.
20.1 Initiating Surgical Guide Design

Once you have finished the implant planning workflow, you can select Design surgical guide in the wizard window to directly
proceed with the surgical guide design.
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Figure 20.1: Last wizard step in implant planning workflow
20.2 Drilling Sleeve Placement

If you have already positioned a drilling sleeve during the implant-planning process in the Sleeve Placement step, this wizard
step will not appear in the surgical guide design process. If you have not yet positioned a drilling sleeve, this step will allow
you to do so as described in Chapter 15.
20.3 Designing the Sleeve Mounts

Figure 20.2: Design Sleeve Mounts step
Design the surgical guide sleeve mounts using the sliders.
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Minimum Base Thickness: Set the mount’s minimum thickness (radius), measured to the beginning of the smoothed
edge area.
Additional Rounding: Set the radius for smoothing the mount’s edges.
Height: Set the mount’s height.
Clearance above: Set an area above the mount which will remain clear for the drilling tool(s). If parts of your surgical
guide design enter this area, they will be removed during finalization. By default, this area is locked to the drilling sleeve
diameter. To unlock the value, click the lock icon.
Radial sleeve offset: Set an additional radial sleeve offset which will be considered during production.
Custom implant rotation marker: If implants in the scene have a rotation marker defined in the implant library, a
marker is automatically created on the sleeve mount so that the dentist can correctly align the connection of the im-
plant during insertion. If there are implants in the scene that do not have their own rotation markers (on the implants
themselves), you have the possibility to create additional markers for these implants (deactivated by default). There
are two ways to create additional markers:
1. aligned at one corner of the hex
2. aligned with one edge of the hex
These markers are always generated vestibularly, if possible.
WARNING
The Minimum Base Thickness of a sleeve mount is a crucial parameter for the stability of a
surgical guide. If the value is too low, the surgical guide may bend or break under load. Please
regard that a suitable value for the minimum thickness is dependent on the material intended
for surgical guide manufacturing.
Hint: Check the minimum requirements specified by the material manufacturer and ask your
reseller if you are in doubt.
Use the Clearance Above function with care and choose a value appropriate for the selected
tools for surgery.
The Radial sleeve offset value is dependent on the material/printer combination used for
surgical guide manufacturing and requires experience with used material and equipment.
Wrong settings result in an ill-fitting surgical guide.
NOTE
The accuracy of the radial sleeve offset is 0.01mm. This means that the virtual gap of the drilling
sleeve to the surgical guide may deviate by 0.01mm.
HINT
Check the recommendations of the printer and the material manufacturers and ask your reseller
for further recommendations.
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Figure 20.3: Sleeve mount in main view
20.4 Designing the Surgical Guide’s Bottom

20.4.1 Bottom Design Properties
Figure 20.4: Design Surgical Guide Bottom step
Design the surgical guide’s bottom using the sliders in the Properties tab.
Block out undercuts

Offset: Set an offset from the teeth to the bottom surface.
Allow undercuts up to: Set a maximum value for allowed undercuts. Undercuts are displayed on the surgical
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guide bottom in colors.

Bottom properties
Smoothing: Set a value for smoothing the surface. The higher the value, the smoother the surface.
Click Apply to apply changes in the properties and to generate the surgical guide’s bottom. Once generated, the bottom is
displayed on the jaw scan with colored undercut visualization.
Figure 20.5: Surgical guide bottom with undercut visualization
NOTE
The accuracy of the desired offset of the surgical guide bottom to the jaw scan is 0.1mm in smooth
areas. In regions with spikes (typically scan data artifacts), the offset may deviate by a larger value.
20.4.2 Free-Forming
Using the functions in the Free-Forming tab, you can free-form the surgical guide’s bottom.
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Figure 20.6: Free-Forming tab
Click Add/Remove to add or remove material. Move your mouse over the surgical guide’s bottom with the left mouse
button pressed to add material, additionally hold SHIFT to remove material.
Click Smooth/Flatten to smooth the bottom surface. Move your mouse over the surgical guide’s bottom with the left
mouse button pressed to smooth the material, additionally hold SHIFT for super-smoothing.
In the Brush section, you can define the brush strength and size using the corresponding sliders. You can also select the
brush type and choose default, point of knife, or cylinder. By unchecking Show Brush, you can hide the brush visualization.
SHORTCUTS
1 Activate Add/Remove
2 Activate Smooth/Flatten
3 Small region
4 Huge region
F2 Select default brush type
F3 Select point of knife brush type
F4 Select cylinder brush type
20.4.3 Insertion Direction

While in Properties tab, the green arrow in the main view shows the insertion direction.
Figure 20.7: Insertion direction
Set the insertion direction by dragging the top of the arrow. Alternatively, you can set the insertion direction from view: set
the view so that you look onto the scan from the desired insertion direction (clicking the icon next to Set insertion direction
from view sets the view to the current insertion direction) and click Set insertion direction from view.
Click Apply to apply a new insertion direction and to generate the surgical guide’s bottom.
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WARNING
Carefully inspect the impact of a particular setting of the insertion direction, blocking or allowing
undercuts or smoothing of the bottom. Inappropriate settings may result in an ill-fitting surgical
guide.
HINT
The surgical guide should have enough (non-blocked) support on the occlusal surface of the neigh-
boring teeth. Ideally, the tooth surface is not blocked out from the occlusal surface down to the
equator.
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20.5 Designing the Surgical Guide’s Top

Define the borders of the surgical guide’s top by clicking the scan along the desired margin lines. Double-click to close a
margin line.
Figure 20.8: Margin lines for the surgical guide top
You can move points on a margin line by dragging them with your mouse. To delete a point, hold the left mouse button and
right-click the point. To add a point, click the margin line at the desired position.
Figure 20.9: Design Surgical Guide Top step
Click Clear to delete any margin line definition. With Undo/Redo, you can undo/redo actions. Use the sliders Thickness
and Smoothing to define the surface properties of the surgical guide’s top.
Click Apply to initiate the surgical guide top generation.
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Figure 20.10: Surgical guide top design
You can still edit the margin lines once the surgical guide top is generated. If parts of the surgical guide top reach into the
area above the drilling sleeve which should remain clear for milling tools as per definition in the Design Surgical Guide Sleeve
Mounts step (see Chapter 20.3), these parts will be cut off automatically when finalizing the surgical guide design. You must
not remove them manually.
WARNING
Insufficient connection of the surgical guide top to the sleeve mount may cause the surgical
guide to bend or break during the surgical procedure.
Do not include soft tissue (e.g. gingiva) in the design of the surgical guide top while defining
the surgical guide top margin line.
HINT
Check the thickness of the surgical guide when the surgical guide has been merged into one piece.
If you are not satisfied with the merged surgical guide or have doubts about the stability of the
merged surgical guide, go back to Design Surgical Guide Top and redraw the margin line or in-
crease the thickness of the surgical guide. Additionally, you can increase the radial thickness of
the sleeve mount in the Design Sleeve Mounts window.
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20.6 Adding Window/Support/Text

You can add supports or cut out windows using predefined shapes. You can also add a text label to the surgical guide’s surface.
Figure 20.11: Add and Remove Structures step
To add a support/window:
Step 1: Select a support/window shape (rectangular/round) in the Structure dropdown menu.

Step 2: Move the support/window shape to the desired position on the surgical guide with your mouse.
Step 3: Click to set the support/window at the current mouse position.
Step 4: Using the sphere handles, you can adjust the support’s/window’s length and rotation.
To add text:
Step 1: Select Text (embossed)/(debossed) in the Structure dropdown menu.

Step 2: Type the desired text into the text field. Using the sliders below the text field, you can change the font size and
thickness.
Step 3: Click Add.
Step 4: Move the text to the desired position on the surgical guide and click to set it.
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Figure 20.12: Options for supports/windows/text
Once you have set a window/support/text, you can still change its position by dragging it with your mouse. To add a new
window/support/text, click New. To delete a window/support/text, click Delete. Click Delete all to delete all existing sup-
ports/windows/text.
To view a preview of the result, click Preview. Clicking this button again will bring you back to editing mode. The sup-
ports/windows/text will finally be applied when proceeding to the next workflow step (Merging and Saving).
WARNING
Use the Add structures / Remove structures function with care because it may impact the sta-
bility and fit of the surgical guide.
HINT
Preferably choose several but smaller inspection windows and check the thickness of the surgical
guide when the surgical guide has been merged into one piece. Go back and change inspection
windows if you are not satisfied with the merged surgical guide or have doubts about the stability
of the surgical guide.
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20.7 Merging and Saving

When you enter this wizard step, merging and saving the surgical guide design is initiated automatically. You can abort the
merging process by clicking Cancel Merging, or restart it by clicking Restart Merging.
Figure 20.13: Merging in progress
exoplan merges all parts of the surgical guide into one single mesh and saves it as stl file in the project folder.
Figure 20.14: Merging completed
NOTE
The fit of the surgical guide on the surgical guide bottom has an accuracy of 0.01mm in smooth
areas. In regions with spikes (typically scan data artifacts), the fit may deviate by a larger value.
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20.8 Free-Forming the Merged Surgical Guide

After merging, you can edit the surgical guide using free-forming functions. You cannot free-form the contact surface with
the drilling sleeve and the contact surfaces with the teeth.
Figure 20.15: Free-form Merged Surgical Guide step
20.8.1 Free-Form Tab

The Free-Form tab provides the same free-forming functions as described in Chapter 20.4.2. By unchecking Visualize thick-
ness, you can hide the colored thickness visualization on the surgical guide. Using the range sliders, you can adjust the range
of visualized thickness measures.
WARNING
Use the Free-Form tool with care because it may impact the stability and fit of the surgical guide.
HINT
You will directly see the impact of freeforming the merged surgical guide’s geometry. Carefully
check the freeforming results and preferably add material. When smoothing or removing material,
carefully check the result for sufficient stability and undo any changes if you are in doubt or not
satisfied with the result.
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20.8.2 Anatomic Tab
Figure 20.16: Free-form Merged Surgical Guide step - Anatomic tab
In the Anatomic tab, you can edit a small region or a huge region of the surgical guide by selecting the corresponding button
and dragging your mouse. You can adjust the thickness visualization as in the Free-Form tab.
20.9 Generating the Surgical Guide Result Files
Figure 20.17: Generate Surgical Guide Result Files step
When you enter the Generate Surgical Guide Result Files, exoplan generates the surgical guide result files automatically
and saves them to the project directory. Once generated, you can select to view the surgical protocol or to open the project
directory. If you have created surgical guide result files and apply certain critical changes to the corresponding implant plan-
ning or the surgical guide design afterwards, exoplan will delete those surgical guide result files.
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WARNING
Note! In the US, the physical surgical guide for endosseous dental implant placement is a medical
device to be manufactured at an FDA registered and listed manufacturing location. Please contact
the FDA for information regarding the regulatory status and requirements related to manufactur-
ing these surgical guides.
20.9.1 Surgical Protocol

The surgical protocol is a PDF file which contains all relevant information about the project’s defined implants and equip-
ment. This includes information about implants and drilling sleeves (model, manufacturer, diameter/length, etc.) as well as
information about surgical kits and drills (type, length, etc.). Furthermore, the surgical protocol includes patient information
(name, birth date, etc.).
WARNING
Validate the surgical protocol document before commencing the surgical procedure.
Do not modify the files created for the manufacturing of the surgical guide.
You must carefully study the surgical protocol.
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21 Saving a Scene / Closing a Project
21.1 Saving a Scene

You can save scenes in expert mode while no workflow step is open. You cannot save scenes in wizard mode or while in a
workflow step with incomplete result.
Step 1: Click Save in the main toolbar (see Chapter 24.1), or right-click the background in the main view and select Save
scene as in the context menu (see Chapter 24.3).
Step 2: Save the scene in the desired directory.
If scene files already exist for the current project, you must decide how to proceed in the dialog shown in Figure 21.1.
Figure 21.1: Save scene dialog
You can save a scene also as STL, OFF, OBJ, and as point cloud formats. To do this, select Save scene as in the context menu
(see Chapter 24.3) and select the desired format from the file format dropdown list in the explorer window.
SHORTCUT (only available in Expert mode)

CTRL + S: Save scene to project directory
21.2 Closing a Project

Step 1: Right-click in the main view to open the context menu (see Chapter 24.3).
Step 2: Select Close project.
Step 3: Confirm you want to close the project in the Close project dialog
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22 Wizard Mode vs Expert Mode
You can use exoplan in two modes: wizard mode and expert mode. Wizard mode guides you through the worksteps of the
implant planning process, whereas in expert mode you can jump freely between worksteps.
To switch between expert and wizard mode, click Wizard / Expert in the main toolbar (see Figure 22.1). You can switch from
wizard to expert mode any time, however switching from expert to wizard mode is only possible if no workstep is open.
(a) Switch to wizard mode (b) Switch to expert mode
Figure 22.1: Mode selection in main toolbar
When returning to wizard mode, the wizard will start at the point where you left it.
22.1 Expert Mode

In expert mode, you can jump freely between the implant planning worksteps by selecting them in the expert toolbar (see
Chapter 22.1.1) or in the context menu (see Chapter 22.1.2).
22.1.1 Expert Toolbar

Access the expert toolbar by hovering your mouse over the lighter-colored line at the bottom of the exoplan screen. The
expert toolbar (see Figure 22.2) slides open and you can select a workstep/option by clicking the corresponding icon. The
next workstep in the wizard steps sequence (see Chapter 22.3) is highlighted in orange. The available worksteps/options
vary depending on the progress in the implant-planning workflow.
Figure 22.2: Expert toolbar

See Chapter 24.2 for a detailed description of the available expert toolbar options.
22.1.2 Context Menu

To access the context menu, right-click the main screen. The available worksteps in your current planning state are listed in
the top section of the menu (see Figure 22.3). The available steps vary depending on your progress in the implant-planning
workflow.
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Figure 22.3: Context menu with expert options
The context menu has the same options as the expert toolbar, but in a different order. The next workstep in the wizard steps
sequence (see Chapter 22.3) is highlighted in bold. See Chapter 24.3 for a detailed description of the context menu and its
options.
22.2 Expert Window vs Wizard Window

In expert mode, selecting a workstep via the expert toolbar or the context menu opens the expert window for this workstep.
In wizard mode, the wizard window for the current workstep of the guided implant-planning workflow is displayed at the
bottom left corner. While you can drag expert windows to any position, the wizard window is fixed at its position.
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(a) Wizard window (b) Expert window
Figure 22.4: Expert and wizard window - examples
The window header shows the current workstep. Clicking the ? symbol opens the exoplan User Manual.
The main window section are explanations and functions for performing the current workstep (same in both windows).
22.2.1 OK/Cancel vs Back/Next

In expert windows, clicking OK closes the window and saves the settings for this workstep. Clicking Cancel also closes the
window, but discards all settings specified since you have started the workstep.
In wizard windows, clicking Back returns you to the previous wizard step. All settings done in the current wizard step are
discarded (just as when clicking Cancel in an expert window). Clicking Next takes you to the next wizard step. The settings
for the current workstep are saved (just as when clicking OK in an expert window).
The Back function is not available in a wizard window if

you have loaded a scene and want to return to a workstep performed before the scene was saved.
you want to return to the DICOM series selection step (see Chapter 4). Once you have loaded a DICOM series and
continue in the workflow, you cannot retrospectively select a different series.
you have made certain changes in expert mode and return to wizard mode. For example, if you have deleted tooth
models in expert mode, you cannot return to the precise placement step in wizard mode as there are no longer any
tooth models.
In these cases, return to past worksteps (except DICOM series selection step) in expert mode.
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22.3 Wizard Steps

The wizard mode guides you through the worksteps of the implant-planning workflow. Table 22.1 lists the wizard steps in
chronological order.
Wizard step Description
Load CT Data Load a DICOM series (see Chapter 4.2).
The DICOM series selection dialog and the DICOM Control are opened automatically.
You cannot return to this wizard step once you continue in the workflow.
Define Density Define density references (see Chapter 6).

References
If density references have already been saved for your project, this step will not appear
in the wizard. You can access it in expert mode.
Axial and View Define axial and view direction (see Chapter 7).
Direction
CT Data Alignment Align CT data to the jaw scan or another alignment object (see Chapter 8).
This wizard step only appears if you have loaded at least one alignment object.
Clicking Next during 3-point alignment will perform the 3-point alignment and take
you to the best fit alignment. Clicking Next during best fit alignment will perform the
best fit alignment. Clicking Back during best fit alignment will bring you back to the
3-point alignment.
Define Panoramic Define the panoramic curve (see Chapter 9).

Curve
Change Implant Type This step only appears if no implants are defined in your project. Define at least one implant
to continue. See Chapter 18 for details.
Define Mandibular Define the mandibular canal (see Chapter 10).

Canal
This wizard step only appears if you are planning implants for tooth numbers in
immediate vicinity of the mandibular nerve.
Place Model Teeth Place tooth models initially (see Chapter 11).
If you have loaded a waxup scan, this wizard step (and the next wizard step) will not
appear.
If you have defined only one bridge in your project, clicking Next takes you to the next
wizard step. If you have defined multiple bridges, clicking Next takes you to the next
bridge (in sequence from lowest to highest tooth number).
Tooth Placement Place tooth models precisely (see Chapter 12).
This wizard step only appears if you have placed tooth models initially in the previous
step.
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Wizard step Description
Define Density Define a density threshold value (see Chapter 13).

Threshold
If a density threshold has already been saved for your project, this step will not appear
in the wizard. You can access it in expert mode.
Implant Positioning Position implants (see Chapter 14).
If you have defined multiple implants in your project, clicking Next selects the next
unpositioned implant (along the tooth bow).
Sleeve Placement Select and position drilling sleeves (see Chapter 15).
Generate Implant Generate the planning result files (see Chapter 19).
Planning Files
This wizard step is available if you have positioned all implants in the previous step.
Table 22.1: Wizard steps
You cannot save a scene in wizard mode. See Chapter 21.1 for information on how to save a scene.
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23 Views
The available and displayed views in exoplan depend on the progress in the implant-planning workflow and on the current
workstep.
There are two types of views:
1. Main view (see Chapter 23.1)
2. Secondary views (see Chapter 23.2)
In certain workflow steps, exoplan arranges the main view and the secondary views automatically, e.g. when defining the
mandibular canal (see Chapter 10). You can change the view arrangement using the Implant Control (see Chapter 25.2) or by
choosing a different view preset (see Chapter 23.7).
23.1 Main View

The main view displays the DICOM series and scene objects as 3D visualizations. It is displayed throughout the whole work-
flow, unless you are selecting a secondary view in Singular view arrangement (see Chapter 25.2.1).
Figure 23.1: Main view showing DICOM series visualization and scene objects
The main view can show all elements you created or loaded during the implant-planning process. You can show/hide these
elements (so-called scene objects) using the Group Selector (see Chapter 25.1).
The main view can show:
DICOM series visualization (adjustable via DICOM Control, see Chapter 5)
optical scans (e.g. jaw scan, antagonist scan)
library tooth models
mandibular nerves
implant parts
other objects (e.g. annotations, collision objects, insertion channels, etc.)
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23.1.1 View Functions
Scroll mouse wheel Zoom in/out (zoom center = mouse position)
Hold right mouse button and drag Rotate the view around the rotation center (center of currently available scene
objects by default)
Right-click outer frame and drag Rotate the view around the view axis which is running through the rotation
center (center of currently available scene objects by default)
Click middle mouse button / mouse Center view and set new rotation center
wheel
Hold both mouse buttons and drag Move the view freely
Arrow keys Move the view in the respective arrow directions
Page up, page down Rotate the view horizontally around pivot
Table 23.1: Main View functions
SHORTCUTS
CTRL+R: open Measurement Tool (see Chapter 26.1)

CTRL+V: show Group Selector window
CTRL+S: save a scene
Numpad 1: back view
Numpad 2: bottom view
Numpad 3: front view
Numpad 4: left view
Numpad 5: focus the view to the selected object or all main view elements
Numpad 6: right view
Numpad 8: top view
F11: window maximization mode
At the bottom of the main toolbar (see Chapter 24.1), view perspective buttons are avail-
able. Click these buttons to set certain predefined view perspectives.
The main view functions are not available in the panoramic curve definition step (see Chapter 9).
23.1.2 Secondary View Indicators

View indicators show the current positions of active secondary views relative to the DICOM series visualization. The indicators
are rectangular frames in the view-specific color. The indicator for the panoramic view (see Chapter 23.5) is shaped like the
panoramic curve (i.e. the jaw ridge).
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Figure 23.2 shows the main view with the DICOM series visualization and view indicators of the axial view and the curve cut
view.
1}
m
2}
m
3}
m
Figure 23.2: Main view with DICOM series visualization and view indicators
1}
mAxial view indicator
2}
mCurve cut view indicator
3}
mView intersection marker
Show/hide view indicators in the secondary view visualization settings (see Chapter 23.2.3).
A cursor indicator in the view-specific color displays the current mouse position in a secondary view (see Figure 23.3; also
displayed if view indicator is hidden).
Figure 23.3: Main view with cursor indicator
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23.2 Secondary Views

Secondary views show different 2D sectional views of the DICOM series, and display certain scene objects. Available sec-
ondary views depend on the progress in the implant-planning workflow and current workstep.
Secondary views are:
Axial-oriented views (see Chapter 23.3): axial, saggital, coronal
Panoramic curve-based views (see Chapter 23.4): curve cut, curve tangent
Panoramic view (see Chapter 23.5)
Implant-based views (see Chapter 23.6): Implant cross, Implant axial
Select secondary views for display using the Implant Control (see Chapter 25.2) or the view preset buttons (see Chapter 23.7).
23.2.1 Secondary View Elements
4}
m
2}
m
1}
m
5}
m
6}
m
7}
m
3}
m
Figure 23.4: Secondary view example

1}
mDICOM series and scene object visualization
2}
mFrame
3}
mRuler for size indication
4}
mOrientation preview
5}
mVisualization settings menu
6}
mFocus button
7}
mVisualization mode buttons
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The secondary view’s main part 1} mshows the 2D sectional view of the DICOM series, and scene object visualizations. In
sectional views, you can change the cut position using the view-specific functions (see view-specific chapters). Furthermore,
you can change contrast and brightness settings for improving the visualization, if necessary (see Chapter 23.2.5).
Other secondary view elements:
Each secondary view has a uniquely colored frame 2} m . The frame color is also used for the view indicators in the main
view (see Chapter 23.1.2), for the view intersection markers (see Chapter 23.2.6), for the view indications in the Implant
Control (see Chapter 25.2), and in the view presets of the main toolbar (see Chapter 23.7).
The orientation preview 4} m shows the current orientation of the 3D DICOM series visualization. The perspective is as if
you are looking onto the cross-sectional plane. If you move the cross-section’s location, the orientation preview moves
accordingly. This feature is not available in the panoramic view.
Using the visualization settings menu 5}m , you can define settings for the secondary view visualization and its repre-
sentation in the main view (see Chapter 23.2.3).
Using the focus button 6}m , you can set the view as focused view (see Chapter 25.2.1 for details on view arrangements).
Clicking the focus button in a focused view unfocuses the view and puts the main view in focus.
Using the visualization mode buttons 7}
m, you can define the visualization mode of sectional views (see Chapter 23.2.4).
23.2.2 Scene Objects in Secondary Views

Show/hide scene objects using the Group Selector (see Chapter 25.1). Scene objects are displayed in 2D or 3D (view-dependent).
Which scene objects can be displayed in a secondary view is view-dependent.
23.2.3 Visualization Settings

Open the visualization settings menu by clicking the top button in the view’s right frame (see Figure 23.4).
Setting Description
Show Grid Display a grid (square size 10mm x 10mm)
Clip CT data by cut plane Clip the 3D DICOM series visualization in the main view at the current secondary
view position
Turn Around Turn the view 180 degrees in horizontal direction, so that you can quickly switch
the view to the opposite side. Also turns around the cut plane in the main view, if
Clip CT data by cut plane is activated.
Activate Orientation Preview Show/hide orientation preview
Show Indicator Show/hide the view indicator in the main view (see Chapter 23.1.2)
Show View Intersection Markers Show/hide intersections with other currently active secondary views (see
Chapter 23.2.6)
Table 23.2: Visualization settings functions
In the panoramic view, only Show Indicator and Show View Intersection Markers are available.
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23.2.4 Visualization Modes
1}
m
Select a visualization mode by clicking the corresponding visualization mode but-
ton in the secondary view’s right frame (see Figure 23.4). The visualization modes
correspond to those available in the DICOM Control (see Chapter 5.2).
The currently active visualization mode has a white frame. Only one visualization
mode can be active at once. 2}
m
Available visualization modes are:
Solid 1}
m
Solid (natural) 2}
m
To display the secondary view’s visualization as a texture in the main view, click
the texture visualization button 3}
m .
3}
m
In Implant cross view, a third visualization mode is available; see Chapter 23.6. The panoramic view has special visualization
modes; see Chapter 23.5.
23.2.5 Contrast and Brightness Settings

Contrast and brightness in secondary views are determined by the size and position of the current CT data window (see Chap-
ter 5.2.5).
To change the brightness, hold CTRL and scroll the mouse wheel. This changes the position of the currently displayed
CT data window.
To change the contrast, hold SHIFT and scroll the mouse wheel. This changes the size of the currently displayed CT
data window.
The panoramic view has special contrast/brightness settings; see Chapter 23.5.3.
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23.2.6 Secondary View Intersections

By checking Show View Intersection Markers in the visualization settings menu (see Chapter 23.2.3), you can visualize
intersections with other currently active secondary views. These intersections are displayed as solid lines in the view-specific
color.
Figure 23.5 shows the axial view with two intersection markers:
2}
m
1}
m
Figure 23.5: Axial view with intersection markers
1}
mcoronal view intersection marker
2}
mcurve cut view intersection marker
You can change the cut position of a corresponding secondary view by dragging the spheres at the intersection marker’s ends.
These spheres are not available for all intersection markers.
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23.3 Axis-oriented Views: Axial, Saggital, Coronal

The axis-oriented views are available when the panoramic curve has been defined in the panoramic curve definition step (see
Chapter 9).
The axis-oriented views show the axial, saggital, and coronal cross-section view of the DICOM series. They are based on the
axial and view direction you have defined in the axial and view direction definition step (see Chapter 7).
(a) Axial (b) Saggital
(c) Coronal
Figure 23.6: Axis-oriented views
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Scroll mouse wheel Zoom in/out
Hold mouse wheel + move mouse Drag the view
Axial view: Move along axial axis

Hold right mouse button + move mouse up/down
Saggital view: Move along saggital axis

Coronal view: Move along coronal axis

Hold right mouse button + move mouse right/left
Table 23.3: Secondary View functions
23.3.2 Scene Object Visualization

Scene objects are displayed as outlines in 2D. Figure 23.7 shows the axes-oriented views with implant parts, jaw scan, and
mandibular canal visualization.
(a) Axial (b) Coronal (c) Saggital
Figure 23.7: Axis-oriented views with scene objects

You can use the axis-oriented views to check and evaluate the result of the CT data alignment (see Chapter 8.3.1). If the
jaw scan visualization fits the DICOM series visualization well (jaw outlines fit well the tooth line), this is an indicator for the
alignment being accurate.
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23.4 Panoramic Curve-Based Views: Curve Cut, Curve Tangent

The panoramic curve-based views are available when the panoramic curve has been defined in the panoramic curve defini-
tion step (see Chapter 9). They show a sectional view orthogonal to the panoramic curve (curve cut) and tangential to the
panoramic curve (curve tangent).
(a) Curve cut (b) Curve tangent
Figure 23.8: Panoramic curve-based views
Hold mouse wheel + move mouse Drag the view. In curve tangent view, vertical dragging is
restricted to the panoramic curve’s course
Hold right mouse button + move mouse right/left Move sectional/tangential along panoramic curve
Table 23.4: Panoramic Curve-based view functions

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Scene objects are displayed as outlines in 2D. Figure 23.7 shows the views with implant parts, jaw scan, and tooth model
visualization.
(a) Curve Cut (b) Curve Tangent
Figure 23.9: Panoramic curve-based views with scene objects
You can use the panoramic curve-based views to check and evaluate the result of the CT data alignment (see Chapter 8.3.1).
If the jaw scan visualization fits the DICOM series visualization well (jaw outlines fit well the tooth line), this is an indicator
for the alignment being accurate.
23.5 Panoramic View

The panoramic view shows the panoramic image created in the panoramic curve definition step (see Chapter 9). It shows the
well-known X-ray panoramic image of the patient’s dental situation.
The panoramic view only displays the CT data between the depth indication lines (see Figure 9.2). If you define the mandibular
canal and/or position implants distant to this data range, distortions can occur in the panoramic view (X-ray mode).
Figure 23.10: Panoramic view
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1}
m
The panoramic view has special visualization modes:
X-ray 1}
m 2}
m
Cut mode 2}
m
To display the panoramic view as a texture (cut mode visualization) in the main
view, click 3}
m.
X-ray mode is the well-known panoramic X-ray image. Cut mode shows a
panoramic curve-shaped cross section view of the DICOM series.
3}
m
Hold mouse wheel + move mouse Drag the view
X-ray mode: Hold right mouse button Switch to cut mode (+ move mouse up/down to move
between depth indication lines)
Cut mode: Hold right mouse button + move mouse Change the cut position (shape-preserving)
up/down
Table 23.5: Panoramic View functions

In X-ray mode, scene objects are displayed in 3D. In cut mode, they are displayed as outlines in 2D. Figure 23.11 shows the
panoramic view with scene object visualizations.
(a) X-ray mode (b) Cut mode
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Figure 23.11: Panoramic view with scene objects
In the panoramic view, only implants (without attached parts) and mandibular canals can be displayed.
23.5.3 Visualization Settings

In X-ray mode, change the contrast by holding CTRL or SHIFT and scrolling the mouse wheel. This also changes the noise
threshold value for the DICOM series visualization in X-ray mode in the main view (see Chapter 5.2.2).
In cut mode, the standard contrast and brightness functions as described in Chapter 23.2.5 are available:
Hold CTRL and scroll the mouse wheel to change the brightness (change DICOM window position)
Hold SHIFT and scroll the mouse wheel to change the contrast (change DICOM window size)
23.6 Implant-based Views: Implant Cross, Implant Axial

The implant-based views are available if you have positioned at least one implant in the implant positioning step (see
Chapter 14). They show the currently focused implant.
The Implant cross view shows a sectional view along the implant axis. The Implant axial view shows a sectional view orthog-
onal to the implant axis.
In the upper right corner of the implant-based views, the tooth number of the focused implant is displayed.
(a) Implant cross (b) Implant axial

Figure 23.12: Implant-based views with implant visualization
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In addition to the default visualization modes (see Chapter 23.2.4), the Implant
Cross view has a third visualization mode: density threshold texturing 1}m . In this
mode, the DICOM series visualization is colored red and blue according to the den-
sity threshold you have defined in the density threshold definition step (see
Chapter 13).
1}
m
Implant cross: Rotate the view around the implant axis

Hold right mouse button + move mouse right/left
Implant axial: Move along the implant axis

Table 23.6: Implant-based view functions
Dragging the view is not possible in the implant-based views since they remain focused on the implant.
If you have positioned multiple implants, you can change the implant focused in the implant-based views by double-clicking
the desired implant in the main view.

Scene objects are displayed as outlines in 2D. In the Implant cross view, the focused implant is displayed in 3D.
Figure 23.13 shows the implant-based views with implant, jaw scan, and tooth model visualization.
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(a) Implant cross (b) Implant axial
Figure 23.13: Implant-based views with scene objects
In the Implant cross view, you can enable density threshold coloring for
implants in the implant positioning step (see Chapter 14). This can help
you to determine if you have positioned the implant in a potentially dense
enough area.
Figure 23.14: Implant with density threshold

visualization
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23.7 View Presets

By clicking a view preset button in the main toolbar (see Chapter 24.1), you can arrange the views according to a certain preset.
exoplan uses the view-specific frame colors to illustrate the arrangement in the view preset buttons.
Figure 23.15: View preset buttons in main toolbar
The available view preset buttons may vary depending on the progress in the implant-planning workflow and on the current
workflow step.
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24 Menus
24.1 Main Toolbar
The main toolbar is always displayed at the right side of the exoplan screen. Figure 24.1 shows
1}
m
the main toolbar with all possible options. These are only available if a project is loaded, and
partially dependend on the workflow progress.
1}
mSave current scene (see Chapter 21.1) 2}
m
2}
mSwitch to wizard/expert mode (see Chapter 22). Right-clicking shows additional options.
3}
mAccess tools (see Chapter 26)
3}
m
4}
mActivate/deactivate TruSmile¹
5}
mShow/hide Implant Control (see Chapter 25.2)
4}
m
6}
mShow/hide Group Selector (see Chapter 25.1)
7}
mShow/hide DICOM Control (see Chapter 5)
8}
mOpen user manual 5}
m
9}
mView preset buttons (see Chapter 23.7)
10}
mView perspective buttons (see Chapter 23.1)
6}
m
7}
m
8}
m
9}
m
10}
m
Figure 24.1: Main toolbar
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24.2 Expert Toolbar

The expert toolbar is only available in expert mode (see Chapter 22.1). It slides open when hovering the mouse over the
lighter-colored bottom line of the screen.
The expert toolbar shows expert mode options. The options available depend on the progress in the implant-planning work-
flow. Figure 24.2 shows the expert toolbar at the end of the workflow with all available options.
1}
m 2}
m 3}
m 4}
m
Figure 24.2: Expert toolbar
1}
mAccess worksteps
2}
mDelete implants (see Chapter 16)
3}
mDelete constructed parts (see Chapter 17)
4}
mChange implant type (see Chapter 18)
After loading a DICOM series and a project, another option is available: Load Implant Settings. See Chapter 4.4 for details.
24.3 Context Menu

To open the context menu, right-click the main view.
(a) Wizard mode (b) Expert mode
Figure 24.3: Context menu
The available options in the context menu depend on whether you are in wizard or in expert mode (see Chapter 22). In wizard
mode, only the Save scene as option (see Chapter 21.1) and the Close project option (see Chapter 21.2) are available. In
expert mode, you can also access the worksteps and other options.
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25 Controls
25.1 Group Selector

Show/hide the Group Selector by clicking Show/Hide Groups in the main toolbar (see Chapter 24.1).
Using the Group Selector, you can show or hide scene objects. The main view displays all scene objects, whereas in the
secondary views not all scene objects can be displayed. Showing/hiding objects helps you to optimize the display of objects
needed at the particular stage of the implant planning process. Use the main view functions (see Chapter 23.1.1) to optimize
your view on the relevant scene objects.
The available scene objects depend on the progress in the implant-planning workflow. As you proceed with the planning,
the list will become more and more populated. Scene objects are grouped by type. Object groups can have subordinate
elements.
1}
m
2}
m
3}
m
Figure 25.1: Group Selector

Show/hide groups/elements by clicking the checkboxes 1}
m.
Change the opacity for a group / an element using the slider which appears when you hover the mouse over the group/element
2}
m(not available for DICOM element).
Right-click a group / an element for further group/element-specific options.
To show all scan data and tooth axes, click Show all 3} m . If all these objects are checked for display, this button is replaced
by Hide all, which will hide all scan data and tooth axes.
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SHORTCUTS
The following keyboard shortcuts toggle the visibility of the corresponding scene objects:
A antagonist
S Jaw scans
M Merged parts (merged parts must exist)
E Anatomic parts (tooth models)
W Waxup scans
D DICOM
P Pre-op scan
CTRL + middle-mouse button hides the object under the mouse pointer, CTRL + SHIFT + middle-
mouse button shows it again. SHIFT + middle-mouse button toggles the transparency of the ob-
ject under the mouse pointer.
WARNING
Ensure that all scene objects necessary for evaluating a scene are activated for visualization in the
Group Selector.
25.2 Implant Control

Using the Implant Control, you can select secondary views, arrange views, and view implant/drilling sleeve information.
Show/hide the Implant Control by selecting Implant Control in the main toolbar (see Chapter 24.1). The secondary views
selection is only available if you have selected CT data and defined the panoramic curve.
25.2.1 Implant Views Tab

Figure 25.2: Implant Control - Implant Views tab
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Select/deselect available secondary views for display by clicking the corresponding buttons in the Secondary Views section.
Select the view arrangement in the Arrangement section:
Singular: Displays only one selected secondary view or the main view.
Partitioned: Displays the selected views in equal-sized sections.
Focused: One of the views is the focused view in the left screen section, the other views are arranged in the right screen
section. You can change the focused view in the secondary view settings (see Chapter 23.2.1).
Panorama: The panoramic view is displayed in the bottom left screen section. The arrangement of additional views
is as with the focused arrangement, with the main view as focused view. If you change the focused view (see Chapter
23.2.1), the Implant Control will automatically deactivate the panorama arrangement and activate the focused arrange-
ment.
In the Options section, you can synchronize the panoramic curve-based views curve cut and curve tangent by checking Sync
curve attached views. This means that when moving one of these views, the other will move accordingly.
25.2.2 Implant Information Tab

The Implant Information tab shows model-related information about the positioned implant(s).
Figure 25.3: Implant Control - Implant Information tab
25.2.3 Sleeve Information Tab

The Sleeve Information tab shows model-related information about the positioned drilling sleeve(s).
Figure 25.4: Implant Control - Sleeve Information tab
25.2.4 Implant Angles Tab

If there are at least two implants in the scene, the Implant Angles tab shows the angles between the implants.
NOTE
The accuracy of the displayed angles is 0.5°.
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Figure 25.5: Implant Control - Implant Angles tab
The Implant Angles tab shows angles between the occlusal axes of the implants, as shown in Figure 25.5. In this example,
the angle between Implant 34 and Implant 44 is 23.29°. You can highlight angles between a specific implant and the other
implants by clicking an Implant button. In the example, Implant 35 is selected and the angles between Implant 35 and
Implant 34, Implant 44, and Implant 45 are highlighted.
25.3 DICOM Control

See Chapter 5 for a description of the DICOM Control.
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26 Tools
Access the tools in the main toolbar (see Chapter 24.1) by clicking Tools.
The following tools are available:
Measurement Tool to measure distances and angles

(see Chapter 26.1)
Add/Remove mesh to add/remove meshes

(see Chapter 26.2)
DICOM Control to open the DICOM Control

(see Chapter 5)
Annotations... to create and/or edit annotations /

project notes
(see Chapter 26.3)
Show project in explorer to open the project direc-

tory (see Chapter 26.4)
Settings to access the general exoplan settings

(see Chapter 26.5)
About to view software information

(see Chapter 26.6)
26.1 Measurement Tool

Using the Measurement Tool, you can measure distances and angles on scene objects in the main view and in sectional
secondary views.
In the panoramic view, you can measure distances/angles only in cut mode. Here, you can measure distances/angles in the
3D space of the DICOM series, but not along the panoramic curve. If you display the DICOM series as X-ray visualization,
distance/angle measurement points will be set to the outer border of the data block.
WARNING
When measuring distances in secondary views, be aware of the limitations of measurements in a
2D image plane within 3D space, e.g. when measuring a distance between two objects. Verify the
start and end point positions in the 3D visualization of the main view.
NOTE
The accuracy of measuring distances and angles depends on the accuracy of the input data. When
measuring distances/angles between CT data and mesh objects, the accuracy depends addition-
ally on the accuracy of the alignment.
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1}
m
3}
m
2}
m
4}
m
5}
m
6}
m
7}
m
8}
m 9}
m
Figure 26.1: Measurement Tool window
1}
mMeasure distances (see Chapter 26.1.1)
2}
mMeasure angles (see Chapter 26.1.2)
3}
mScene object of starting point
4}
mScene object of end point
5}
mShow/hide arrows
6}
mDisplay scene objects semi-transparent (no effect on DICOM series visualization in main view)
7}
mDistance/angle information
8}
mCreate annotations from the result (see Chapter 26.1.3)
9}
mClear all defined points
26.1.1 Measuring a Distance

Activate Distance and define the start and the end point by clicking the desired positions on the scene object(s). To redefine
the points, either drag and drop them, or select the corresponding button at the top of the Measurement Tool window and
click new positions.
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Figure 26.2: Distance measure
NOTE
The achievable accuracy for measuring distances on scene objects (no CT scans) is 0.01mm. The
achievable accuracy of measuring distances on CT scans depends on the quality of the input data.
The achievable accuracy is additionally limited by 0.1 x maximum_voxel_size when mea-
suring in isosurface or solid mode. When measuring distances of a CT scan to other scene objects,
the achievable accuracy additionally depends on the quality of the alignment.
26.1.2 Measuring an Angle

Activate Angle and define the start and the end point for a measurement as described in Chapter 26.1.1. Define the angle
center (yellow sphere) by clicking the desired position on a scene object. To redefine the points, either drag and drop them,
or select the corresponding button at the top of the Measurement Tool window and click new positions.
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Figure 26.3: Angle measure
NOTE
The achievable accuracy for measuring angles on scene objects (no CT scans) is 0.5°. The achiev-
able accuracy of measuring angles on CT scans depends on the quality of the input data. The
achievable accuracy is additionally limited by 0.1 x maximum_voxel_size when measur-
ing in isosurface or solid mode. When measuring angles of the CT scan to other scene objects, the
achievable accuracy additionally depends on the quality of the alignment.
26.1.3 Creating Annotations from Measurement Results

By clicking the annotation button in the Measurement Tool window, you can create an annotation from the current mea-
surement result. Clicking the button opens the Annotation editor window (see Figure 26.7). See Chapter 26.3 for details
on annotations.
26.2 Add/Remove Mesh

Using this tool, you can add and/or remove meshes. It is only available in expert mode.
Clicking Add/Remove Mesh in the tools menu opens the Add/Remove Mesh window (see Figure 26.4).
Figure 26.4: Add/Remove Mesh window
26.2.1 Adding a Mesh

Step 1: Select the type of mesh you want to load from the Select mesh type dropdown list (see Chapter 27.10 for details
on mesh types).
Step 2: Click Load.
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Step 3: Select the mesh in the appearing explorer window. Once selected, exoplan loads and visualizes the mesh.
Step 4: If required, move the mesh using the mesh placement options (see Chapter 26.2.2).
Step 5: Click OK.
If you are loading a mesh of type implant planning generic collision object, you cannot complete the loading process if there
is a collision (see Chapter 27.7). You must resolve the collision before you can close the Add/Remove Mesh window.
26.2.2 Mesh Placement Options

The Correct Placement section of the Add/Remove Mesh window (see Figure 26.4) shows mesh placement options. Which
options are available depends on the type of mesh you have loaded.
Correct height Change the mesh’s height position along the z-axis by
dragging it up/down
Correct position Change the mesh’s position in x/y direction by dragging it
Move freely Move the mesh freely by dragging it
Set color Define the mesh’s color (color selection via Choose color
button)
Table 26.1: Mesh placement options
At the bottom of the Correct Placement section, you can

move the mesh up or down along the z-axis with a specific
step size. Define the step size by using the slider or typing
in a value, and move the mesh by clicking Up/Down.
Check Allow resizing to allow scaling the mesh. To scale the mesh, hold SHIFT and drag the mouse in the desired scaling
direction, indicated by a green arrow. To perform direction-based scaling, hold CTRL and SHIFT. Although this option is
available per default, you cannot actually scale all mesh types.
Using Undo/Redo you can undo/redo mesh placement actions.
26.2.3 Generating a Plane

By clicking Generate Plane, you can generate a plane, e.g. to visualize the occlusal plane. This button is only available if
you select Generic visualization mesh or Antagonist as mesh type. You can position the plane using the mesh placement
options (see Chapter 26.2.2).
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26.2.4 Removing a Mesh

Step 1: Click Remove object(s). This opens the Remove meshes... window. It lists all existing meshes of the currently
selected mesh type.
Step 2: Check the checkboxes for meshes you want to delete.

Step 3: Click OK.
You cannot delete the mesh the CT data is aligned to (see CT data alignment step, Chapter 8).
26.3 Annotations
You can add annotations to scene objects in the main view. You cannot create annotations in secondary views.
Clicking Annotations... in the tools menu opens the Annotation editor window (see Figure 26.5).
1}
m
2}
m
Figure 26.5: Annotation editor window
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26.3.1 Adding an Annotation
Step 1: In the Add tab, type in your annotation text 1}

m.
Step 2: Click Set note position 2}

m.
Step 3: Click a scene object in the main view where you

want to position the annotation. The annotation
text will be displayed with an arrow pointing to
the defined note position (see Figure 26.6).
Change the annotation’s location or the text position by

dragging the spheres at the arrow’s end/tip. You can adjust
the arrow length using the corresponding slider.
Figure 26.6: Annotation
26.3.2 Editing Annotations

Select the Edit tab. It contains a list of all annotations (see Figure 26.7).
Figure 26.7: Annotation editor window - Edit tab
Select the annotation in the list and change the annotation text. You cannot edit annotations created in the Measurement
Tool (see Chapter 26.1). To delete an annotation, select it in the list and click Delete.
26.3.3 Adding Project Notes

The Project Notes tab displays project notes. You can add project notes by typing in text. These notes will be saved auto-
matically in the scene file, and will be displayed in the implant planning report.
26.4 Show Project in Explorer

Clicking Show project in explorer opens the file directory of the currently loaded project in an explorer window.
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26.5 Settings
Click Settings in the tools menu to open the Settings window (see Figure 26.8). In this window, you can view and change
general settings for your exoplan application. For applying certain changes, you must restart exoplan.
Figure 26.8: Settings window
26.6 About
Click About in the tools menu to open the About window. The window shows information about the exoplan software:
product version, copyright information, engine build number, and dongle serial number (with option to copy to clipboard).
The About window contains the Unique Device Identifier (UDI) as per 21 CFR 801.50.
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27 Appendix
27.1 System Exceptions
WARNING
If exoplan shows an exception dialog, it is highly advisable to discard the current planning and quit
exoplan. Scence files stored before the exception appeared may be reused to resume the ongoing
planning.
HINT
Please contact your reseller’s support in case an exception should occur.
If an exception dialog appears, stop your current work and close the application without saving the current state, as it may
contain corrupted data. If you continue working or save the current state, be aware that any generated output files (meshes,
XML files, PDF files, etc.) based on the further work or on the reloaded state may be corrupted. These files may contain wrong
information and construction, treatment, or surgery based on them may lead to unforeseeable risks and complications. To
recover the current work, restart the application and load a state that was saved before this dialog appeared or reload the
project from scratch.
27.2 DICOM Control: Information in Data Tab

The information is extracted from the values defined in the CT data. If a value is not defined there, N/A is displayed for the
corresponding information.
Patient information:
Name (name and surname)
ID
Birth date
Sex (M for male, F for female, O for others)
Study information:
Description: a description of what was captured in the study
Accession number: ID which specifies the sequence of studies

Date: date by when the study was recorded
Series information:
Modality: type of record
Description: short description
No. of images: number of images
Image type: AXIAL or VOLUME
Series date: date by when the series was recorded
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27.3 Axial and View Direction Purposes

exoplan uses axial and view direction as basic orientation for the following purposes:
Generating directions for the view perspective buttons (see Chapter 23.1.1)
Generating axis-oriented secondary views (see Chapter 23.3)
Orientation of all secondary views (see Chapter 23.2)
View direction in worksteps: CT data alignment (see Chapter 8), panoramic curve definition (see Chapter 9), mandibular
canal definition (see Chapter 10), density threshold definition (see Chapter 13), implant positioning (see Chapter 14),
Planning result files (see Chapter 27.9): section view orientation in planning report PDF, axes in planning info file
Initial orientation of tooth models and implants in initial tooth model placement step (see Chapter 11) and implant
positioning step (see Chapter 14)
27.4 Tooth Libraries

The exoplan standard configuration includes the generic library. Which additional libraries are available in your exoplan in-
stallation depends on your provider.
27.5 Implant Libraries

Available implant libraries depend on your exoplan installation and on the tooth number (libraries can be restricted to certain
tooth numbers).
WARNING
Using an implant library not signed by exocad (delivered by a third party or another manu-
facturer) is made at the risk of the user. exocad claims no warranty for cases which include
implant libraries not signed by exocad.
If an implant library is updated, the implant parts of the previous library version used in saved
scenes will not be updated automatically. You must select the respective implant of the new
library version manually in the implant positioning step (see Chapter 14.2) after loading the
scene.
Not all implant parts available in the implant libraries might have regulatory clearance in your
country. Please verify the regulatory status with the respective implant manufacturer(s).
HINT
Contact your reseller for a complete list of available legally marketed implants for your geograph-
ical region.
27.6 Drilling Sleeve Libraries

Available drilling sleeve libraries depend on your exoplan installation.
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27.7 Collisions
An implant can collide with other implants, mandibular nerves, and generic collision objects. You cannot create planning
result files if there is a collision.
exoplan detects a collision if an implant is located at a position where the safety distance defined for implants is violated
(when checking for collisions between two implants, the safety distance is doubled). The default safety distance is specified
in the exoplan settings (see Chapter 26.5). You can change the safety distance in the implant positioning step (see Chapter
14.5.3).
Above the bone level, the safety distance can be locally greater than the defined safety distance value (see Figure 27.1). This
depends on the shape of the implant above the bone level. A collision can thus be detected at these locations even if the
colliding object is located further away than the defined safety distance. If such collisions above the bone level are the only
remaining collisions, you can resolve them by reducing the safety distance value.
Figure 27.1: Examples for a locally greater safety distance above the bone level (dotted line) with a defined safety distance of
2 mm.
27.8 Implant Types

The implant types you define using the Select Implant Type option (see Chapters 18 and 14.5.1) determine which parts you
can select for a specific implant in the implant positioning step (see Chapter 14.2).
Implant types:
None: No implant-based restoration. When changing the implant type to None, or changing it from None to another
type, the restoration type will change automatically.
Custom Abutment: You can select implant, titanium base and stock abutment. Stock abutment is only for visualization
purposes.
Stock Abutment: You can select implant and stock abutment. When selecting a multi-unit library, you can additionally
select adhesive caps. Choose this implant type if you want to use a one-piece implant (with integrated stock abutment).
Screw Retained: Screw-retained restoration. You can select implant and titanium base.
Abutment (custom or stock, decide later): This category summarizes custom abutment and stock abutment, if the
tooth restoration will be an abutment, but you cannot yet decide the type. You can select implant, stock abutment,
and titanium base.
Abutment or screw retained (decide later): This category summarizes abutment restorations (custom and stock), and
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screw-retained restorations, if the tooth restoration will be an implant, but you cannot yet decide the type. You can
select implant, stock abutment, and titanium base.
27.9 Planning Result Files

Planning result files are created in the planning result files generation step (see Chapter 19).
exoplan saves planning result files in the project directory and in the archive directory (C:\ImplantPlanningData\Archive
- default directory). In the project directory, only the last generated set of planning result files is stored. The archive directory
also retains past planning result files which must be deleted manually.
The planning result files contain patient information (e.g. patient name, birth date, sex, etc.) as it is specified in the CT data
and in the dental project.
Table 27.1 lists planning result files and describes their content.
File Description
Planning info file Contains all information on the implant planning result necessary for importing the
.implantPlanningInfo result into another software (e.g. exocad DentalCAD). The planning info file is in XML
format and not encrypted.
Planning report PDF Overview of the planning result with all relevant information:
planningReport
Patient information
DICOM data information
Project information
Panoramic radiograph images (with and without implants and drilling sleeves)
Implant information (implant parts, tooth number, library model information,

angles, drilling sleeves, etc.) and cross-sectional views of each implant
Date and time of report creation (DD.MM.YYYY HH:MM)
Scene file The current planning state when the planning result files are generated is saved as a
.implantPlanningScene scene file. This scene file can be loaded in exoplan.
stl files stl meshes containing different coordinates (DICOM coordinates and/or scan
coordinates) are created for each implant. Which meshes are generated depends,
among other preconditions, on how you evaluated the alignment result in the CT data
alignment step (see Chapter 8.3.1). In addition to implant meshes, meshes for the
mandibular canal/s (if defined) and an stl file for the DICOM bounding box are created.
Checklist PDF List of generated stl files with hash values for verifying purposes.
SHA256Checklist
Table 27.1: Planning result files
All planning result files will be stored in a zipped folder inside the project directory. Additionally, you can find the scene file,
the planning report PDF and the planning info file inside the project directory.
All planning result filenames have the same prefix generation date (yyyymmdd)_generation time (hhmmss)_project name and
the same suffix -implantplan.
Example: Filename of PDF report for planning result generated March 1st 2016 at 2 PM, project name JohnDoe01.
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Filename = 20160301_140000_JohnDoe01-planningReport-implantplan.pdf.
If the project includes implant planning in both jaws, the related jaw is also part of the filename. Date and time format in
filenames depend on the settings in your operating system.
WARNING
Do not modify planning result files. Modifications of planning result files can cause unwanted ef-
fects.
27.10 Mesh Types for Loading in exoplan

You can load the following meshes in exoplan using the Add/Remove Mesh tool (see Chapter 26.2):
Antagonist: If you already have an antagonist, exoplan will ask you if you want to replace it with the new antagonist
mesh.
Pre-op model: Scan of pre-operative situation (also known as situ-scan)
Generic visualization mesh
Face scan
CT alignment object: An object for aligning the CT data to (see Chapter 8)
Jaw scan
Waxup scan
Implant planning generic collision object: Object which will be included in collision detection, e.g. a surface mesh of
the sinus cavity. A collision will be detected if you position an implant too close to the collision object (see Chapters
14.5.3 and 26.5 for safety distance settings).
Supported file formats: STL (Binary or ASCII), OFF (Binary or ASCII), OBJ ASCII, PLY.
27.11 Saving Meshes

To save a mesh as an stl file, right-click it and select Save to file from the context menu. You cannot save an encrypted mesh
(e.g. an implant library element).
To save a scene as a mesh, right-click Save in the main toolbar and select Export scene to mesh.
If there is a transformation matrix file in the project directory or a CT data alignment has already been performed, exoplan
prompts you to decide in which coordinate system you want to save the mesh (see Figure 27.2).
Figure 27.2: Saving mesh coordinates
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27.12 Shortcuts
CTRL + Z / Y: Undo/Redo
ALT + F4: Close exoplan. You can still choose if you want to save the current scene.
Wizard windows
F1: Open user manual
CTRL + SPACE: Next
CTRL + BACKSPACE: Back
All windows
TAB: Switch to next tab
SHIFT + TAB: Switch to previous tab
CTRL + BACKSPACE: Back
27.13 Troubleshooting
The DICOM data cannot be loaded.
Ensure that the DICOM data fulfills the requirements of the DICOM Conformance Statement. Only data sets that meet the
preconditions listed in 1.10.1 can be loaded. You can view the DICOM Conformance Statement by following this link.
The optical scan data is not loaded automatically.

When you start to design your project, the software will offer to locate certain scans that will be loaded (depending on
your project definition). If the desired scan is not offered, switch to Expert mode and open the corresponding tool: Tools
> Add/Remove Mesh.
The loaded DICOM data set shows a lot more of the anatomy than I would like to see.
Use the clipping function in the DICOM Control and cut the regions as required. See chapter 5.2 for details.
Why is it important to precisely align the optical scan to the DICOM data?
The positions of the implants are planned in relation to the anatomical information from the DICOM data (bone, tooth roots,
nerves, etc.). However, the surgical guide design will be based on the position and shape of the optical scan. In order to place
the implants precisely at the planned positions during surgery, it is therefore crucial that the optical scan and the DICOM data
match as precisely as possible during the planning process. Any offset between them will result in a respective misplacement
of the implants.
How can I decide if the alignment between scan data and DICOM data is acceptable?
After performing the Best Fit Alignment, the optical scan will be colored in a specific way, showing the deviation of the
optical scan data from the surface of the visualized DICOM data (depending on the chosen surface threshold). Try to achieve
the lowest possible deviation (dark blue) in the crucial areas that are in direct contact with the surgical guide designed later
(usually the teeth).
There are many scatters/artifacts in the DICOM data that make it difficult to align the DICOM data to the optical scan.
Use the tool for cropping the extracted CT mesh and cut away all the scattering. Furthermore, use the tool for marking
feature regions on the optical scan mesh and mark only areas where correspondent anatomical structures are clearly visible
and not masked by scattering in the DICOM data. See chapter 8.4 for details.
I want to use a special reference object (e.g. a Lego brick) in my alignment process and do not want to match the DICOM
data and the optical scan of the jaw directly.
While in Expert mode, open Tools > Add/Remove mesh and load your reference object as CT alignment object. It will be
selectable as a target in the alignment step afterwards. Note that you must ensure the correct relative positioning between
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jaw scan and reference object scan in this case.
The loaded DICOM data is displayed too bright/dark in the software and/or I want to adjust the contrast of the visual-
ization.
Adjust the brightness and contrast in the View tab of the DICOM Control window by adjusting the slider Current CT Data
window. For best results, view the adjustment in Solid mode. You can also select one of the windows defined in the DICOM
data set or manipulate the mentioned window by using shortcuts (SHIFT or CTRL + mouse wheel while the cursor is above
the cross-sectional view).
I want to create a persistent measurement that will not change during the workflow.
You can create a persistent measurement by clicking the button Create annotation from current measurement in the
measurement tool (Tools > Measurement tool). See chapter 26.1 for a detailed description of the measurement tool.
During the workflow I decided I want to plan more/less implants than originally intended.
In Expert mode, open the Select Implant Type window by clicking on Implant Control in the main toolbar or the context
menu. Here you can adjust the amount/type of implants you want to plan.
After positioning implants, I noticed that the alignment between optical scan and DICOM data still needs to be im-
proved.
Switch to Expert mode and open the CT Data Alignment window by clicking on CT Data Alignment in the main toolbar or
the context menu. All movement applied to the DICOM data will also be applied to the parts depending on it (e.g. implants,
nerves, ...). See chapter 8 for details about the alignment steps.
I accidentally deleted my planning results.

When planning of the surgical guide is completed, a backup copy of the results is stored in C:\ImplantPlanningData\Archive
as a ZIP file. The results can be restored from the ZIP file.
The safety distance used during implant positioning is set too low/high each time I start planning a new case.
You can change the default value in the settings (Tools > Settings... > Default safety distance).
The software displays an error/exception message when trying to access files on the hard drive, e.g. when writing output
data.
Ensure that the files the software tries to access have an access path shorter than 250 characters (technical limitation). If
the respective path is longer, please ask your reseller to reconfigure the software so that the file paths of the installation and
output files do not exceed the limit of 250 characters.
The step Merge and Save Surgical Guide stops with the message that the merging process failed.
Ensure that you only use signed drilling sleeve libraries. Afterwards, start the step Design Sleeve Mounts in Expert mode
and slightly adjust one of the parameter sliders. Restart the Merge and Save Surgical Guide step and make sure the merg-
ing process can be finished. If the merging process still fails, keep adjusting the parameter sliders until the merging process
can be finished successfully. If the adjustment of the parameter sliders has no effect and the merging process still fails to
finish, start the step Add Window, Support, and Text and slightly move any text attachments that are present. Afterwards,
restart the step Merge and Save Surgical Guide and ensure the merging process can be finished.
I want to learn more about exocad’s exoplan. Where can I find more information?
Check out our video tutorial explaining the exoplan workflow: https://www.youtube.com/watch?v=zjoKUg2yv7Q.
Visit exocad’s YouTube channel for recent exoplan tutorials. Ask your reseller for further training.
For all problems/solutions listed above: If the suggested solution fails, please contact your reseller.
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27.14 Safety Warnings
WARNING
Federal Law (USA) restricts the sale of this device to or on the order of a physician, dentist, or li-
censed practitioner.
WARNING
exoplan must only be used by qualified professionals. Using exoplan and Surgical Guide de-
sign and its features as well as the manufacturing of surgical guides without the necessary
medical knowledge in dentistry and professional diligence can lead to serious injuries of the
patient during the surgical implanting process, such as a permanent injury of the mandibular
nerve, a vessel, sinus, or healthy teeth.
exoplan must not be used by users with a physical handicap in color perception (e.g. color-
blind). exoplan users must be physically able to distinguish colors used for the display of ob-
jects (e.g. colors used for collisions and bone densities).
WARNING
Ensure to use only the recommended hardware, drivers, operating system, and software applica-
tions (e.g. PDF reader), such as graphics adapter, and that your graphics and monitor settings as
well as the light conditions of your work environment are configured in an optimal way.
WARNING
Do not apply modifications to the installed system. In particular, do not update drivers for the
graphics adapter. To avoid system modifications due to automatic updates, deactivate automatic
software and driver updates. Modification and/or corruption of the software installation may lead
to dangerous results in the implant planning process and the design of a surgical guide with haz-
ardous impact for the surgical implanting process.
WARNING
Ensure that the DICOM series has a sufficient spatial resolution, an acceptable accuracy, and is not
blurred (e.g. due to patient movement during acquisition).
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WARNING
The relevant anatomical structures must be sufficiently visible in the 3D CT data to proceed with
implant planning. E.g. the mandibular nerve must be visible in the mandible. In maxillae, the
anterior palatine nerve and the maxillary sinus floor must be visible. Insufficiently visible anatom-
ical structures in the 3D CT data may lead to an erroneous planning process and thus may cause
permanent injury of the patient.
WARNING
When loading a DICOM series and an optical scan, ensure that the series and the scan belong
to the same and current patient.
Ensure that the data quality of optical scans used in exoplan is sufficient for implant planning.
WARNING
Make sure that the optical scan is based on a recent physical model and/or was recorded recently.
Scans based on outdated information may not fit the patient’s anatomical situation or lead to in-
juries, complications, or additional surgery.
WARNING
Wrong visualization settings for the DICOM series may lead to undesired results of the implant
planning process with the consequence of seriously injuring the patient (mandibular nerve, sinus,
healthy tooth) in the surgical implanting procedure.
WARNING
When alignment with the CT data is done using a particular alignment object which is not the jaw
scan, the user is responsible for assuring that the jaw scan used for surgical guide design is in cor-
rect relative geometrical position to the used alignment object.
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WARNING
Aligning CT data is a sensitive process which must be performed accurately. This process includes
appropriate isosurface value settings, the accurate placement of points during the 3-point align-
ment step (see Chapter 8.2), and, if applicable, appropriate cropping of the CT mesh (see Chapter
8.4.1) and appropriate marking of feature regions (see Chapter 8.4.2). The alignment accuracy is
directly connected to the accuracy of surgical guides created from the jaw scan.
WARNING
If you perform the CT data alignment step after annotations have been added or collision objects
have been loaded, you must decide if these should be transformed (see Chapter 8.5).
WARNING
An incorrect definition of the mandibular nerve can cause a permanent injury of the patient during
the surgical implanting procedure.
WARNING
An incorrect density threshold value definition can impede the recognition of suboptimal implant
positions.
WARNING
exoplan does not verify if you have placed an implant at an eligible position for the selected
tooth number.
When selecting an implant for a particular tooth location make sure that the intended use/the
indications of the implant allows the usage for the respective tooth and purpose.
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WARNING
Please ensure that the correct implant type including platform type / platform length and diame-
ter is selected according to the clinical situation of the patient. Please pay particular attention to
this when planning an implant case near a major anatomical feature such as arteries or alveolar
nerve.
WARNING
During implant positioning, ensure the feasibility of the surgery for the particular implant position.
Consider the existing dentition and study the insertion channels for the respective implant.
WARNING
A safety distance below 1.5 mm should only be used in exceptional cases with particular care.
WARNING
When you have selected a freely positionable drilling sleeve, exoplan does not automatically
select a compatible surgical kit and respective tools. This responsibility fully remains with
the user.
The displayed drill depth is approximated from the geometric mesh provided by the manu-
facturer of the respective implant.
WARNING
Please note that manufactured surgical guides for endosseous dental implant placement are clas-
sified as medical devices by the FDA, regulated under 21 CFR 872.3980. As such, they are subject to
legal requirements such as registration and listing as a manufacturer of medical devices, validation
of production equipment/processes and quality system regulations.
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WARNING
Verify the surgical guide manufacturing process and the surgical guide before using it for the
treatment of patients.
When the surgical guide bridges over multiple missing teeth, make sure that the solid fit of the
surgical guide is still ensured and that it does not bend under load. In particular, this applies
for multiple canine and incisors.
WARNING
The Minimum Base Thickness of a sleeve mount is a crucial parameter for the stability of a
surgical guide. If the value is too low, the surgical guide may bend or break under load. Please
regard that a suitable value for the minimum thickness is dependent on the material intended
for surgical guide manufacturing.
Hint: Check the minimum requirements specified by the material manufacturer and ask your
reseller if you are in doubt.
Use the Clearance Above function with care and choose a value appropriate for the selected
tools for surgery.
The Radial sleeve offset value is dependent on the material/printer combination used for
surgical guide manufacturing and requires experience with used material and equipment.
Wrong settings result in an ill-fitting surgical guide.
WARNING
Carefully inspect the impact of a particular setting of the insertion direction, blocking or allowing
undercuts or smoothing of the bottom. Inappropriate settings may result in an ill-fitting surgical
guide.
WARNING
Insufficient connection of the surgical guide top to the sleeve mount may cause the surgical
guide to bend or break during the surgical procedure.

Do not include soft tissue (e.g. gingiva) in the design of the surgical guide top while defining
the surgical guide top margin line.
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WARNING
Use the Add structures / Remove structures function with care because it may impact the sta-
bility and fit of the surgical guide.
WARNING
Use the Free-Form tool with care because it may impact the stability and fit of the surgical guide.
WARNING
Note! In the US, the physical surgical guide for endosseous dental implant placement is a medical
device to be manufactured at an FDA registered and listed manufacturing location. Please contact
the FDA for information regarding the regulatory status and requirements related to manufactur-
ing these surgical guides.
WARNING
Validate the surgical protocol document before commencing the surgical procedure.
Do not modify the files created for the manufacturing of the surgical guide.
You must carefully study the surgical protocol.
WARNING
Ensure that all scene objects necessary for evaluating a scene are activated for visualization in the
Group Selector.
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WARNING
When measuring distances in secondary views, be aware of the limitations of measurements in a
2D image plane within 3D space, e.g. when measuring a distance between two objects. Verify the
start and end point positions in the 3D visualization of the main view.
WARNING
If exoplan shows an exception dialog, it is highly advisable to discard the current planning and quit
exoplan. Scence files stored before the exception appeared may be reused to resume the ongoing
planning.
WARNING
Using an implant library not signed by exocad (delivered by a third party or another manu-
facturer) is made at the risk of the user. exocad claims no warranty for cases which include
implant libraries not signed by exocad.
If an implant library is updated, the implant parts of the previous library version used in saved
scenes will not be updated automatically. You must select the respective implant of the new
library version manually in the implant positioning step (see Chapter 14.2) after loading the
scene.
Not all implant parts available in the implant libraries might have regulatory clearance in your
country. Please verify the regulatory status with the respective implant manufacturer(s).
WARNING
Do not modify planning result files. Modifications of planning result files can cause unwanted ef-
fects.
© 2017-2021 exocad GmbH page 176/176

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4 Selecting a DICOM Series 15

6 Defining Density References 27

7 Defining Axial and View Direction 31

9 Defining the Panoramic Curve 50

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10 Defining the Mandibular Canal 59

11 Initial Placement of Tooth Models (Backward Planning) 68

12 Precise Placement of Tooth Models (Backward Planning) 75

13 Defining the Density Threshold Value 85

16 Deleting Implants 103

18 Selecting Implant Types 106

19 Generating Planning Result Files 107

20 Creating Surgical Guides 112

© 2017-2021 exocad GmbH page 4/176

20.9 Generating the Surgical Guide Result Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

21 Saving a Scene / Closing a Project 127

22 Wizard Mode vs Expert Mode 128

27.5 Implant Libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

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1.0.1 Typographic Conventions

necessary expertise in implant dentistry.

1.2 Intended Use

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1.3 Indications and Contraindications

1.4 Safety Information

1.5 Units and Conventions

1.5.1 Measurement Accuracy

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measurements calculated and displayed during distance/angle measurement,

1.6 Hardware Requirements

1.7 Software Requirements

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1.8 Software Installation

1.9 Software Activation

1.10 Input Data and Requirements

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1.10.2 Scan Data

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1.11 Color Scheme

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Figure 2.1: exoplan startup screen

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3.1 Loading a Scene

3.2 Loading a Project

Figure 3.1: Loading a project with existing scene files

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3.3 Loading a Scan

3.4 Importing an Implant Planning Result

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4 Selecting a DICOM Series

4.1 Step 1: Open the DICOM Control

4.2 Step 2: Select a DICOM Series

Figure 4.1: DICOM Control with no DICOM series selected/loaded

Figure 4.2: DICOM series selection dialog

© 2017-2021 exocad GmbH page 15/176

Figure 4.3: DICOM series selection dialog with patient name

Figure 4.4: Analysis section: Figure 4.5: Analysis section:

Figure 4.6: DICOM Control while loading a DICOM series

© 2017-2021 exocad GmbH page 16/176

4.3 Result: DICOM Series Loaded

Figure 4.7: exoplan screen with DICOM series visualization

4.4 Loading Implant Planning Settings