Exoplan.3.0.User Manual Surgical Guide en

English
2022–07–05
User Manual
exoplan
Rx Only
exocad.com 2797
User Manual by exocad GmbH
© 2017–2022 exocad GmbH
exocad GmbH
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64293 Darmstadt
Germany
phone: +49-6151-629489-0
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Document version
exoplan.3.0_User_Manual_en, 2022–07–05
Product version
exoplan 3.0 Galway
Distributed in the U.S. by

exocad America, Inc.
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Woburn, MA 01801
USA
exoplan — User Manual
Content
1 General Information 7
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.2 Indications for Use / Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.3 Clinical Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.4 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.5 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.6 Units and Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.7 Hardware Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.8 Software Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.9 Software Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.10 Software Activation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.11 Input Data and Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.12 Color Scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2 Launching exoplan 16
3 Loading a Scene/Project/Scan 17
3.1 Loading a Scene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.2 Loading a Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.3 Loading a Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.4 Importing an Implant Planning Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
4 Selecting a DICOM Series 20

4.1 Step 1: Open the DICOM Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.2 Step 2: Select a DICOM Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.3 Result: DICOM Series Loaded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
5 DICOM Control 23
5.1 Data Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.2 View Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.3 Surface Generation Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
6 Defining Density References 32

6.1 Interface Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
6.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
7 Defining the Panoramic Curve 37

7.2 Manual Definition of the Panoramic Curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
8 Selecting a CT Alignment Workflow 46
9 CT-to-Mesh Alignment 47
9.2 3-Point Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
9.3 Best Fit Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
9.4 Transformation of Objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
9.5 Options to Improve the Best Fit Alignment Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
10 CT-to-CT Alignment 64
10.1 Extracting a Mesh from the Prosthesis CT Dataset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
© 2017–2022 exocad GmbH page 3/222

10.2 Evaluating the CT-to-CT Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

10.3 Manual Marker Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
11 Changing the Implant Setup 70
12 Defining the Mandibular Canal 71

12.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
13 Sinus Segmentation 80
13.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
13.3 Manually editing collision objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
14 Initial Placement of Tooth Models (Backward Planning) 84

14.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
14.3 Placing Multiple Bridges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
14.4 Selecting a Tooth Library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
14.5 Deleting Bridges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
15 Precise Placement of Tooth Models (Backward Planning) 90

15.2 Step-by-Step: Simple Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
15.3 Step-by-Step: Chain Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
16 Implant Positioning 100

16.2 Selecting Implant Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
16.3 Initially Positioning an Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
16.4 Moving/Rotating an Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
16.5 Implant Positioning Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
17 Sleeve Placement 111

17.2 Selecting a Sleeve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
17.3 Positioning a Sleeve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
18 Anchor Pin Placement 116

18.2 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
19 Generating Implant Planning Result Files 120

19.1 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

19.2 Aborting the Implant Planning Result Files Generation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
19.3 Generating Provisional Implant Planning Result Files for Individual Implants . . . . . . . . . . . . . . . . . . . 124
19.4 Errors During Implant Planning Result Files Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
19.5 Selecting the Workflow After Generating Implant Planning Result Files . . . . . . . . . . . . . . . . . . . . . . 125
20 Creating Surgical Guides 126

20.1 Workflow of Different Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
20.2 Drilling Sleeve Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
20.3 Designing Sleeve Mounts and Anchor Pin Mounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
20.4 Defining the Gingiva Contact Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
20.5 Designing the Surgical Guide’s Bottom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

20.6 Designing the Surgical Guide’s Top . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

20.7 Adding Attachments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
20.8 Merging the Surgical Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
20.9 Free-Forming the Merged Surgical Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
20.10Creating a Fixation Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
20.11 Merging the Fixation Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
20.12 Free-Forming the Merged Fixation Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
20.13 Generating the Surgical Guide Result Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
20.14Selecting the next step after generating the Surgical Guide Result Files . . . . . . . . . . . . . . . . . . . . . . 152
21 Saving a Scene / Closing a Project 154

21.1 Saving a Scene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
21.2 Closing a Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
22 Wizard Mode vs Expert Mode 155

22.1 Expert Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
22.2 Expert Window vs Wizard Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
22.3 Wizard Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
23 Expert features 161

23.1 Defining Axial and View Direction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
23.2 Deleting Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
23.3 Deleting Constructed Parts (Tooth Models, Drilling Sleeves, and more) . . . . . . . . . . . . . . . . . . . . . . . 165
23.4 Virtually Extracting Teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
24 Views 168
24.1 Main View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
24.2 Secondary Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
24.3 Axis-oriented Views: Axial, Sagittal, Coronal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
24.4 Panoramic Curve-Based Views: Curve Cut, Curve Tangent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
24.5 Panoramic View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
24.6 Implant-based Views: Implant Cross, Implant Axial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
24.7 View Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
25 Menus 183
25.1 Main Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
25.2 Expert Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
25.3 Context Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
26 Controls 186
26.1 Group Selector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
26.2 Implant Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
26.3 DICOM Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
27 Tools 191
27.1 Measurement Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
27.2 Add/Remove Mesh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
27.3 Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
27.4 Aligning Meshes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
27.5 Show Project in Explorer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
27.6 Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
27.7 About . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

28 Appendix 206
28.1 System Exceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
28.2 DICOM Control: Information in Data Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
28.3 Axial and View Direction Purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
28.4 Libraries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
28.5 Collisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
28.6 Implant Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
28.7 Planning Result Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
28.8 Mesh Types for Loading in exoplan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
28.9 Saving Meshes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
28.10Shortcuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
28.11 Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
28.12 Safety Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

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.
Any serious incident that occurrs in relation to this device must be reported to the manufacturer
and the competent authority of the member state in which the user and/or patient is established.
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 Indications for Use / 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.
Alternatively, instead of optical surface data a second CBCT/CT dataset can be used. 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 Clinical Benefit

exoplan provides a guided workflow and an open system approach to the dentist that shortens the planning phase for the
planning of the implant position(s) and the design phase of a surgical guide. The use of a surgical guide enables a minimally
invasive, flapless surgical procedure in edentulous cases.
1.4 Indications and Contraindications

1.4.1 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.
1.4.2 Contraindications
exoplan is not for diagnostic purposes.
exoplan is not intended for edentulous patients in need of bone-supported 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.

1.5 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).
1.6 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.
1.6.1 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).
See Chapter 1.11 for further details.
1.7 Hardware Requirements

Full workstation configuration:
CPU: Intel Core-i7 9700k / AMD Ryzen 7 2700X
16GB DDR4 non ECC
Graphics: Nvidia RTX 2060 (6GB GDDR6) / AMD Radeon RX 5600 XT (6 GB GDDR6), OpenGL 4, DirectX 11.1, Shader
Model 5 and a graphics driver dated August 2017 or newer
Screen resolution: WQHD (2560x1440), recommended: UHD (3840x2160)
Power: 750+ Watt
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), if a DPI setting of 100% is used. If you use a higher DPI setting, a higher
resolution is required.
Power: 450 Watt
Peripherals/Human Interface devices (HID):
Standard computer keyboard required
Standard computer mouse required
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.
1.8 Software Requirements

A PDF reader (Adobe Acrobat Reader) must be installed to view PDF files generated by exoplan.
A 64bit version of Microsoft Windows 10 is required.
1.9 Software Installation

Step 1: Download Framework2020(.exe) 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
It is suggested to use the version of the graphics adapter driver that was current when exoplan was
released. Furthermore, disable automatic driver updates to avoid newer drivers that could have
potential negative side effects to the performance and stability of exoplan. Modification and/or
corruption of the software installation may lead to dangerous results in the implant planning pro-
cess and the design of a surgical guide with hazardous 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.

The exoplan user manuals are available on the exocad website.
1.10 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 automatically reactivated when you go online.

1.11 Input Data and Requirements

1.11.1 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 an-
terior palatine nerve and the maxillary sinus floor must be visible. Insufficiently visible anatomical
structures in the 3D CT data may lead to an erroneous planning process and thus may cause per-
manent injury of the patient.
NOTE
Use data for exoplan from a trustable source only.
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.
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 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 9).
All the mentioned requirements and recommendations apply as well for capturing the prosthesis DICOM data for the dual
scan protocol, except for the structures at risk. Additionally, the following requirements apply for the dual scan workflow:
When acquiring the patient’s DICOM data, ensure that the patient wears the prosthesis with the radio-opaque markers
attached to the prosthesis.
Ideally, acquire the prosthesis DICOM data with the attached radio-opaque markers directly afterwards to ensure that
the proshtesis data matches the patient data.

Loading datasets with DICOM data issues
exoplan allows DICOM datasets with certain issues (nonconformance to the DICOM standard or other unfavorable proper-
ties, e.g. insufficient image resolution) to be loaded. The following types of datasets can be loaded by exoplan, but you will
have to confirm that you understand the risks when proceeding to load them for further usage:
Datasets defined as Enhanced CT Image Storage SOP class (UID: 1.2.840.10008.5.1.4.1.1.2.1, DICOM tag <0008,0016>) that
are saved as single-frame, instead of multi-frame.
Datasets where the third value of the Image Type parameter (DICOM tag <0008,0008>) is not defined as AXIAL or
VOLUME but as something else which is not defined as a valid value for this parameter (e.g., REFORMATTED) according
to the DICOM standard.
Datasets where the maximum slice positioning error (i.e., the distance deviation between two consecutive slices) is
more than 1 % of the current slice thickness (z-spacing). Note that if the distance deviation is higher than 0.006mm,
exoplan will refuse to load the data.
Datasets where there is an inconsistency between the listed UIDs in the DICOMDIR file and the UIDs of the correspond-
ing single-frame files.
Datasets where the size of a voxel as per Pixel Spacing (DICOM tag <0028,0030>) and Slice Thickness (DI-
COM tag <0018,0050>) in the DICOM series to load is larger than 0.6 mm in any of the dimensions.
After loading a DICOM dataset that contains at least one of these issues, a warning dialog appears that lists all detected
DICOM issues. It shows information about the affected dataset 1}
m , the issue type 2}
m, and a detailed issue description 3}m
(see Figure 1.1).
1}
m 2}
m 3}
m
4}
m
5}
m
Figure 1.1: DICOM data issues detected
Click Continue anyway 4} mto load the dataset. A red, clickable indicator will be shown in the DICOM Control (see Figure
1.2). Click Load another dataset 5}
m to close the dialog and load another dataset.
Click the indicator in the DICOM Control 6}m to show an overview dialog listing all isues with the DICOM dataset (see Chapter
5 for a detailed description of the DICOM Control). The indicator is permanently shown in the DICOM Control, which is also
the case when a scene file with an affected DICOM dataset is loaded or when implant planning information with an affected
DICOM dataset is imported.

6}
m
Figure 1.2: DICOM Control - accepted DICOM data issues
The implant planning report (see Chapter 19) and the surgical protocol (see Chapter 20.13) will also contain a warning with
information that the DICOM series had a user-accepted issue.
1.11.2 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, pre-op etc.), verify that you have loaded the correct scan.
1.12 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 their 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 25.1) or the context menu (see Chapter 25.3), 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 25.1)

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. Scenes/projects/scans
can be loaded as described in chapters 3.1, 3.2, and 3.3, or by Drag&Drop into to the main view.
3.1 Loading a Scene

Step 1: Click Load in the main toolbar (see Chapter 25.1) or right-click the background in the main view to access the
context menu (see Chapter 25.3).
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. When loading scene files, exoplan checks if library parts (implant, sleeve, drill...) that are contained in the scene
were originally loaded from libraries that are not supported any more or are not correctly signed due to any other reason. In
such cases, exoplan will either display a messagebox or a notification that lists all these parts.
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).
NOTE
If a CT alignment data file belonging to the project file exists and is named
<project name>-ctalignmentobject, this data file is automatically loaded with the project.
This is similar to a scan data file, but instead of a scan data file, a CT alignment object can be artifi-
cially created and may not be based on a 3D scan.
Supported file formats for CT alignment data files: STL (Binary or ASCII), OFF (Binary or ASCII), OBJ
ASCII, PLY.
3.2.1 Importing a DentalCAD tooth setup

You can save a *.dentalCAD scene file to an exoplan project directory and import the containing tooth setup (e.g., from a
Smile Design) to improve the backward planning workflow:
When loading a project, and your project directory contains a *.dentalCAD file, you can decide if you want to load the tooth
setup from the DentalCAD scene (See figure 3.2).
Figure 3.2: DentalCAD scene file import dialog
If you import a tooth setup for the current tooth number(s), the step Place Model teeth (see Chapter 14) will not appear
in the Wizard workflow. Note that you can still initiate the Place Model Teeth step via Expert mode. If you start the Place
Model Teeth step via Expert mode, and have imported a tooth setup for the current tooth number(s) from a *.dentalCAD
scene file, exoplan will remove the imported tooth setup for the current tooth number(s).
If the *.dentalCAD scene contains SmileDesign image parts, an additional custom view button Smile Design View is dis-
played above the view presets in the main toolbar (see Chapter 25.1). Click this button to align the camera so that it is per-
pendicular to the imported smile face image. Note that this button is disabled in the steps Define Panoramic Curve and
Load Prosthesis CT Dataset.
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 28.7). 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.
Figure 3.3: Importing an Implant Planning Result
NOTE
exoplan does not load implant planning files where the result of the alignment was stated to
be inaccurate.
If the imported implant planning information is missing information (e.g. the bone level height),
exoplan will cancel the import and the current project will be closed. As a workaround, you
can open the latest planning scene associated with the implant planning information file in
your exoplan version and restart the output generation. Afterwards, import the newly cre-
ated file again.
If the imported implant planning information contains any DICOM data issues, exoplan prompts
you to decide how to proceed as described in Chapter 1.11.1.

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 1.11.1
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 25.1), 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 4.2).
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.
HINT
You can set a default directory for searching for DICOM data in the exoplan settings. See chapter
27.6.
Figure 4.3: Analysis section: Figure 4.4: 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 sex, 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 4.5). You can abort the loading process by clicking Cancel loading.

Figure 4.5: DICOM Control while loading a DICOM series
4.3 Result: DICOM Series Loaded

The loaded DICOM series is visualized in the main view. In Wizard mode, exoplan automatically initiates the next Wizard step
after the DICOM series has been loaded.
3}
m
2}
m
1}
m
Figure 4.6: exoplan screen with DICOM series visualization
1}
mMain view: DICOM series visualization (for view functions see Chapter 24.1.1)
2}
mDICOM Control (see Chapter 5)
3}
mGroup Selector (see Chapter 26.1) 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.

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 25.1).
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 Tooth 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 28.2.
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, Tooth 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 24.5) 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 24).
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 24.2.5). 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 manually de-

fine density reference values for soft tissue, NAVIGATION
bone, and teeth. Using these references you
Expert toolbar / context menu:
can quickly change the DICOM series visu-
Define Density References
alization to the particular structure type. Fur-
thermore, the density references serve as ini- This step is part of the guided
tial values in later worksteps, which would Wizard workflow (see Chapter 22.3)
require manual adjustment if you have not
defined them. exocad recommends to at least define the bone density reference.
You can also redefine a threshold value for visually separating hard bone areas from softer areas. Areas above the defined
value will be displayed in blue, areas below the defined value will be displayed in red (see Figure 6.4). In the implant posi-
tioning step (see Chapter 16), the colors will help you avoid positioning an implant in an area which may be of insufficient
density.
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
When defining the density references, the main view displays the DICOM series visualization. For available navigation
functions, see Chapter 24.1.
When defining the threshold value, 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 24.1.
6.1.2 DICOM Control

When defining the density references, the only available visualization mode is Isosurfaces.
When defining the threshold value, 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.
6.1.3 Group Selector

During this step, no elements will be added. See Chapter 26.1 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 and the density threshold.
Figure 6.3: Define Density References window - Density

Figure 6.2: Define Density References window
Threshold definition
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, Tooth Buttons for defining density references (see Chapter 6.2).
Threshold Button for defining the density threshold value. You can change the slider range using
the context menu (see Chapter 25.3).
Define Value Save value and continue with the next value type.

Discard Value Discard the currently set value.
Reset View (Threshold) Reset the view and the sliders in the Clip section of the DICOM Control window to the
initial orientation/value.
Use suggested values on If checked, suggested values for each type will be applied when choosing to skip the
skip manual definition.
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: Click the Soft tissue button in the Define Density References window.
Step 2: Set a density reference 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. 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.
Step 3: Define the density reference by clicking the corresponding button. A green checkmark appears when the value
type has been defined. The next value type will be selected automatically when you have defined a value.
Step 4: Repeat steps 2 & 3 for Bone and Tooth.
Step 5: Define a Threshold value for visually separating hard bone areas from softer areas by moving the Surface
Threshold slider or by entering a value. Voxels above the defined value will be displayed in blue, voxels below
the defined value will be displayed in red. In the implant positioning step (see Chapter 16), the colors will help you
avoid positioning an implant in an area which may be of insufficient density.
Define a value that leads to all bone and denser areas being blue. Figure 6.4 shows an example of the DICOM
series visualization with correctly defined density threshold. Bone and denser areas appear blue, all other areas
appear red.
Ensure all blue areas are always bone areas. Red areas can be bone areas, blue areas must be bone areas.
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 tooth defined (d) Soft tissue, bone, tooth, and threshold defined
Figure 6.4: Visualization of correctly defined density threshold

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 define
a higher value for the soft tissue than for the bone structure. If you define such
values, a warning section in the info section 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 xml file is created, containing the
threshold value(s) you have specified. These values also apply to all future projects and the Wizard step Define Density
References will not appear again for future projects. Note that you can define to always show the step in the exoplan
settings (see Chapter 27.6).
The density threshold value you define in this step affects how implants
are displayed in the implant positioning step (see Chapter 16). In certain
views, the implant will be colored blue and red, as shown in Figure 6.5. 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 an area of
low density.
Figure 6.5: Implant with colors
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.

7 Defining the Panoramic Curve
In this step, exoplan automatically defines

the panoramic curve by drawing a line along NAVIGATION
the jaw ridge. Defining the panoramic curve
is necessary for generating the panoramic
Define Panoramic Curve
view (see Chapter 24.5). You can make man-
ual adjustments to the panoramic curve def- This step is part of the guided
inition in this Wizard step or in Expert mode. Wizard workflow (see Chapter 22.3).
3}
m
1}
m
4}
m
2}
m
Figure 7.1: Panoramic curve definition screen
1}
2}
mPanoramic view (see Chapter 7.1.2)
3}
4}
mDefine Panoramic Curve window (see Chapter 7.1.4)
WARNING
Verify the correctness of the position and shape of the panoramic curve before proceeding in the
workflow.


7.1.1 Main View
The main view shows a sectional view of the DICOM series, cut across the axial plane, determined by the axial/view direction,
which is automatically defined by exoplan.
In the DICOM series visualization, the pre-defined panoramic curve with markers is displayed (see Figure 7.2).
4}
m
1}
m
2}
m
3}
m
Figure 7.2: Main view - DICOM data with initial panoramic curve
1}
mPanoramic curve
2}
mDepth indication lines
3}
mDrag point for moving the panoramic curve (see Chapter 7.2)
4}
m
Orientation 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.

7.1.2 Panoramic View

This secondary view shows the panoramic image resulting from your settings in the main view (see Chapter 7.2). 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 7.2).
3}
m 2}
m
1}
m
Figure 7.3: 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 24.5.
7.1.3 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.

7.1.4 Define Panoramic Curve Window

The Define Panoramic Curve window provides functions and explanations for defining the panoramic curve.
Figure 7.4: Define Panoramic Curve window
View Default / View flipped Change the view direction.
Automatic Curve Detection Checkbox to toggle the automatic detection of the panoramic curve.
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.
Reset Deactivate the automatic curve detection and reset the curve to the default initial state.
Cancel Abort the step, close the window. All changes made since you entered the panoramic
curve definition step will be discarded.
Table 7.1: Define Panoramic Curve window functions

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 26.1 for a detailed description of the Group Selector.

7.2 Manual Definition of the Panoramic Curve

You can define the panoramic curve manually if you do not want to use the automatic detection. This section describes how
to use the manual definition of the panoramic curve.
You can define the panoramic curve for the whole jaw ridge (see Chapter 7.2.1) or only for parts of the jaw ridge (see Chapter
7.2.2). 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 7.5), this does not
necessarily mean that you have defined the panoramic
curve incorrectly. Check the panoramic curve in such cases,
and if it is correct, continue in the workflow.
Figure 7.5: Depth indication lines with angles/loops
7.2.1 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 7.6).

Figure 7.6: Panoramic curve and image for the whole jaw ridge
7.2.2 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 7.7 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 7.2.1.

(a) Panoramic curve for one jaw side

(b) Panoramic curve for tooth area
Figure 7.7: Partial panoramic curve definition examples

7.2.3 Defining the Panoramic Curve in Partial Head Scans
NOTE
Especially for partial head scans, it might be necessary to define the panoramic curve manually be-
cause automatic curve detection lacks crucial information of the dental arch and oral and vestibu-
lar orientation.
If defining the panoramic curve for a partial head scan, ensure that the oral and vestibular markers point to the correct direc-
tion. The direction varies with the orientation of the dental arch in the DICOM series.
Figure 7.8 shows the correct definition of a panoramic curve for a partial head scan where tooth 36 will be implanted.
Figure 7.8: Correctly defined panoramic curve for partial head scan

8 Selecting a CT Alignment Workflow
After you have defined the panoramic curve, you can align the CT data. CT
alignment is key to designing surgical guides after placing the implants.
Without CT alignment you will not be able to design surgical guides.
First, you need to choose a CT alignment workflow. The Wizard window

1}
m
Select CT Alignment Workflow offers three possibilities:
2}
m CT-to-mesh alignment 1} m : Align CT data to an alignment object,
e.g an optical jaw scan. See chapter 9.
3}
m
CT-to-CT alignment 2} m is typically referred to as Dual Scan Proto-
col in which a CT scan of a patient’s prosthesis is aligned to the pa-
tient’s CT scan of the anatomy. exoplan will align the CT datasets au-
tomatically to each other, based on radio-opaque markers present in
both CT scans. See chapter 10.
Skip CT alignment 3} m : Skip the CT data alignment step and con-

tinue with the next Wizard step. You will not be able to design a sur-
gical guide unless you perform an alignment via the context menu
in Expert mode.
Select the appropriate workflow for your project and confirm with Next.
Figure 8.1: Select the CT data alignment

workflow
HINT
You can select a default alignment workflow in the exoplan settings. See chapter 27.6.

9 CT-to-Mesh Alignment
This Wizard step is initialized if you selected

CT-to-Mesh alignment in the previous Wiz- NAVIGATION
ard step Select CT Alignment Workflow
(see Chapter 8).
CT Data Alignment
In this optional step, you can align the CT
data to an alignment object. Typically, this This step is part of the guided
object is an optical jaw scan, but you can also Wizard workflow (see Chapter 22.3)
use different alignment objects (pre-op scan,
waxup scan). If the CT data has already been aligned to an alignment object externally, you can skip this step.
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 9.2)
Best fit alignment (see Chapter 9.3)
Additionally, you can perform a manual alignment after either of these steps (see Chapter 9.2.2).
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 9.2), and, if applicable, appropriate cropping of the CT mesh (see Chapter
9.5.1) and appropriate marking of feature regions (see Chapter 9.5.2). 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 9.1: CT data alignment screen
1}
mMain view - split screen (see Chapter 9.1.1)
2}
3}
4}
mCT Data Alignment window (see Chapter 9.1.4)

9.1.1 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. You can modify
the views separately using the main view navigation functions (see Chapter 24.1.1).
You can access the context menu (see Chapter 25.3) only in the left screen.
If you have defined a density reference for bone (see Chapter 6), the CT data is displayed accordingly.

9.1.2 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 26.1 for a detailed description of the Group Selector.
9.1.4 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 9.2 and 9.3).
9.2 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 9.4).
HINT
In most scenarios the annotations and collision objects should be transformed as well.
The CT Data Alignment window shown in Figure 9.2 consists of two tabs. The Align tab provides options and explanations
for performing the 3-point alignment, the Evaluation tab (see Chapter 9.2.1) is for evaluating a possible external alignment
(if no alignment has been performed in exoplan yet).

Figure 9.2: 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.
Select additional floating Choose which objects should be transformed. See chapter 9.4 for a detailed description.
parts
The alignment object is a A loaded alignment object can be defined as prosthesis mesh by activating this
prosthesis of an checkbox. When activated, the workflow will be adjusted to an edentulous case, i.e., the
edentulous case workflow steps Place Anchor Pins (see Chapter 18) and Define Gingiva Contact
Surface (see Chapter 20.4) will appear during the workflow. This is useful when you
only have CT data of the patient wearing the prosthesis and an optical scan of the
prosthesis but no separate CT data of the prosthesis.
Next / Apply Alignment Initiates the 3-Point-Alignment or the Best-Fit-Alignment, depending on your progress
in the CT-Alignment step.
Back / Cancel Abort the CT data alignment step. All changes made since you entered the CT data
alignment step will be discarded. In Wizard mode, the Back button has the same
function, except only the last alignment will be discarded.
Table 9.1: 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 27.2),
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 9.3: 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 that are not on a straight line and are 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 Next (Wizard mode) / Apply Alignment (Expert mode). The CT data is now aligned
to the alignment object. Once done, three secondary views are displayed by default: Panorama view, Coronal view, and Curve
cut view.
Figure 9.4: CT data and jaw scan after 3-point alignment
Use the main view 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 9.3).

9.2.1 Evaluation Tab
1}
m
In case the data is already aligned (e.g. externally) or you do not need an
alignment for further processing, you can skip the alignment process by
switching to the Evaluation tab.
By selecting one of the options provided in the Evaluation tab, you can
evaluate the CT data alignment before the 3-point alignment. If you select
2}
m an option, the CT data alignment step will be closed (3-point and best-fit
alignment will be skipped).
Continue with acceptable (external) alignment 1} m : Choose this

option if the CT data and the selected alignment object are already
aligned, e.g. externally.
Continue without acceptable alignment 2} m : Choose this option

if the CT data and the selected alignment object are not aligned, but
an alignment is not relevant for further processing.
Figure 9.5: CT Data Alignment window -

Evaluation tab

9.2.2 Manual Alignment after 3-Point Alignment

After you have performed the 3-point alignment, you can either perform the best fit alignment (see chapter 9.3) or adjust the
3-point alignment manually in the Manual Alignment tab. Note that a manual alignment will skip the best fit alignment
step that would succeed the 3-point alignment when no manual alignment is performed. A manual alignment is also possible
after the best fit alignment step (see chapter 9.3.2).
Select Move CT Alignment Object 1}

mand move the alignment ob-
1}
m ject using the arrow keys.
2}
m Select Rotate CT Alignment Object 2}
mand rotate the alignment
object using the arrow keys.
Adjust the step size using the Define Step Size 3}

mslider.
When you are satisfied with the manual alignment, click Accept and Eval-
3}
m
uate 4}m . This will skip the best fit alignment and you will be prompted to
4}
m evaluate the manual alignment result as described in chapter 9.3.1.
To discard the manual alignment, click Undo manual alignment 5} m .
5}
m
Figure 9.6: CT Data Alignment window -

Manual Alignment tab
NOTE
The achievable accuracy for object movement is 0.01mm. The achievable accuracy for object ro-
tation is 0.5°.

9.3 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 9.7). The best fit alignment will refine the alignment, taking the intial 3-point alignment as start point.
1}
m
2}
m
3}
m
Figure 9.7: CT Data Alignment window for best fit alignment
Crop CT mesh 1}
m, Reset CT Options to improve the alignment accuracy. See chapter 9.5.
m
}
mesh 2 , Mark Feature
Regions 3}
m
Next (Wizard mode) Start the best fit alignment.

Back (Wizard mode) Discard the 3-point alignment to position the points again.
Cancel (Expert mode) 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.
Start Best Fit Alignment Start the best fit alignment.

(Expert mode)
Discard Alignment (Expert Discard the complete alignment, return to the 3-point alignment step.
mode)
Table 9.2: CT Data Alignment window for best fit alignment

Click Next (Wizard mode) / Start Best Fit Alignment (Expert mode). exoplan refines the fitting of the CT data with the jaw
scan. This process may take several minutes depending on your hardware configuration.
When the best fit alignment is complete, the alignment object is displayed with colors (see Figure 9.8). 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 9.9).
Figure 9.8: 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 9.8), 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 at the chosen surface threshold value.

9.3.1 Evaluating/Discarding the Best Fit Alignment Result

Once the alignment is completed, the main view visualizes the CT dataset
with the aligned mesh and the secondary views Panorama, Curve Cut,
and Coronal are displayed by default. These secondary views with the
activated option Show cut texture (Panorama view) provide the possibil-
ity to evaluate the CT data alignment. The CT Data Alignment window
provides options for evaluating the alignment result.
1}
m
Continue with acceptable alignment 1} m : The term ”acceptable”
refers to the accuracy of the alignment result. The less the devia-
tion of the CT data to the alignment object at the common areas,
the more accurate the alignment result. You can check the accuracy
2}
m of your alignment using the color scale displayed on the alignment
object after the best fit alignment.
Selecting this option will finish the CT-to-Mesh alignment step and
initiate the next Wizard step.
Continue without acceptable alignment 2} m : If you evaluate the

3}
m alignment result as unacceptable, exoplan skips the CT data align-
ment step and initiates the next Wizard step (if you are in Wizard
mode). Note that you cannot design a surgical guide until you have
performed a CT alignment.
4}
m
If you want to discard the best fit alignment result, select Discard
alignment 3} m . This will restart the CT-to-Mesh alignment step.
Check the accuracy of the CT-to-Mesh alignment by using the color

Figure 9.9: Options for evaluating the align- scale 4}
m . The color scale encodes the local distances between the
ment result CT alignment object and the CT mesh extracted from the DICOM
dataset of the patient based on the current surface threshold value.
9.3.2 Manual Alignment after Best Fit Alignment

After you have performed the best fit alignment, you can adjust the best fit alignment manually in the Manual Alignment
tab using the same functions as descibed in chapter 9.2.2.
9.3.3 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 9.10 appears:

Figure 9.10: 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.
9.4 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 these objects along with the changing position of
the CT Data.
Objects which require transformation decisions:
Optical scan data of an antagonist
Tooth models (decide for each tooth model)
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 initial 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 which of the existing objects you want to transform. Pressing and holding CTRL
while hovering over an object in the list will focus the main view on the selected object.
Select all objects that are already correctly aligned to the CT data. The selected object(s) will be moved together with the CT
data.
Your decision(s) 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 also have to make the transformation decision(s) again.

Figure 9.11 shows the dialog for transforming tooth models, annotations, and collision objects.
Figure 9.11: Transformation dialog
9.5 Options to Improve the Best Fit Alignment Accuracy

After the 3-point alignment has been performed, The Best Fit tab in the CT Data Alignment window provides tools for im-
proving the best fit alignment accuracy.
1}
m
2}
m
1}
mCrop CT Mesh (see Chapter 9.5.1)
3}
m 2}
mReset CT Mesh: Reset the CT mesh to its initial state
3}
mMark Feature Regions (see Chapter 9.5.2)
Figure 9.12: Best Fit tab

9.5.1 Cropping the CT Mesh
During 3-point alignment, exoplan gener-

ates a mesh from the Isosurfaces visualiza-
tion of the CT data around the area of inter-
est (see Figure 9.13). You can crop this mesh
(e.g. to remove noisy surface areas created
by metallic artifacts) in order to improve the
best fit alignment accuracy.
Figure 9.13: Mesh generated during best fit alignment

Click Crop CT Mesh in the Best Fit tab (see Figure 9.12) to open the CT Mesh Editor window (see Figure 9.14).
Figure 9.14: 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 9.15: 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.

Close Holes Close all holes in the selected part of the mesh. If no selection is present, close all holes
that are smaller than the size threshold (adjust the threshold by clicking the drop-down
arrow).
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 9.3: CT Mesh Editor window functions
9.5.2 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 undo the last best fit alignment and mark feature regions on the align-
ment 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 9.16).
4}
m
1}
m
2}
m
3}
m
5}
m 6}
m
Figure 9.16: Surface Marker Tool window
1}
mMark All: mark the entire alignment object
2}
mInvert Markings: marked regions become unmarked, unmarked regions become marked
3}
m
Delete 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 9.17: Brush tool in marking and demarking mode
After marking feature regions to be exclusively considered during the best fit alignment, you can return to the best fit align-
ment step by pressing OK.

10 CT-to-CT Alignment
CT-to-CT alignment is typically referred to

as Dual Scan Protocol in which the patient’s NAVIGATION
CT scan of the anatomy is aligned to a CT
scan of the patient’s prosthesis. exoplan will
CT to CT Alignment
align the CT datasets automatically to each
other, based on radio-opaque markers present This step is part of the guided
in both CT scans. Wizard workflow (see Chapter 22.3)
This Wizard step is initialized if you have selected CT-to-CT alignment in the previous Wizard step Select CT Alignment
Workflow (see Chapter 8). You can load the DICOM dataset of the patient’s prosthesis in order to align it to the patient’s
CT dataset. The main view is split in two synchronized screens visualizing the loaded CT datasets. You can set a surface
threshold and extract a mesh from the prosthesis CT dataset. Additionally, you can edit the mesh, e.g. to remove possible
artifacts. The mesh will be used for manual correction of the CT-to-CT alignment.
HINT
Ensure that the patient’s CT data and the patient’s prosthesis CT data meet the requirements listed
in Chapter 1.11.
3}
m
1}
m 2}
m
Figure 10.1: DICOM series selection dialog
Step 1: Load the prosthesis CT data in the DICOM series. If you have loaded a project file containing the patient name, the
dialog’s title will display it (see Figure 4.2).
Step 2: Select the directory that 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.

10.1 Extracting a Mesh from the Prosthesis CT Dataset
After loading the CT dataset of the prosthesis, exoplan opens the 2D sec-
5}
m tional views Axial, Sagittal and Coronal to support the evaluation of the
selected surface threshold. In these 2D views, the prosthesis is colored ac-
cording to the currently selected threshold.
You can load a different prosthesis CT dataset by clicking the corre-

sponding button 1} m.
Using the Surface Threshold slider 2} m , adjust the threshold so

1}
m that the contact surface of the prosthesis with the gingiva is clearly
visible. Adjusting the surface threshold is an essential step be-
2}
m cause this contact surface will be taken afterwards to design the
surgical guide. See Figures 10.3 and 10.4.
Activate the checkbox Finish step after extraction 3} mto skip

3}
m
editing of the extracted mesh. Deactivate the checkbox if you want
4}
m to be able to edit the mesh after extraction.
6}
m Selecting Extract mesh 4} m will extract a mesh from the prosthesis
CT dataset. The mesh will be displayed in the main view and in 2D
sectional views as an outline overlaying the CT data of the prosthesis.
The tab Mesh Editing 5} mbecomes available after extracting the

mesh. You can use free-forming and/or edit the mesh using the CT
Mesh Editor (see Chapter 10.1.1).
Delete the extracted mesh using the corresponding button 6}

m.
Figure 10.2: Loading a Prosthesis dataset
2}
m
1}
m
Figure 10.3: Bad surface threshold setting Figure 10.4: Optimal surface threshold setting
1}
m: Make sure there are no holes in the contact surface to the gingiva.
2}
m: Avoid a disruptured ridge on the prosthesis mesh.
Click Next to initiate the automatic marker detection followed by the automatic alignment of the CT dataset to the extracted
prosthesis mesh. You will be prompted to evaluate the alignment in the next Wizard step CT-to-CT Alignment. If the auto-
matic marker detection fails, you will be prompted to select the markers manually (see Chapter 10.3).

WARNING
If you perform the CT-to-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 10.1.2).
WARNING
In order to be able to mark the gingiva correctly, it is essential to use the proper threshold settings
when extracting the patient’s prosthesis.
NOTE
You should compare the outlining of the extracted mesh with the CT data of the prosthesis in the
secondary views to see if it reflects the shape of the prosthesis accurately enough, especially in the
area of the contact surface with the gingiva.
10.1.1 Mesh Editing
In the Mesh Editing tab, you can edit the extracted prosthesis mesh using
the CT Mesh Editor 1} m (see Chapter 9.5.1) and the free-forming function-
1}
m
m
}
ality 2 (see Chapter 20.5.2). Note that you can perform the free-forming
3}
m
in both the main view and the secondary 2D views.
2}
m To restore the extracted CT prosthesis mesh to its original state, select Re-
store Mesh 3} m .
Figure 10.6: Free-forming the extracted prosthesis mesh in sagittal view

Figure 10.5: Functions to edit the extracted
prosthesis mesh
HINT
Use the tools in the tab Mesh Editing to remove mesh artifacts from the prosthesis mesh. Espe-
cially, remove floating or connecting mesh artifacts within the prosthesis mesh by using the CT

Mesh Editor tool. This is described in detail in Chapter 20.8.1.
10.1.2 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-to-CT data alignment, you must decide if you want to transform these objects along with the changing position
of the patient’s CT data.
Objects which require transformation decisions:
Optical scan data
Tooth models (decide for each tooth model)
Annotations (decide for each annotation)
Collision objects (decide for each collision object)
See Chapter 9.4 for a detailed description of the transformation dialog.
10.2 Evaluating the CT-to-CT Alignment
Once the alignment is completed, the main view visualizes the CT dataset with
the aligned prosthesis mesh and the secondary views Panorama, Curve Cut, and
Coronal are displayed by default. These secondary views with the activated op-
tion Show cut texture (Panorama view) provide the possibility to visualize the fit
of the prosthesis in the patient’s mouth as shown in Figure 10.8.
1}
m The Evaluation tab of the CT-to-CT Data Alignment window provides further
options for evaluating the alignment result:
Continue with acceptable alignment 1} m : The term ”acceptable” refers to

the accuracy of the alignment result. The less the deviation of the CT data
2}
m to the extracted mesh, the more accurate the alignment result. Carefully
check the accuracy of the alignment. Selecting this option will finish the
CT-to-CT data alignment step and initiate the next Wizard step.
Continue without acceptable alignment 2} m : If you evaluate the align-

ment result as unacceptable, exoplan skips the CT-to-CT data alignment
step and initiates the next Wizard step (if you are in Wizard mode). Note
3}
m
that you cannot design a surgical guide until you have performed a CT-to-
CT alignment.
Completely discard the extracted mesh and the applied alignment by se-
lecting Completely discard extracted mesh and applied alignment 3} m
.
This will restart the CT-to-CT data alignment step and you will be prompted
to load a prosthesis CT dataset again.
Back (Wizard mode) / Undo marker alignment (Expert mode): Initiate the
Figure 10.7: Evaluating the CT-to-CT manual marker detection step (see Chapter 10.3).
Alignment

Figure 10.8: Evaluating the CT-to-CT Alignment in secondary views
10.2.1 Manual Alignment

You can improve the alignment result manually in the Manual Alignment tab using the same functions as described in
chapter 9.2.2.

10.3 Manual Marker Detection

If the automtic detection of radio-opaque markers fails, or you canceled the CT-to-CT Alignment step after the automatic
marker detection, exoplan initiates the manual Marker Detection step. In order to perform a manual alignment, you need
to add at least three pairs of corresponding markers 7}
m and then press the button Apply alignment 2}
m .
Start marker detection 1} m: Starts the automatic marker detec-

tion. If the checkbox Automatic alignment after detection is ac-
tivated, exoplan will automatically start the marker alignment and
prompts you to evaluate the alignment, providing the same funtions
as described in Chapter 10.2.
Apply alignment (Expert mode) 2} m : Starts the marker alignment

and prompts you to evaluate the alignment, providing the same fun-
1}
m
tions as described in Chapter 10.2. In Wizard mode, clicking Next has
the same effect.
2}
m
Automatic alignment after detection 3} m : Deactivate this check-
3}
m
box to prevent exoplan from automatically initiating the alignment
evaluation upon clicking Start Marker Detection 1} m .
4}
m Surface threshold patient 4} m: Slider to set the threshold for the
surface visualization of the patient CT data.
5}
m Surface threshold prosthesis 5} m : Slider to set the threshold for
the surface visualization of the prosthesis CT data.
6}
m
Synchronize Split view 6} m: Deactivate this checkbox to disable
7}
m 8}
m the synchronized split view. You will be able to move and rotate both
views individually.
9}
m
Add marker 7} m : Add markers to be considered during alignment.
Click alternating the CT data of the patient and prosthesis to define
pairs of markers, each pair consisting of one point on the CT dataset
and one corresponding point on the prosthesis CT data (See Figure
10.10). Hold CTRL while clicking on on a marker in one of the CT
datasets to remove that marker. You need to define at least three
pairs of markers in order to start the alignment.
Remove marker 8} m : Remove markers by clicking on a marker in

Figure 10.9: CT-to-CT Alignment window: one of the CT datasets. Hold CTRL to add a marker in one of the CT
Marker Detection tab datasets.
The Summary section 9} mprovides a marker count for both CT

datasets and lists the number of correlating markers (if you defined
at least three pairs of markers).
Figure 10.10: Manual marker detection in synchronized main view

11 Changing the Implant Setup
Using this option, you can edit the implant

setup. The option is also available in the im- NAVIGATION
plant positioning step (see Chapter 16.5).
Change Implant Setup
This step is part of the guided Wizard
workflow if no implants have been defined in
your project.
Clicking Change Implant Setup in the Expert toolbar / context menu opens the Change Implant Setup window (see Figure
11.1).
Figure 11.1: Change Implant Setup window

To change the implant setup for a tooth:
Step 1: Select a tooth by clicking it in the dental arch. The selected tooth turns red.
Step 2: Select the connecting element type for this tooth from the dropdown menu (see Chapter 28.6 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 Change Implant Setup window, click OK. Clicking Cancel
discards 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 12) will appear in the further
workflow (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.

12 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 16), 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 28.5 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.
Skipping the process of defining the mandibular nerve canal might cause injury to the patient,
e.g., resulting in permanent impairment of the nerve.
HINT
Use one of the methods described in the chapters 12.2.2 and 12.2.3 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 12.1.7) 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 7.2), this can cause distortion effects in the panoramic view (see Chapter 7 for details on how
to create the panoramic view; see Chapter 24.5 for details on the panoramic view).

5}
m 4}
m
1}
m
7}
m 2}
m
6}
m
3}
m
Figure 12.1: Mandibular canal definition screen
1}
2}
mSecondary view: curve cut view (see Chapter 12.1.2)
3}
mSecondary view: panoramic view (see Chapter 12.1.3)
4}
5}
6}
mView presets (see Chapter 12.1.6)
7}
mDefine Mandibular Canal window (see Chapter 12.1.7)
Clicking in a sectional view (e.g. curve cut, panoramic view in cut mode) directly sets a point for the mandibular canal.
See Chapter 12.2.1 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 26.2) or the view preset buttons (see Chapter 12.1.6).
12.1.1 Main View

The main view displays the DICOM series visualization. For available view-related functions in the main view, see Chapter
24.1. View indicators (colored frames) indicate positions of active secondary views. See Chapter 24.1.2 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.

12.1.2 Secondary View: Curve Cut

This secondary view shows a cross-section view of the DICOM series oriented orthogonally to the panoramic curve. See
Chapter 24.4 for a detailed description of the curve cut view.
12.1.3 Secondary View: Panoramic View

This secondary view shows the panoramic image you have defined in the panoramic curve definition step (see Chapter 7).
See Chapter 24.5 for a detailed description of the panoramic view. You can only define the mandibular canal in cut mode.
12.1.4 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 26.1 for a detailed description of the Group Selector.
12.1.6 View Presets

Special view presets are available in this step. Select a view preset by clicking the corresponding icon. See Chapter 24.7 for a
detailed description of view presets.
12.1.7 Define Mandibular Canal Window

The Define Mandibular Canal window provides functions and explanations for defining the mandibular canal(s).
1}
m
3}
m
2}
m
4}
m
5}
m
6}
m 7}
m
Figure 12.2: 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 1}

m Toggle between right and left nerve.
Clear 2}
m Clears any existing definition for the corresponding mandibular canal.
Lock 3}
m 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 27.1) and want to avoid
unintended changes in your mandibular canal definition.
Nerve Diameter 4}
m Define the nerve tube’s diameter. Choose a diameter covering the complete extent of
the mandibular nerve at any point.
Undo/Redo 5}
m Undo/redo previous actions. If you define canals on both sides, these buttons
undo/redo the last action on the currently selected side.
Next / OK 6}
m Complete the mandibular canal definition step, save all your settings and close the
window.
Back / Cancel 7}
m Abort the mandibular canal definition step, close the window. All changes made since
you entered the step will be discarded.
Table 12.1: Define Mandibular Canal window functions
12.2 Step-by-Step
This chapter describes three possible methods for defining the mandibular canal:
Method A: Using the curve cut view (see Chapter 12.2.2)
Method B: Using the panoramic view (see Chapter 12.2.3)
Combining method A and method B (see Chapter 12.2.4)
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.
12.2.1 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. A yellow out-

line around the point indicates the canal’s diameter.

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).
The canal’s diameter is displayed as a thin yellow/blue out-
line.
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 in the Define Mandibular Canal window (see Chapter 12.1.7). This can
be helpful if you want to use other tools, e.g. the Measurement Tool (see Chapter 27.1).
12.2.2 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 12.1 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 12.3).

(a) Main view (semi-transparent)

(b) Panoramic view
Figure 12.3: 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 24.4. For a detailed description of view-
related functions in the curve cut view see Chapter 24.4.1).

12.2.3 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 24.2.3). An orange line then indicates the current position of the panoramic view,
allowing you to see the depth position of points.

12.2.4 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 12.4: Mandibular canal defined in curve cut view and panoramic view
Once you have set all points for the mandibular canal, you can leave the mandibular canal definition step and proceed in the
workflow. Note that you do not need to finalize the mandibular canal definition with a specific action like double-clicking.
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 23.3).

13 Sinus Segmentation
This Wizard step is only available when plan-

ning implants for tooth numbers 24-28 or NAVIGATION
14-18. You can still perform the sinus seg-
mentation via Expert mode if your project
Sinus Segmentation
does not involve any of these tooth numbers.
Sinus segmentation is important to avoid dam- This step is part of the guided
aging the sinus cavities when drilling chan- Wizard workflow (see Chapter 22.3)
nels for implants into the patient’s jaw bone.
When positioning implants (see Chapter 16), a collision will be detected if you move an implant too close to the segmented si-
nus cavity. It is not possible to finish the implant planning process until you resolve the collision (see Chapter 28.5 for details
on collisions).
5}
m
2}
m
3}
m
1}
m
6}
m 4}
m
Figure 13.1: Sinus segmentation screen
1}
m
Main view (see Chapter 12.1.1)
2}
mSecondary view: axial view (see Chapter 12.1.2)
3}
mSecondary view: sagittal view (see Chapter 13.1.3)
4}
mSecondary view: coronal view (see Chapter 13.1.4)
5}
6}
mSinus Segmentation window (see Chapter 12.1.7)

WARNING
An incorrect definition of the sinus cavity can cause a permanent injury of the patient during
the surgical implanting procedure.
Skipping the process of defining the sinus cavity can cause a permanent injury of the patient

exoplan automatically suggests the preset of main view and secondary views. You can change the preset using the Implant
Control (see Chapter 26.2) or the view preset buttons (see Chapter 24.7).
13.1.1 Main View

The main view displays the DICOM series visualization. For available view-related functions in the main view, see Chapter
24.1. View indicators (colored frames) indicate positions of active secondary views. See Chapter 24.1.2 for details on view
indicators.
Clicking in the main view using the middle mouse button focuses all secondary views to this position. You cannot set a seed
point in the main view.
13.1.2 Secondary View: Axial

This secondary view shows a cross-section view of the DICOM series oriented orthogonally to the occlusal plane. See Chapter
24.3 for a more detailed description of the axis oriented views.
13.1.3 Secondary View: Sagittal

This secondary view shows a sagittal cross-section view of the DICOM series. See Chapter 24.3 for a more detailed description
of the axis oriented views.
13.1.4 Secondary View: Coronal

This secondary view shows a coronal cross-section view of the DICOM series. See Chapter 24.3 for a more detailed description
of the axis oriented views.

Use the DICOM Control for modifying the DICOM series visualization in the main view. The only available visualization mode
is Isosurfaces. See Chapter 5 for a detailed description of the DICOM Control and the available visualization modes.

During this step, the group CT segmentation objects will be added. If you define both sinus cavities, two elements Sinus
segmentation will be added. See Chapter 26.1 for a detailed description of the Group Selector.
13.1.7 View Presets

Special view presets are available in this step. Select a view preset by clicking the corresponding icon. See Chapter 24.7 for a
detailed description of view presets.

13.2 Step-by-Step
Step 1: Using the Threshold slider 1} m, you can adjust which intensity
values exoplan will consider as potential sinus region. In
Preview mode 2} m, the secondary view visualization switches
from solid segmentation cut mode to solid critical cut
mode, clearly showing the differences in density. Select a
threshold value that clearly separates the sinus areas from the
surrounding nasal areas (i.e.: there should be no holes visible in
the sinus area and no connection between the sinus area and
other surrounding areas). Click the Show more button 3} m to
display positive and negative examples for the threshold value.
3}
m
Step 2: In a secondary view, click within the sinus area. We recommend
using the axial view as shown in Figure 13.3.
2}
m
Step 3: You can start the segmentation with the Start Segmentation
1}
m button 4} m . Once the segmentation is done, the segmented
area (the area which is considered as sinus region) is highlighted
4}
m
in the secondary views as shown in Figure 13.4.
6}
m Step 4: Now you can decide to either accept the segmentation by
selecting Create collision object 5}
m or to redo it.
5}
m Clicking undo segmentation 6} m will only undo the last segmention
and all created collision objects will remain. Clicking Delete all Si-
7}
m
nus Meshes 7} mwill delete all created collision objects and the Si-
nus Segmentation step will restart from the beginning.
If you accept the segmentation by clicking Create collision object

5}
m , exoplan creates a collision object from the segmentation (see
Figure 13.6).
Figure 13.2: Sinus Segmentation window: Step 5: Now you can either perform a second segmentation or
Semi-automatic tab continue with the implant planning workflow.
Similar to the mandibular nerve canals, the sinus area meshes are now collision objects that prevent the user from placing
an implant, sleeve , or anchor pin too close to the collison object mesh.
Figure 13.3: Sinus Segmentation: Setting the seed point in Figure 13.4: Sinus Segmentation: Highlighted sinus cavity
axial view after successful segmentation

HINT
After exoplan segmented the sinus cavity, make use of the provided secondary views to check if you
are satisfied with the segmentation. See Chapter 24.2 for details. If you are not satisfied with the
segmented sinus cavity, use the tools described in Chapter 13.3 to manually edit the segmented
volume.
13.3 Manually editing collision objects
Figure 13.5: Free-forming a sinus cavity collsion object in Axial view
After creating a collision object, you can edit the mesh using free-forming functions. The Manual Adjustments tab provides
the same free-forming functions as described in Chapter 20.5.2. When free-forming a collision object, you can switch to the
secondary view Axial if you prefer to perform the free-forming in 2D (see Figure 13.5).
Figure 13.6: Sinus Segmentation screen after successful segmentation

14 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. If you have loaded a waxup scan or a
situ scan, or have performed a CT-to-CT align-
Place Model Teeth for Backward
ment, you can only access this step (and the
Planning
subsequent precise placement step) in Ex-
pert mode. If you have loaded an optical jaw This step is part of the guided
scan for your project, exocad highly recom- Wizard workflow (see Chapter 22.3)
mends to perform the CT data alignment step
(see Chapter 9) before placing tooth models.
The tooth placement consists of two steps:
1. Initial placement (see this chapter)
2. Precise placement (see Chapter 15)
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.
3}
m 2}
m
1}
m
4}
m
Figure 14.1: Initial placement startup screen
1}
2}
3}
4}
mPlace Model Teeth window (see Chapter 14.1.4)


14.1.1 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 24.1.

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 26.1 for a detailed description of the Group
Selector.
14.1.4 Place Model Teeth Window

The Place Model Teeth window as shown in Figure 14.2 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 14.2: 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 14.1: 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.
14.2 Step-by-Step
This chapter provides instructions for the following scenarios:
1. Placing a bridge for a single tooth with two adjacents: Chapter 14.2.1
2. Placing a bridge for a single tooth with one adjacent (usually last molars on distal side): Chapter 14.2.2
3. Placing a bridge consisting of multiple teeth: Chapter 14.2.3
14.2.1 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 14.3: 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 14.2.4.

14.2.2 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.
Figure 14.4: 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 14.2.4.
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.
14.2.3 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 14.2.1 and 14.2.2).
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 14.5 shows examples for the placement of multi-tooth bridges.
(a)

(b)
Figure 14.5: Placement of multi-tooth bridges
14.2.4 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.
14.3 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).
14.3.1 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)
14.4 Selecting a Tooth Library
Tooth libraries can be found in the Choose Library section of the Place
Model Teeth window (see Figure 14.6).
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
28.4.4 for details on available tooth libraries.
Figure 14.6: Tooth library selection

14.5 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 23.3).
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.

15 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 14). 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
Wizard workflow (see Chapter 22.3)
2}
m
1}
m
3}
m
4}
m
Figure 15.1: Precise placement startup screen
1}
2}
3}
mSecondary views ( see Chapter 15.1.3)
4}
mTooth Placement window (see Chapter 15.1.4)


15.1.1 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 24.1.

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

When accessing this step, three secondary views are displayed by default: coronal view, curve cut view, and curve tangent
view. See Chapter 24.2 for detailed descriptions of secondary views.
15.1.4 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 15.2). You can move/scale/rotate tooth models in any view (main view
and secondary views).
(a) Simple tab (b) Chain Mode tab
Figure 15.2: 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 15.1: Tooth Placement window Simple tab functions
See Chapter 15.2 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 15.2: Tooth Placement window Chain Mode tab functions
See Chapter 15.3 for precise tooth model placement using the chain mode.
15.2 Step-by-Step: Simple Mode

Figure 15.3: Action buttons in Tooth Placement window

15.2.1 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
15.2.2 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.
15.2.3 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.


15.3 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 15.4).
2}
m
1}
m
3}
m
Figure 15.4: 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 disc, 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 15.3.1)
Single: transforms a single tooth (see Chapter 15.3.2)
Tube: transforms all teeth on a fixed arch (see Chapter 15.3.3)
15.3.1 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
15.2):
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 15.3: Tooth Placement window Chain Mode checkboxes
15.3.2 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
15.2):
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 Chapter15.3.1).
15.3.3 Tube Mode

In this mode, you can move, scale, and rotate teeth in a chain along a fixed arch, indicated by a red tube extending the ends
of the main tube (see Figure 15.5).
Figure 15.5: Tube mode - Main and red tube

Move the teeth along this arch by dragging your mouse. Rotation and scaling behavior are the same as in Chain mode (see
Chapter 15.3.1).
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 15.3.1).
15.3.4 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 15.6: Chain mode options

The Symmetry button actually consists of four buttons. Hovering over one of the corners of these buttons displays blue sym-
metry indicators in the main view, indicating the symmetry plane, considered teeth (blue control points), and the symmetry
direction.
Figures 15.7 to 15.10 show the symmetry button functions.
Figure 15.7: Overall symmetry from right to left

Figure 15.8: Overall symmetry from left to right

Figure 15.9: Front teeth symmetry from right to left
Figure 15.10: 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 15.11). The arrows indicate which teeth are used as
reference for the plane orientation. The reference teeth are locked (red control points).
Figure 15.11: 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 15.11).
To pin the symmetry plane, click the sphere between the arrows.

15.3.5 Reset Options

Clicking Reset in the Options section of the Chain Mode tab (see Figure 15.6) displays available reset options you can select
from.
Figure 15.12: 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 15.4: Chain mode reset options


16 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 16.4 for more information on placing an implant. See chapter 24.6 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 16.2) Implant Positioning
2. Initial positioning of the selected This step is part of the guided
implant (see Chapter 16.3) Wizard workflow (see Chapter 22.3)
3. Refining the implant position by
moving and/or rotating the implant
(see Chapter 16.4)
© 2017–2022 exocad GmbH page 100/222

6}
m 5}
m
2}
m
1}
m
3}
m
7}
m 4}
m
Figure 16.1: Implant placement startup screen
1}
2}
3}
mCurve cut view (see Chapter 16.1.3)
4}
mCurve tangent view (see Chapter 16.1.4)
5}
6}
7}
mImplant Positioning window (see Chapter 16.1.7)

16.1.1 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 24.1.

The panoramic view shows the panoramic image you defined in the panoramic curve definition step (see Chapter 7). See
Chapter 24.5 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 7.2), this can cause distortion effects in the panoramic view.
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16.1.3 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 24.4 for a detailed description of the curve cut view.
16.1.4 Curve Tangent View

The curve tangent view shows a cross-section view of the DICOM series oriented tangentially to the panoramic curve. See
Chapter 24.4 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 16.4), 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 26.1 for a detailed description of the Group Selector.
16.1.7 Implant Positioning Window

The Implant Positioning window provides controls and explanations for selecting and positioning implants.
5}
m
1}
m 2}
m 3}
m 6}
m
4}
m
Figure 16.2: Implant Positioning window
Three tabs are available:

1}
mSelect: functions for selecting an implant and attachable parts (see Chapter 16.2).
2}
mAlign: functions for moving and rotating the implant and all attached parts (see Chapter 16.4).
3}
mSettings: implant settings (see Chapter 16.5).
4}
m: The left side of the window lists all tooth numbers for which an implant is planned.
5}
m: Using the search field at the top of the window, you can find implant manufacturer libraries and individual implants.
6}
m: All implant types of a selected manufacturer are shown on the lower right. Subtype, length, and diameter become
available for selection when you have chosen an implant type.
© 2017–2022 exocad GmbH page 102/222

16.2 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.
2}
m
3}
m
1}
m
4}
m
5}
m
6}
m
Figure 16.3: Implant selection functions
Step 1: Select the tooth number of the implant you want to position 1}
m.
Step 2: Select a manufacturer library using the search field at the top of the window 2} m . You can combine several filters.
Alternatively, use the scroll bar to browse through the list of manufacturers. If you position multiple implants, an
implant part library based on the already positioned implant models will be preselected in the library list.
Step 3: Select an implant type from the selected manufacturer’s library 3m
}.
Step 4: Select the implant type’s subtype, length, and diameter using the table 4}
mbelow the implant library selection
menu. The colors shown in the table indicate the implant’s diameter. The color selection and the availibility of
colors depend on the manufacturer.
Step 5: The preview section 5}mshows the selected implant and potentially selected, compatible parts (e.g. stock
abutment). Hold the right mouse button and drag to rotate the preview.
Information about the implant is displayed in an information box next to the implant preview. The displayed
information depends on the implant library settings defined by the manufacturer / library provider.
Step 6: Click OK 6}mto complete the implant selection step. Now you can position the selected implant using the
functions described in chapter 16.3.
If you are planning multiple implants, select the tooth number in the menu on the left 1}
mto choose and position the desired
implant. Possible implant part combinations (e.g. compatible stock abutments) depend on compatibility settings defined by
the library provider. See Chapter 28.4.1 for details on implant libraries.
After you positioned all planned implants, click OK (when in Expert mode)/ Next (when in Wizard mode) 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.
© 2017–2022 exocad GmbH page 103/222

HINT
Click the star symbol next to a library entry to define this library as a favorite. Favorites can be
accessed using the button Favorites Only 1} m and will persist when you restart exoplan.
If your desired implant part is not available for selection in this step, check exocad’s website to
download the newest libraries by clicking the Download more link at the top of the Implant Po-
sitioning window 2} m .
1}
m 2}
m
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.
© 2017–2022 exocad GmbH page 104/222

16.3 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. 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 16.5).
Figure 16.4: Before initial implant positioning

Figure 16.5: After implant positioning
© 2017–2022 exocad GmbH page 105/222

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 Align tab becomes active and can be selected. Using this tab, you can move and rotate implants (see Chapter 16.4).
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 16.2).
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 24.7 for details on view presets.
exoplan will show an implant marker axis in the main view and the implant axial view that visualizes the orientation of
the implant connection to the user (if defined in the implant library). You can toggle the visibility of the marker axis in
the Group Selector (see Chapter 26.1).
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 16.1.7). 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.
NOTE
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 16.5.3). See Chapter 28.5 for details on collisions.
SHORTCUTS
While the mouse cursor is above an implant preview or a positioned implant:
Hold CTRL and scroll the mouse wheel to change the implant length.
Hold SHIFT and scroll the mouse wheel to change the implant diameter.
16.4 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 16.3).
1}
m 2}
m
© 2017–2022 exocad GmbH page 106/222

Figure 16.6: 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 1} m , 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 2}m , click the implant and drag it in the desired rotation direction. You
can select to move the implant around its center, around the implant axis, or around the top/bottom of the implant.
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.
If your project contains a multi-unit abutment with an angled superstructure relative to the implant, an aditional widget is
available which you can use to move the implant along the superstructure’s direction. Activate the widget by right-clicking
an implant with angled superstrucure and select Rotate around superstructure (see Figure 16.7). When activated, the
behaviour of the rotation widgets changes so that the implant is rotated around the superstructure’s direction.
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 16.2).
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 will
be damaged. You have to visually inspect the vicinity of the chosen implant position.
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)
© 2017–2022 exocad GmbH page 107/222

and the visual representation of the minimum safety distance around the implant to visually
assess the distances to anatomical structures.
16.4.1 Parallelize implants and prosthetic directions

Besides the manual positioning of implants via the Move/Rotate function (see Chapter 16.4), exoplan also offers the possi-
bility of an automated parallelization of two implants or their prosthetic directions.
Note that you need to select an implant using the dropdown menu at the top of the Implant Positioning window in order to
be able to parallelize it to another implant. Alternatively, you can double-click an implant in the main view to select it. The
currently selected implant is colored in yellow.
To parallelize two implants to each other, right-click on a selected positioned implant during the Implant Positioning
step to open the context menu. Select Align implant directions > Align this implant’s direction to and choose the
implant you want to parallelize the currently selected implant to (See Figure 16.7).
To parallelize two implant’s prosthetic directions to each other, right-click on a selected positioned implant during the
Implant Positioning step to open the context menu. Select Align implant directions > Align this implant con-
sruction’s prosthetic direction to and choose the implant prosthetic direction you want to parallelize the currently
selected implant’s prosthetic direction to. This is helpful when working with angulated prosthetic components (e.g.
angulated stock abutments).
Figure 16.7: Parallelize implants/superstrucures

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16.5 Implant Positioning Settings
Changes in the implant positioning settings affect all implants (not only
1}
m
the currently selected implant).
In the Settings tab of the Implant Positioning window, you can
2}
m change the implant type and setup 1}
m
(see Chapter 16.5.1),
define implant visualization settings 2}

m
(see Chapter 16.5.2),
change the safety distance around implants 3}

m
3}
m (see Chapter 16.5.3).
Figure 16.8: Implant settings tab
16.5.1 Changing the Implant Setup

Clicking Change Implant Setup opens the Change Implant Setup window (see Figure 16.9).
Using the functions in this window, you can change the implant setup, de-
fine additional implants, and delete implants. See Chapter 11 for detailed
instructions on how to change the implant setup.
If you have already positioned implants for the affected teeth, a dialog in-
forms you that the implant and all its parts will be deleted if you change
the implant setup. Click OK to confirm.
In Expert mode, you can edit the implant setup at any point using the
Change Implant Setup option (Chapter 11).
Figure 16.9: Change Implant Setup window
16.5.2 Implant Visualization Settings

In the Implant Positioning window, the implant of the currently selected tooth is displayed in yellow by default. Possibly
planned implants for unselected teeth are displayed in the manufactorer’s predefined color(s). Upon exiting the Implant
Positioning window, all planned implants are displayed in the manufactorer’s predefined color(s).
© 2017–2022 exocad GmbH page 109/222

Visualization Modes:
Standard: Sets the implant visualization to the manufacturer’s predifined color.
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).
16.5.3 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 de-
fined in the exoplan settings (see Chapter 27.6). 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.
Consider increasing the safety distance for the collision detection to compensate for the de-
creased precision of the surgical guide when working with edentulous patients in the dual
scan workflow.
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 28.5 for details on collisions.
Figure 16.10: Implant with safety distance

visualization
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17 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
Wizard workflow (see Chapter 22.3)
6}
m 5}
m
2}
m
1}
m
3}
m
7}
m 4}
m
Figure 17.1: Sleeve placement startup screen
1}
2}
3}
mImplant cross view (see Chapter 17.1.3)
4}
mImplant axial view (see Chapter 17.1.4)
5}
6}
7}
mSleeve Placement window (see Chapter 17.1.7)
© 2017–2022 exocad GmbH page 111/222


17.1.1 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 24.1.

The panoramic view shows the panoramic image you have defined in the panoramic curve definition step (see Chapter 7).
See Chapter 24.5 for a detailed description of the panoramic view.
17.1.3 Implant Cross View

The Implant cross view shows a sectional view of the DICOM series along the implant axis. See Chapter 24.6 for a detailed
description of the Implant cross view.
17.1.4 Implant Axial View

The Implant axial view shows a sectional view of the DICOM series orthogonal to the implant axis. See Chapter 24.6 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 26.1 for a detailed description of the Group Selector.
17.1.7 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.
© 2017–2022 exocad GmbH page 112/222

17.2 Selecting a Sleeve
7}
m
1}
m 4}
m
2}
m
3}
m
6}
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. You can download more libraries by clicking the Download more libraries... link at
the top of the libraries dropdown menu. Select the desired drilling sleeve type and subtype using the two dropdown menus
2}
m below. Select a surgical kit using the third dropdown menu 3} m . Only surgical kits compatible with the selected drilling
sleeve are available for selection.
To clear your selection, click the trash bin icon 4}
m. Select Show additional information 5} mto open the Implant Control
in the Sleeve Information tab (see Chapter 26.2.3). exoplan displays detailed information about the placed implants at the
top of the window 7} m .
HINT
If your desired drilling sleeve library is not available for selection in this step, check exocad’s web-
site to download the newest libraries by clicking the Download more libraries... link at the top
of the libraries dropdown menu 1} m .
17.3 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.
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Figure 17.2: Sleeve in main view
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 rotaion handles and 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 being displayed next to the dark arrows may be different from the one in figure 17.2.
An alternative method for freely positioning a drilling sleeve is to select the option Manual Height/Rotation 6}
min the
Sleeve Placement window (see Chapter 17.2). This will open a new window allowing you to enter values for angle (from
default orientation) and height (from implant connection, bone level, or apical peak).
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.
The distance of the sleeve shoulder to the implant’s apical peak is calculated based on the
implant mesh provided by the implant manufacturer. In case this mesh does not perfectly
represent the real physical implant geometry, there will be a deviation.
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).
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.
The usage of a generic sleeve in a drill guide requires to verify the real drill depth during the
intervention.
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17.3.1 Sleeve Visualization

During implant planning, positioned sleeves are visualized in the following views:
Main view
Panorama view (3D and outlining)
All other secondary views (outlining)
Panoramic image (3D) and cross-sectional images in the implant planning report (outlining)
Images in the Surgical Protocol (3D)
Positioned sleeves are visualized in the manufactorer’s predefined color. Figure 17.3 shows an example of various sleeve types
in the main view.
Figure 17.3: Various sleeve types in the manufactorer’s predefined color

© 2017–2022 exocad GmbH page 115/222

18 Anchor Pin Placement
In this step, you can select and position an-

chor pins. This serves to design a stable sur- NAVIGATION
gical guide for edentulous patients for use
in guided surgery.
Place Anchor Pins
This step is part of the guided Wizard
workflow for edentulous cases
(See chapter 22.3)
5}
m 4}
m
2}
m
1}
m
6}
m
3}
m
Figure 18.1: Anchor pins placement startup screen
1}
m
Main view (see Chapter 18.1.1)
2}
mAxial view (see Chapter 18.1.2)
3}
mCurve cut view (see Chapter 18.1.3)
4}
5}
6}
mPlace Anchor Pins window (see Chapter 18.1.7)
© 2017–2022 exocad GmbH page 116/222


18.1.1 Main View
The main view shows the DICOM series visualization, the jaw scan, the extracted prosthesis mesh, implant planning ele-
ments, and view indicators. For available view-related functions in the main view, see Chapter 24.1.
18.1.2 Axial View

The axial view shows an axial cross-section view of the DICOM series. See Chapter 24.6 for a detailed description of the axial
view.
18.1.3 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 24.4 for a detailed description of the curve cut view.
18.1.4 Implant Cross View

The Implant cross view shows a sectional view of the DICOM series along the implant axis. It appears upon placing the first
anchor pin. You can freely move and rotate placed anchor pins in this secondary view. See Chapter 24.6 for a detailed de-
scription of the Implant cross view.

By default, the visualization mode in the anchor pin placement 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.

During this step, the group Anchor Pins will be added. Which groups/elements are available for individual anchor pins de-
pends on the library settings of the selected anchor pin. See Chapter 26.1 for a detailed description of the Group Selector.
18.1.7 Anchor Pin Placement Window

The Place Anchor Pins window provides controls and explanations for selecting and placing anchor pins.
© 2017–2022 exocad GmbH page 117/222

18.2 Step-by-Step
Step 1: Select an anchor pin library from the dropdown menu 1} m. You
can download more libraries by clicking the Download more
libraries... link at the top of the libraries dropdown menu.
Step 2: Select diameter 2}

mand length 3}
mfrom the two dropdown
menus below.
7}
m
Step 3: Place the anchor pin by left-clicking the desired position in
the main view. It is not possible to place anchor pins in the
secondary views. Placing the first anchor pin activates the
secondary view Implant Cross.
Step 4: Adjust the postion of the placed anchor pin by left-clicking and
dragging it in the main view or in the active secondary views.
1}
m
Adjust the insertion direction of the placed anchor pin using the
2}
m 3}
m gray rotation handles adjacent to the anchor pin in the main
view. Alternatively, hold CTRL while clicking and dragging the
anchor pin, or use the blue rotation handles in the secondary
4}
m view Implant Cross. Use the gray arrow widget to adjust the
anchor pin’s position along the insertion axis.
5}
m
Step 5: Place another anchor pin by selecting Add new anchor pin 4}
m
and repeat steps 1-4.
Remove selected anchor pins using the corresponding button 5}

m.
6}
m
Define the desired safety distance around the anchor pins using the
slider Safety distance 6} m . This setting affects all placed anchor
pins.
When placing an anchor pin too close to a collision object, the se-
lected anchor pin’s color changes from yellow to orange, the affected
collision object will be colored in red.
When several anchor pins have been placed, you can select an an-
chor pin from the top dropdown menu 7} m or by double-clicking it in
the Main View or in any of the secondary views.
WARNING
The implant planning report shows information regarding which anchor pins are used/placed
but neither the implant planning report nor the surgical protocol will detail information about
the drill (length/diameter) to use.
When a library with anchor pins is updated, the parts of the previous version of the updated li-
brary in saved scenes are not updated automatically. To update them in the scene, the anchor
pin step must start again with subsequent confirming to update the libraries.
© 2017–2022 exocad GmbH page 118/222

HINT
Carefully read the instructions of the anchor pin manufacturer and check which drill to use for the
specific anchor pin. If in doubt, contact the anchor pin manufacturer or your reseller.
HINT
If your desired anchor pin is not available for selection in this step, check exocad’s website to down-
load the newest libraries by clicking the Download more libraries... link at the top of the libraries
dropdown menu 1} m.
Figure 18.2: Anchor pin placement finished
HINT
Anchor pins can only be placed in the implant planning workflow but not in the surgical guide work-
flow. If you do not place any anchor pins in this Wizard step and proceed to the next step by clicking
Next, exoplan prompts you to decide whether you really want to skip the anchor pin placement or
return to the anchor pin placement step.
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19 Generating Implant Planning Result Files
In this final step of the implant-planning work-

flow, you generate the implant planning re- NAVIGATION
sult files. These files contain all information
on the final implant planning state and can
Generate Implant Planning Result Files
be used for creating surgical guides, or for
designing restorations in another software This step is part of the guided
(e.g. exocad DentalCAD). The planning re- Wizard workflow (see Chapter 22.3)
sult files generation step is available if you
have positioned all implants defined for your project in the implant positioning step (see Chapter 16). For creating provi-
sional result files before you have positioned all implants, see Chapter 19.3.
For details on implant planning result files, see Chapter 28.7.
Figure 19.1: Implant planning result files generation screen

© 2017–2022 exocad GmbH page 120/222

19.1 Step-by-Step
To generate implant 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. For edentulous cases (Dual Scan Protocol), an additional column shows the
information specified in the CT data of the prosthesis for ensuring you are using the correct prosthesis CT data.
Approval content section: planning approval statements you confirm by approving the implant planning result.
If the loaded DICOM dataset contains accepted issues as described in chapter 1.11.1, you need to confirm that you are
aware of the issue(s) in the loaded DICOM dataset(s).
Read the statements in the dialog carefully and confirm only if you agree with all listed items.
To generate the implant 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 Im-
plant Planning Result Files dialog (see Figure 19.3).
You can save the scene without approving the implant planning using the button Save scene.
© 2017–2022 exocad GmbH page 121/222

Figure 19.3: Generate Implant 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 Implant Planning Result Files window
is updated (see Figure 19.4).
Figure 19.4: Generate Implant 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 Project 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 Implant Planning Result Files dialog. exoplan prompts
you to decide if you want to delete the previously generated implant planning
result files from the project directory.
Table 19.1: Generate Implant Planning Result Files window functions
If you change implant positions or settings in exoplan and save the result, existing planning result files will not be updated.
© 2017–2022 exocad GmbH page 122/222

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 implant planning result files (or no implant planning result files,
if they were deleted). You can access previous implant planning result files in the archive directory. See Chapter 28.7 for
more information.
19.2 Aborting the Implant Planning Result Files Generation Process

During generation of the implant planning result files, the Generate Implant Planning Result Files window as shown in
Figure 19.5 is displayed.
Figure 19.5: Generate Implant Planning Result Files window during files generation
Click Abort Writing to abort the files generation process. Implant planning result files already generated during this process
will be deleted.
Clicking Cancel in the Generate Implant Planning Result Files window during files generation also aborts the process
but closes the Generate Implant Planning Result Files window after prompting you to delete already generated planning
result files.
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19.3 Generating Provisional Implant Planning Result Files for Individual Implants
In Expert mode, you can generate provisional implant 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 Implant 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 implant planning result files for all positioned implants. The
implant planning result files will be marked as provisional, indicating that not all implants are considered.
19.4 Errors During Implant Planning Result Files Generation

If errors occur during implant planning result files generation, all implant planning result files which have already been cre-
ated in this generation process will be deleted. In the appearing dialog (see Figure 19.6), you can try to generate the implant
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 19.6: Implant Planning Result Files Generation Error Dialog
© 2017–2022 exocad GmbH page 124/222

19.5 Selecting the Workflow After Generating Implant Planning Result Files
1}
m
2}
m
3}
m
4}
m
5}
m
Figure 19.7: Finished window
In this window, you can decide what to do next:
Design surgical guide 1}

m: Start the Surgical Guide design workflow in Wizard mode.
I’m done 2}
m: Close the application.
Expert mode 3}
m: Enter Expert mode to make adjustments to the complete design.
Show Report 4m
}: Open the implant planning report (PDF file).
Open Project Directory 5}
m: Open the project directory where exoplan saves the planning result files.
© 2017–2022 exocad GmbH page 125/222

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 missing canine and incisors.
Make sure that the design of the surgical guide does not contain sharp edges, ridges, or peaks
to avoid injuries of the patient’s soft tissue such as the tongue.
In case of edentulous cases, use anchor pins to guarantee a stable fit of the surgical guide.
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.
If the surgical guide is created by a dental lab, both parties (i.e. dentist and lab) must clearly
communicate and agree on which implants, sleeves, surgical kit, anchor pins and additional
requirements for particular design properties to use (collaborating parties/partners may use
the project notes to exchange notes).
© 2017–2022 exocad GmbH page 126/222

20.1 Workflow of Different Treatments

This chapter shows the workflow for different treatments. Chapter 20.1.1 lists all steps of the workflow for tooth-supported
surgical guides. Chapter 20.1.2 lists all steps of the workflow for edentulous cases (Dual Scan Protocol).
20.1.1 Workflow for tooth-supported surgical guides
Wizard step Description
Design Sleeve Mounts Design the mounts for the planned drilling sleeves (see Chapter 20.3) and the define the
settings for placed anchor pins (see Chapter 20.3).
Design Surgical Guide Design the bottom of the surgical guide by blocking out undercuts, setting the insertion
Bottom direction, and using free-forming tools (see Chapter 20.5).
Designing the Surgical Define the shape of the surgical guide’s top (see Chapter 20.6).
Guide Top
Adding Attachments Stabilize the surgical guide with supports, add inspection windows and text attachments to
the surgical guide (see Chapter 20.7).
Merging the Surgical exoplan automatically merges and saves the designed surgical guide into one single mesh
Guide (see Chapter 20.8).
Free-Forming the Use free-forming tools to adjust the shape of the merged surgical guide (see Chapter 20.9).
Merged Surgical Guide
Generating the exoplan automatically generates the surgical guide result files (see Chapter 20.13).
Surgical Guide Result
Files
Table 20.1: Wizard steps for tooth-supported surgical guides
20.1.2 Workflow for edentulous cases
settings for placed anchor pins (see Chapter 20.3).
Defining the Gingiva This Wizard step only appears if your project contains a prosthesis mesh that will be used as
Contact Surface surgical guide base (see Chapter 20.4).
Guide Top
© 2017–2022 exocad GmbH page 127/222

Creating a Fixation Design a separate fixation guide to be used in guided surgery (see Chapter 20.10).
Guide
Merging the Fixation exoplan automatically merges and saves the designed fixation guide and its attachments
Guide into one single mesh (see Chapter 20.11).
Free-Forming the Use free-forming tools to adjust the shape of the merged fixation guide (see Chapter 20.12).
Merged Fixation Guide
Files
Table 20.2: Wizard steps for edentulous cases
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 17.
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20.3 Designing Sleeve Mounts and Anchor Pin Mounts

20.3.1 Sleeves tab
Design the surgical guide sleeve mounts using the sliders.
Minimum Base Thickness 1} m : Set the mount’s minimum thickness

(radius), measured to the beginning of the smoothed edge area.
Additional Rounding 2}
m: Set the radius for smoothing the
mount’s edges.
Height 3}
m: Set the mount’s height.
1}
m
Clearance above 4} m: Set an area above the mount which will re-
main clear for the drilling tool(s). If parts of your surgical guide de-
2}
m
sign enter this area, they will be removed during finalization. By de-
fault, this area is locked to the sleeve mount’s diameter. To unlock
3}
m the slider, click the lock icon.
4}
m Clearance Height 5}
m: Slider to set the sleeve mount’s clearance
height.
5}
m Rotation Marker Count 6} m : Single displays a single rotation
marker on the sleeve mount. Multiple displays multiple equally dis-
6}
m tibuted rotation markers on the sleeve mount. All displays all rota-
tion markers.
Custom implant rotation marker 7} m: If implants in the scene

7}
m have a rotation marker defined in the implant library, a marker is au-
8}
m 9}
m
tomatically created on the sleeve mount so that the dentist can cor-
rectly align the connection of the implant during insertion. If there
10}
m are implants in the scene that do not have their own rotation mark-
ers (on the implants themselves), you have the possibility to cre-
ate additional markers for these implants (deactivated by default).
There are two ways to create additional markers:
1. aligned at one corner of the hex 8}
m
2. aligned with one edge of the hex 9}
m
Figure 20.1: Design Sleeve Mounts win-
These markers are always generated vestibularly, if possible.
dow: Sleeves tab
Radial sleeve offset 10} m : Set an additional radial sleeve offset
which will be considered during production.
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WARNING
The Minimum Base Thickness of a sleeve mount/anchor pin 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 ill-fitting sleeves in the 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.
Figure 20.2: Sleeve mount with custom implant rotation markers
© 2017–2022 exocad GmbH page 130/222

20.3.2 Anchor Pins tab
1}
m
If your project contains any placed anchor pins, you can design the anchor
2}
m pin mounts using the following sliders:
3}
m Minimum Base Thickness 1} m : Set the mount’s minimum thickness
(radius), measured to the beginning of the smoothed edge area.
4}
m
Additional Rounding 2}
m: Set the radius for smoothing the
mount’s edges.
5}
m
Clearance above 3} m : Set an area above the mount which will re-
main clear for the drilling tool(s). If parts of your surgical guide de-
sign enter this area, they will be removed during finalization. By de-
fault, this area is locked to the pin’s diameter. To unlock the slider,
click the lock icon.
Clearance Height 4}
m: Slider to set the anchor pin mount’s clear-
ance height.
Radial sleeve offset 5} m : Set an additional radial sleeve offset

which will be considered during production.
Figure 20.3: Design Sleeve Mounts win-

dow: Anchor Pins tab
20.3.3 Printer presets tab

In the Printer Presets tab, you can choose presets of bundled sets of pa-
rameters for an available printer. You can also adjust the settings in the
tabs Sleeves and Anchor Pins and create your custom preset using the
Save to preset button 1} m .
Use the Reload Preset button 2} mto reset a preset to its original
state. Use the checkbox Auto Save Preset 3}
m to automatically save
4}
m 1}
m
any created presets.
2}
m Create more presets by adjusting the sliders in the tabs Sleeves and
3}
m Anchor Pins and save them by right-clicking the upper dropdown
menu 4} min the Printer Presets tab. Choose a name for your pre-
set(s) that contains no special characters or spaces. The custom pre-
Figure 20.4: Design Sleeve Mounts win- sets are saved to a directory on your harddrive which can be opened
dow: Printer Presets tab by right-clicking the upper dropdown menu 4} mand selecting the
corresponding option Open preset folder.
© 2017–2022 exocad GmbH page 131/222

20.4 Defining the Gingiva Contact Surface

If your project contains an extracted prosthesis mesh originating from the prosthesis CT data of an edentulous patient, you
need to mark an area on the prosthesis mesh that will be used as the contact surface to the surgical guide.
You can define the contact surface by painting an area on the mesh using a brush tool 1}
m(see Chapter 20.4.1) or by marking
m
}
the boundaries of the contact surface with a spline tool 2 (see Chapter 20.4.2).
Note that you cannot continue the workflow without generating a gingiva contact surface from an area of the prosthesis
mesh.
20.4.1 Defining the contact surface with the brush tool
Mark an area on the prosthesis mesh using the brush tool (see Figure 20.6).
This area will be used as the contact surface to the surgical guide.
7}
m You can adjust the size of the brush using the Brush Size 3}
mslider
or by holding SHIFT while scrolling up or down.
1}
m 2}
m
You can delete parts of the painted area by holding SHIFT while us-
ing the brush tool.
4}
m
Apply the marking by clicking Generate contact surface 4}
m. This
3}
m will extract the marked area from the prosthesis mesh.
5}
m
You can delete the generated marking by clicking the Clear mark-
ing & mesh 5}m button.
Click the button Show More 7} m to see positive and negative examples of
6}
m the contact surface definition using the brush tool.
Choose whether you want to design the surgical guide bottom freely (i.e.,
by defining the bottom and top part), or use the prosthesis mesh as the
surgical guide base by selecting the corresponding option 6} m(see Figure
20.9). In case you do not select any of the options and want to proceed to
the next step, exoplan will prompt you to do so.
If you want to set a default surgical guide design option, select the corre-
sponding option in the exoplan settings (see Chapter 27.6).
Figure 20.5: Defining the contact surface -

Brush Tool
Figure 20.6: Brush tool: Positive and negative example of the contact surface definition
© 2017–2022 exocad GmbH page 132/222

20.4.2 Defining the contact surface with the spline tool
Define a curve along the outer ridge of the prosthesis mesh by placing con-
trol points using the left mouse button (see Figure 20.8). To delete a con-
trol point, right-click it while holding it with the left mouse button. Make
sure the area you define includes the possible contact surface to the sur-
4}
m gical guide.
Avoid free floating connection lines (indicated in red), e.g. by placing
more control points in the vicinity of the red lines.
Apply the marking by clicking Generate contact surface 1}

m. This
1}
m
will extract the marked area from the prosthesis mesh.
2}
m
You can delete the generated marking by clicking the Clear curve
& mesh 2}m button.
Click the button Show More 4} m to see positive and negative examples of
the contact surface definition using the spline tool.
3}
m
Choose whether you want to design the surgical guide bottom manually
or use the prosthesis mesh as the surgical guide bottom by selecting the
corresponding option 3} m(see Figure 20.9). In case you do not select any
of the options and want to proceed to the next step, exoplan will prompt
you to do so.
If you want to set a default surgical guide design option, select the corre-
sponding option in the exoplan settings (see Chapter 27.6).
Figure 20.7: Defining the contact surface -

Spline Tool
Figure 20.8: Spline tool: Positive and negative example of the contact surface definition
Figure 20.9: Freely designed surgical guide vs prosthesis-based surgical guide
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20.4.3 Editing the prosthesis mesh

In the tab Mesh Editing, you can edit the prosthesis mesh using the same functions as described in Chapter 10.1.1.
HINT
Use the tools in the tab Mesh Editing to remove mesh artifacts from the prosthesis mesh. Espe-
cially, remove floating or connecting mesh artifacts within the prosthesis mesh by using the CT
Mesh Editor tool. This is described in detail in Chapter 20.8.1.
20.5 Designing the Surgical Guide’s Bottom

20.5.1 Bottom Design Properties
1}
m Design the surgical guide’s bottom using the sliders in the Properties tab.
2}
m Block out undercuts
Offset 1}
m: Set an offset from the teeth to the bottom surface.
Allow undercuts up to 2} m : Set a maximum value for allowed
3}
m undercuts. Undercuts are displayed on the surgical guide bot-
4}
m tom in colors.
Bottom properties
Smoothing 3} m : Set a value for smoothing the surface. The
higher the value, the smoother the surface.
5}
m Anticipate milling 4} m : When milling the guide, this setting
ensures that the drill head with its particular drill head diam-
eter reaches each part of the guides bottom side. Adjust the
Diameter slider to define the drill head diameter to be used.
Figure 20.10: Design Surgical Guide Bottom
Click Apply 5} m to apply changes in the properties and to generate the sur-
gical guide’s bottom. Once generated, the bottom is displayed on the jaw
scan with colored undercut visualization as shown in Figure 20.11.
Figure 20.11: Surgical guide bottom with un-

dercut visualization
© 2017–2022 exocad GmbH page 134/222

WARNING
The Offset value in the Block out Undercuts section is dependent on the material/printer com-
bination 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 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.
Insertion Direction
While in Properties tab, the green arrow in the main view shows the insertion direction.
2}
m 1}
m
Figure 20.12: Functions to set the insertion Figure 20.13: Insertion direction
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 1} mnext to Set insertion
direction from view sets the view to the current insertion direction) and click Set insertion direction from view 2} m.
Click Apply to apply a new insertion direction and to generate the surgical guide’s bottom.
WARNING
Carefully inspect the impact of a particular setting of the insertion direction (e.g., blocking or al-
lowing undercuts or smoothing of the bottom). Inappropriate settings may result in an ill-fitting
© 2017–2022 exocad GmbH page 135/222

surgical guide.
HINT
The tooth-supported surgical guide should have enough (non-blocked) support on the occlusal
surface of the neighboring teeth. Ideally, the tooth surface is not blocked out from the occlusal
surface down to the equator. For tissue-supported guides for edentulous cases, use anchor pins to
ensure a stable fit of the surgical guide.
20.5.2 Free-Forming
Using the functions in the Free-Forming tab, you can free-form the surgical guide’s bottom.
Figure 20.14: 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.
© 2017–2022 exocad GmbH page 136/222

SHORTCUTS
1 Activate Add/Remove
2 Activate Smooth/Flatten
3 Small region
4 Large region
F2 Select default brush type
F3 Select point of knife brush type
F4 Select cylinder brush type
20.5.3 Printer presets

In the Printer Presets tab, you can choose presets of bundled sets of parameters for an available printer. See Chapter 20.3.3
for a detailed description of printer presets.
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20.6 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 20.15: 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.
Use the sliders Thickness 1}

m and Smoothing 2} m to
1}
m define the surface properties of the surgical guide’s
top.
2}
m
Click Clear 3}
mto delete any margin line definition.
With Undo/Redo, you can undo/redo actions.
4}
m
Click Apply 4}
mto initiate the surgical guide top gen-
eration.
3}
m
Figure 20.16: Design Surgical Guide Top step
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You can still edit the margin lines once the surgical guide
top is generated. If parts of the surgical guide top col-
lide with the planned implant, or 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 do not have to remove them manually.
For an edentulous case (Dual Scan Protocol), exoplan also

checks whether areas of the defined margin line are placed
either 1 mm below the extracted contact surface to the gin-
giva (see Chapter 20.4) or more than 5 mm above it. If so,
you will be informed before you can continue.
Figure 20.17: Surgical guide top design
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.
For tooth-supported surgical guides, 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 increase the thickness of the surgical guide. Additionally, you can increase the radial
thickness of the sleeve mount in the Design Sleeve Mounts window.
Include sufficient undercuts during definition of the margin line of the surgical guide top for
a proper retain of the surgical guide.
The contact surface of the surgical guide with the remaining dentition must be sufficient for
a stable fit.
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20.7 Adding Attachments

You can add supports or cut out windows using predefined shapes. You can also add a text label to the surgical guide’s surface
and connect sleeve mounts/anchor pins for better stability and fit of the surgical guide.
WARNING
Use the attachment function with care because it may impact the stability and fit of the surgical
guide.
Figure 20.18: Attachments Surgical Guide step
20.7.1 Adding a support structure/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 and rotation widgets shown in figure 20.19, you can adjust the support’s/window’s
length and rotation. Alternatively, hold SHIFT to scale or CTRL to rotate the support structure/inspection
window.
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Figure 20.19: Placing an inspection window
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.
20.7.2 Adding text

Step 1: Select Text (embossed)/(debossed) in the Structure dropdown menu.
Step 2: exoplan selects the patient’s name as the default text and truncates it to a maximum of 50 characters. You can
type your desired text into the text field overwriting the default text. Using the sliders below the text field, you can
change the font size and thickness. You can enter multiple lines of text into the text field.
Step 3: Clicking the arrow icon next to the textbox opens a new window where you can select a font, format your text
attachment bold and/or italic, and choose from a selection of supported symbols. Confirm your font selection by
clicking OK.
Step 4: Move the text to the desired position on the surgical guide and click to set it.
Figure 20.20: Adding a text attachment
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.
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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).
20.7.3 Adding Mount Connectors

If your project contains more than one sleeve mount, you can connect the mounts to provide more stability.
Step 1: Select Mount Connector in the Structure dropdown menu 1}

m.
Step 2: Click on a mount in the main view, then click the mount you want to connect. The connected mounts will be
highlighted in orange and the mount connector is now visible in the main view. The connected mounts are
displayed in the Settings section 2}m.
Step 3: Using the slider Minimum size area 3}
m, you can adjust the diameter of the mount connector.
Step 4: Click New 4m
}if you want to add another connector, then repeat steps 2-3.
1}
m
2}
m
3}
m
4}
m 5}
m
6}
m 7}
m
Figure 20.21: Adding sleeve mount connectors
To delete a mount connector, select it in the main view and click Delete 5}
m. Click Delete all 6}
mto delete all existing mount
m
}
connectors. Click the Preview button 7 to generate a preview of the merged surgical guide.
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20.7.4 Shortcuts
You can use the following shortcuts to scale the placed attachments:
Window / support structure:
SHIFT + mouse wheel: length scaling
CTRL + mouse wheel: thickness scaling
SHIFT + left mouse button: uniform scaling
CTRL + SHIFT + left mouse button: direction based scaling
CTRL + Arrow keys Up/Down: Rotate a window/support structure in 15° steps.
Mount connectors:
SHIFT + mouse wheel: change the minimum area size
Text:
SHIFT + mouse wheel: size scaling
CTRL + mouse wheel: thickness scaling
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20.8 Merging the Surgical Guide

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 in the tab Merging, or restart it by clicking Restart Merging.
Figure 20.22: Merging in progress Figure 20.23: Merging tab - Merging completed
exoplan merges all parts of the surgical guide into one single mesh and saves it as stl file in the project folder when generating
the surgical guide result files (See chapter 20.14). Selecting Next while the option No extra fixation guide is chosen will
initiate the free-forming of the merged surgical guide (see Chapter 20.9). Selecting Next while the option Create fixation
guide later is chosen will allow you to design a separate fixation guide after completing the free-forming step (see Chapter
20.10).
Note that if the merged surgical guide consists of multiple parts, exoplan will display a warning dialog, prompting you to
decide whether you want to proceed in the workflow or return to the merging step.
Figure 20.24: 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.
© 2017–2022 exocad GmbH page 144/222

Note that exoplan will display a warning dialog upon selecting Next if the merged surgical guide for an edentulous case does
not contain any anchor pins. The dialog prompts you to decide whether you want to continue in the workflow without placing
anchor pins retroactively or whether you want to switch to Expert mode to place anchor pins. (see Figure 20.25).
Figure 20.25: Warning dialog shown if no anchor pins were placed (edentulous case)
© 2017–2022 exocad GmbH page 145/222

20.8.1 Troubleshooting in Case the Merging Fails

In case the merging of the surgical guide or fixation guide fails for an edentulous case, enter Expert Mode, open the step
Define Gingiva Contact Surface (see Chapter 20.4) and use the tools of the CT Mesh Editor (see Chapter 9.5.1) in the tab
Mesh Editing as follows:
Step 1: Check for detached mesh parts by selecting the prosthesis mesh with the option Select by click on surface and
invert the selection. If the Delete button is enabled, floating parts are selected and should be removed by clicking
Delete.
Step 2: Check if there are connected mesh artifacts on the outside of the prosthesis that might result from noise and
beam hardening artifacts in the CT dataset of the prosthesis. Select and remove them individually. At the end,
select the prosthesis and click on Close holes. Use free-form tools to smooth affected areas if necessary.
Step 3: In secondary views, check for remaining mesh artifacts within the prosthesis mesh that are connected with the
prosthesis mesh (see Figure 20.26). Use the option Select only surface and select the mesh surface section
where the mesh artifacts are connected to. Delete the selection to detach the mesh artifacts from the prosthesis
mesh. Select the prosthesis mesh with the option Select by click on surface and invert the selection. This will
select the detached mesh artifacts. Finally, delete these mesh artifacts, select the complete prosthesis mesh and
click on Close holes. Use free-form tools to smooth affected areas if necessary.
Figure 20.26: Troubleshooting in Case the Merging Fails
© 2017–2022 exocad GmbH page 146/222

20.9 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 20.27: Free-form Merged Surgical Guide step
Note that exoplan will display a warning dialog upon selecting Next if intersections in the bottom of a free-formed tooth-
supported surgical guide are detected. The dialog prompts you to decide whether you want to continue in the workflow with
intended intersections or whether you want to return to the Free-forming step to resolve the intersections (see Figure 20.28).
Figure 20.28: Warning dialog shown if intersections in the surgical guide bottom are detected (tooth-supported case)
© 2017–2022 exocad GmbH page 147/222

The following notes apply to tooth-supported and gingiva-supported cases:
In this workflow step, there is a check between the clearance object and the free-formed guide.
In this workflow step, there is a check between invasive parts (implants and anchor pins) and free-formed guides.
If you proceed with Continue for at least one of these warning messages, a corresponding entry will be written into in
the Surgical Protocol.
20.9.1 Free-Form Tab

The Free-Form tab provides the same free-forming functions as described in Chapter 20.5.2. 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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20.9.2 Anatomic Tab
In the Anatomic tab, you can edit a Small region or a Large region of
the surgical guide by selecting the corresponding button. Click the merged
surgical guide in the main view and drag your mouse. You can adjust the
thickness visualization as in the Free-Form tab.
Figure 20.29: Free-form Merged Surgical

Guide step - Anatomic tab
© 2017–2022 exocad GmbH page 149/222

20.10 Creating a Fixation Guide

If your project contains a prosthesis mesh (when planning the treatment
of an edentulous patient) and a bite registration key has been used dur-
ing CBCT data acquisition of the patient wearing their prosthesis, an addi-
tional option Create fixation guide later is available after merging the
surgical guide. Choose this option to design a separate fixation guide to
be used in guided surgery: place attachments on the prosthesis mesh and
merge the attachments and prosthesis into a single separate fixation guide
mesh.
If the merged surgical guide already has attachments, exoplan will prompt
you to decide whether they should be ignored or also be used for the fixa-
tion guide (see Figure 20.32). Ignored surgical guide attachments can still
be activated for the fixation guide.
This optional step of the workflow provides the same functions as de-
scribed in Chapter 20.7.
Figure 20.30: Merging completed (Edentu- exoplan will merge the anchor pin mounts and fixation guide attachments
lous case) into the prosthesis mesh. Sleeves and attachments only defined for the
surgical guide will not be merged into the prosthesis mesh.
Figure 20.32: Fixation Guide decision dialog
Figure 20.31: Attachments Fixation Guide

window
© 2017–2022 exocad GmbH page 150/222

20.11 Merging the Fixation Guide
When you enter this Wizard step, merging and saving the fixation guide de-
sign is initiated automatically. You can abort the merging process by click-
ing Cancel Merging, or restart it by clicking Restart Merging. exoplan
merges all parts of the fixation guide into one single mesh and saves it as
stl file in the project folder when generating the surgical guide result files
(See chapter 20.14).
Note that if the merged fixation guide consists of multiple parts, exoplan
will display a warning dialog, prompting you to decide whether you want
to proceed in the workflow or return to the merging step.
Figure 20.33: Merging of fixation guide in

progress
HINT
If the merging of the fixation guide fails for edentulous cases, follow the instructions in Chapter
20.8.1.
20.12 Free-Forming the Merged Fixation Guide
In this Wizard step, you can free-form the merged fixation guide as de-
scribed in Chapter 20.9.
Figure 20.34: Free-Forming the Merged Fix-

ation Guide
© 2017–2022 exocad GmbH page 151/222

20.13 Generating the Surgical Guide Result Files
When you enter the step Generate Surgical Guide Result Files, exoplan
automatically generates the surgical guide result files and .stl files of the
merged surgical and fixation guide (if available) as well as the defined con-
tact gingiva surface (if available) and saves them to the project directory.
The scene is also saved to the project diectory after the surgical protocol
has been created.
Figure 20.35: Generate Surgical Guide Re-

sult Files step
20.14 Selecting the next step after generating the Surgical Guide Result Files
3}
m
4}
m Once the surgical guide result files are generated, you can select to view
the surgical protocol 1}mor to open the project directory 2} m. If you have
created surgical guide result files and apply certain critical changes to the
corresponding implant planning or the surgical guide design afterwards,
exoplan will delete those surgical guide result files.
I’m done 3}
m: Close exoplan.
1}
m
Expert Mode 4}
m: Enter Expert mode.
2}
m
Figure 20.36: Selecting the next step after

generating Surgical Guide Re-
sult Files
© 2017–2022 exocad GmbH page 152/222

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
Verify the surgical guide before usage.
20.14.1 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 (manufacturer, model, length, diameter, 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.
© 2017–2022 exocad GmbH page 153/222

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 25.1), or right-click the background in the main view and select Save
scene as in the context menu (see Chapter 25.3).
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 25.3) 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 25.3).
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, 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 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 workflow.
Figure 22.2: Expert toolbar
See Chapter 25.2 for a detailed description of the available Expert toolbar options.
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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 workflow.
The context menu has the same options as the Ex-

pert toolbar, but in a different order. The next
workstep in the Wizard steps sequence (see Chap-
ter 22.3) is highlighted in bold. See Chapter 25.3 for
a detailed description of the context menu and its
options.
Figure 22.3: Context menu with Expert options
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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 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.
(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 workflow. Table 22.1 lists the Wizard steps in chronological order.
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 the density references step has been finished once for the local software version,
this step will not appear in the Wizard again for other projects by default. This
behavior can be changed via the settings menu (see Chapter 27.6). You can always
access the step in Expert mode.
Define Panoramic Define the panoramic curve (see Chapter 7).

Curve
exoplan defines the panoramic curve automatically.
You can make adjustments to the automatic panoramic curve definition in Wizard-
and Expert mode.
Select CT Alignment Select the CT alignment workflow for your project (see Chapter 8).
Workflow
CT Data Alignment Align CT data to the jaw scan or another alignment object (see Chapter 9).
This Wizard step only appears if you loaded at least one alignment object and selected
CT to Mesh Alignment in the step Select CT Alignment Workflow.
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.
CT-to-CT Alignment Align CT data to the patient’s prosthesis CT data (see Chapter 10).
This Wizard step only appears if you loaded at least one alignment object and selected
CT-to-CT Alignment in the step Select CT Alignment Workflow.
exoplan will prompt you to load a prosthesis CT dataset before proceeding to the
Wizard step CT-to-CT Alignment.
Change Implant Setup This step only appears if no implants are defined in your project. Define at least one implant
to continue (see Chapter 11).
Define Mandibular Define the mandibular canal(s) (see Chapter 12).

Canal
This Wizard step only appears if you are planning implants for tooth numbers in
immediate vicinity of a mandibular nerve.
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Sinus Segmentation Define sinus areas as collision objects (see Chapter 13).
This Wizard step only appears when planning implants for tooth numbers 24-28 or
14-18.
Place Model Teeth Place tooth models initially (see Chapter 14).
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 15).
This Wizard step only appears if you have placed tooth models initially in the previous
step.
Implant Positioning Position implants (see Chapter 16).
If you have defined multiple implants in your project, clicking Next selects the next
unpositioned implant (along the detnal arch).
Sleeve Placement Select and position drilling sleeves (see Chapter 17).
Place Anchor pins This Wizard step only appears for edentulous patients’ cases but is always available via
Expert mode (see Chapter 18).
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.
and Anchor Pins settings for placed anchor pins (see Chapter 20.3).
Defining the Gingiva This Wizard step only appears if your project contains a prosthesis mesh that will be used as
Contact Surface surgical guide base (see Chapter 20.4).
Guide Top
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Creating a Fixation Design a separate fixation guide to be used in guided surgery (see Chapter 20.10).
Guide
Merging the Fixation exoplan automatically merges and saves the designed fixation guide and its attachments
Guide into one single mesh (see Chapter 20.11).
Merged Fixation Guide
Files
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 Expert features
This chapter lists all features that are exclusively accessible in Expert Mode.
23.1 Defining Axial and View Direction
In this optional Expert step, you can man-

ually specify the patient’s axial and view di- NAVIGATION
rection to change the basic orientation of the
DICOM series. If the patient’s head was scanned
Axial and View Direction
in a slanted position leading to an incorrectly
defined view axis in exoplan, you can cor- This feature is only available in Expert Mode
rect this here. exoplan uses this basic ori-
entation for the creation 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.
2}
m
3}
m
1}
m
4}
m
Figure 23.1: Axial and view direction definition screen
1}
2}
3}
mGroup selector (see Chapter 23.1.3)
4}
mAxial and View Direction window (see Chapter 23.1.4)
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23.1.1 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 24.1.

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.

During this step, no elements will be added. See Chapter 26.1 for a detailed description of the Group Selector.
23.1.4 Axial and View Direction Window

The Axial and View Direction window provides controls and explanations for defining the axial and view direction.
Figure 23.2: 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 23.1: Axial and View Direction window functions
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23.1.5 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 23.3: 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 3}
mto change the section plane’s position in vertical direction.
Drag the origin position point 4m
}to change the coordinate system’s location on the section plane.
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23.2 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 23.4) 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 23.4: Implant deletion dialog
If you delete an implant, the attached parts will also be deleted.

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23.3 Deleting Constructed Parts (Tooth Models, Drilling Sleeves, and more)
Using this function, you can delete constructed

parts in Expert mode. NAVIGATION

Delete Constructed Parts
23.3.1 Delete all tooth models, drilling sleeves, etc.

Step 1: Click Delete Constructed Parts in the Expert toolbar or the context menu. This opens the Delete
Reconstructions window (see Figure 23.5).
Figure 23.5: Delete Reconstructions window
Step 2: Select the parts to delete from the Delete: dropdown menu. The Parts to delete section lists the parts which
will be deleted. You cannot select individual items in the list.
23.3.2 Delete individual tooth models, drilling sleeves, etc.

Step 1: Select the model/s, canal/s, drilling sleeves ¹, etc. 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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23.4 Virtually Extracting Teeth
In this optional Expert step, you can extract

a tooth from a loaded jaw scan mesh by click- NAVIGATION
ing the tooth. exoplan automatically detects This feature is only available in Expert Mode:
which part of the mesh belongs to the tooth.
Expert toolbar:
A new mesh can be added to the scene con-
Extract tooth
sisting of the detected parts of the jaw scan
mesh. exoplan removes these parts from Context menu:
the jaw scan mesh and closes the hole. Virtually extract tooth
This is useful if you are performing implant
planning and want to design an appropriate surgical guide while the patient still has residual teeth left in the mouth, which
are extracted during/before surgery.
6}
m
5}
m
4}
m
1}
m 2}
m 3}
m
Figure 23.7: Extract Tooth window after

Figure 23.6: Extract Tooth window tooth extraction
Step 1: Decide whether you want to extract and remove the tooth, or also want to copy it.
If you only want to extract the tooth from the jaw scan, select No Copy 1}
m.
If you want to copy the tooth, choose whether to copy the extracted tooth as Virtual pre-op 2}
mor Direct
Copy 3 .m
}
Step 2: Select the tooth you want to extract by left-clicking the jaw scan.
When copying a tooth, exoplan displays a dental arch in a separate window. Select the tooth number that
should be the target of the copy.
Move a tooth copy by left-clicking and dragging it. Rotate a tooth copy by dragging it using the left mouse
button while holding CTRL. Scale a tooth copy by dragging it while holding SHIFT.
Step 3: To simulate the root extraction, you can change the shape of the gingiva below the extracted tooth using the
slider Collapse gingiva 5}m . You can influence the axis of the hole in the main view: Use the blue arrow handles
7 to rotate around the x-axis and the pink arrow handles 8}
m
} mto rotate around the z-axis. Influence the axis
freely by moving the green sphere 9} m (see Figure 23.8). Click the button next to the slider 6}
m to deactivate the
© 2017–2022 exocad GmbH page 166/222

3D placement handles in the main view. This will allow you to correct the placement of the copied tooth.
Step 4: To extract another tooth, select Extract another 4}
mand repeat steps 1-2.
7}
m
8}
m
9}
m
Figure 23.8: Collapse gingiva functions
23.4.1 Optimizing Tooth Detection Manually
In the Margin tab of the Extract Tooth window you can redefine the
margin of the tooth to be extracted by moving and/or placing control
points. You can move points on the 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.
1}
m Keep Surface Selection 1} m: Activate to use the surface area
2}
m
shown in the Correct tab. When deactivated, exoplan will re-detect
3}
m the surface area of the scan data based on the defined margin.
Select Clear all Points 2m

}to delete all control points.
4}
m
Ignore margin 3}m : Ignore the margin line. Disables the Margin tab
and switches back to the Select tab.
Figure 23.9: Extract Tooth window - Mar- Apply 4}

m: Extract the tooth with the chosen settings.
gin tab
In the Correct tab of the Extract Tooth window, you can optimize the
tooth detection by defining areas on the jaw scan with a brush tool.
Brush size 1} m: Slider to define the size of the brush. Alternatively,

you can increase/decrease the brush size by holding SHIFT and and
scrolling the mouse wheel.
1}
m
Additional extraction area 2} m: Define an area around the de-
2}
m fined extraction area that will also be considered when extracting
the tooth.
3}
m
4}
m Keep Margin 3} m : Activate to use the margin defined in the Margin
tab. When deactivated, exoplan will recalculate the margin based on
5}
m the selected surface area.
Clear surface selection 4m

}: Remove the defined extraction area.
Figure 23.10: Extract Tooth window - Cor- Apply 5m

}: Extract the tooth with the chosen settings.
rect tab
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24 Views
The available and displayed views in exoplan depend on the progress in the workflow and on the current workstep.
There are two types of views:
1. Main view (see Chapter 24.1)
2. Secondary views (see Chapter 24.2)
In certain workflow steps, exoplan arranges the main view and the secondary views automatically, e.g. when defining the
mandibular canal (see Chapter 12). You can change the view arrangement using the Implant Control (see Chapter 26.2) or by
choosing a different view preset (see Chapter 24.7).
24.1 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 26.2.1).
Figure 24.1: Main view showing DICOM series visualization and scene objects
The main view can show all elements you created or loaded. You can show/hide these elements (so-called scene objects)
using the Group Selector (see Chapter 26.1).
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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24.1.1 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. Hold SHIFT for fast
movement, CTRL for slow movement, or SHIFT + CTRL for very slow
movement.
Page up, page down Rotate the view horizontally around pivot
Table 24.1: Main view functions
SHORTCUTS
CTRL+R: open Measurement Tool (see Chapter 27.1)

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 25.1), 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 7).
24.1.2 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 24.5) is shaped like the
panoramic curve (i.e. the jaw ridge).
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Figure 24.2 shows the main view with the DICOM series visualization and view indicators of the axial view and the curve cut
view.
3}
m
1}
m
2}
m
Figure 24.2: 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 24.2.3).
A cursor indicator in the view-specific color displays the current mouse position in a secondary view (see Figure 24.3; also
displayed if view indicator is hidden).
Figure 24.3: Main view with cursor indicator
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24.2 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 workflow and current workstep.
Secondary views are:
Axial-oriented views (see Chapter 24.3): axial, sagittal, coronal
Panoramic curve-based views (see Chapter 24.4): curve cut, curve tangent
Panoramic view (see Chapter 24.5)
Implant-based views (see Chapter 24.6): Implant cross, Implant axial
Select secondary views for display using the Implant Control (see Chapter 26.2) or the view preset buttons (see Chapter 24.7).
24.2.1 Secondary View Elements

4}
m
2}
m
1}
m 5}
m
6}
m
7}
m
3}
m
Figure 24.4: 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
The secondary view’s main part 1}

mshows the 2D sectional view of the DICOM series and scene object visualizations. In
© 2017–2022 exocad GmbH page 171/222

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 24.2.5).
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 24.1.2), for the view intersection markers (see Chapter 24.2.6), for the view indications in the Implant
Control (see Chapter 26.2), and in the view presets of the main toolbar (see Chapter 24.7).
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 24.2.3).
Using the focus button 6}m , you can set the view as focused view (see Chapter 26.2.1 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 24.2.4).
24.2.2 Scene Objects in Secondary Views

Show/hide scene objects using the Group Selector (see Chapter 26.1). Scene objects are displayed in 2D or 3D (view-dependent).
Which scene objects can be displayed in a secondary view is view-dependent.
24.2.3 Visualization Settings

Open the visualization settings menu by clicking the top button in the view’s right frame (see Figure 24.4).
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 24.1.2)
Show View Intersection Markers Show/hide intersections with other currently active secondary views (see
Chapter 24.2.6)
Hide all Indicators Show/hide all view indicators and intersection markers (see Chapter 24.1.2)
Table 24.2: Visualization settings functions
In the panoramic view, only Show Indicator, Show View Intersection Markers, and Hide all Indicators are available.
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24.2.4 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 24.4). 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) 2m
}
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 24.6. The panoramic view has special visualization
modes; see Chapter 24.5.
24.2.5 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 24.5.3.
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24.2.6 Secondary View Intersections

By checking Show View Intersection Markers in the visualization settings menu (see Chapter 24.2.3), you can visualize
intersections with other currently active secondary views. These intersections are displayed as solid lines in the view-specific
color.
Figure 24.5 shows the axial view with two intersection markers:
2}
m
1}
m
Figure 24.5: 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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24.3 Axis-oriented Views: Axial, Sagittal, Coronal

The axis-oriented views are available when the axial and view direction have been defined. (See Chapter 23.1).
The axis-oriented views show the axial, sagittal, and coronal cross-section view of the DICOM series. They are based on the
axial and view direction which exoplan defines automatically at the beginning of the workflow. Note that you can define the
axial and view direction manually in Expert mode. (see Chapter 23.1).
(a) Axial (b) Sagittal

(c) Coronal
Figure 24.6: Axis-oriented views
© 2017–2022 exocad GmbH page 175/222

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
Sagittal view: Move along sagittal axis

Coronal view: Move along coronal axis

Hold right mouse button + move mouse right/left
Table 24.3: Secondary View functions
24.3.2 Scene Object Visualization

Scene objects are displayed as outlines in 2D. Figure 24.7 shows the axes-oriented views with implant parts, jaw scan, and
mandibular canal visualization.
(a) Axial (b) Coronal (c) Sagittal
Figure 24.7: 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 9.3.1). If the
alignment object (e.g., jaw scan) visualization fits the anatomical structures in the DICOM series visualization (i.e., jaw outlines
fit well the tooth shape), this is an indicator for the alignment being accurate.
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24.4 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 7). 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 24.8: 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 24.4: Panoramic Curve-based view functions

© 2017–2022 exocad GmbH page 177/222


Scene objects are displayed as outlines in 2D. Figure 24.7 shows the views with implant parts, jaw scan, tooth model visual-
ization, and mandibular canal visualization.
(a) Curve Cut (b) Curve Tangent
Figure 24.9: 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 9.3.1).
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.
24.5 Panoramic View

The panoramic view shows the panoramic image created in the panoramic curve definition step (see Chapter 7). 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 7.2). 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 24.10: Panoramic view
© 2017–2022 exocad GmbH page 178/222

The panoramic view has special visualization modes:
Cut mode 1}
m 1}
m
X-ray 2}
m 2}
m
To display the panoramic view as a texture (cut mode visualization) in the main
view, click 3}
m. 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.
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 24.5: Panoramic View functions

In X-ray mode, scene objects are displayed in 3D. In cut mode, they are displayed as outlines in 2D. Figure 24.11 shows the
panoramic view with scene object visualizations.
(a) X-ray mode (b) Cut mode

Figure 24.11: Panoramic view with scene objects
In the panoramic view, only implants (with attached parts), sleeves, anchor pins, and mandibular canals can be displayed.
24.5.3 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 24.2.5 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)
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24.6 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 16). They show the currently focused implant. Any anchor pins you have positioned are also displayed in these views
and can be focused with a double click.
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 24.12: Implant-based views with implant visualization and jaw scan visualization
In addition to the default visualization modes (see Chapter 24.2.4), 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 automatically defined by exoplan. Note that you can manually de-
fine the density threshold in Expert mode. (see Chapter 6).
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 24.6: Implant-based view functions
© 2017–2022 exocad GmbH page 180/222

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 24.13 shows the implant-based views with implant, jaw scan, and tooth model visualization.
(a) Implant cross (b) Implant axial
Figure 24.13: Implant-based views with scene objects
In the implant positioning step, you can enable density threshold coloring
for implants (see Chapter 16). The density threshold will be visualized in
the Implant cross view. This can help you to determine if you have posi-
tioned the implant in a potentially dense enough area.
Figure 24.14: Implant with density threshold

visualization
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24.7 View Presets

By clicking a view preset button in the main toolbar (see Chapter 25.1), 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 24.15: View preset buttons in main toolbar
The available view preset buttons may vary depending on the progress in the workflow and on the current workflow step.
© 2017–2022 exocad GmbH page 182/222

25 Menus
25.1 Main Toolbar
The main toolbar is always displayed at the right side of the exoplan screen. Figure 25.1 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.
2}
m
1}
mSave current scene (see Chapter 21.1)
2}
mSwitch to Wizard/Expert mode (see Chapter 22). Right-clicking shows additional options.
3}
m
3}
mAccess tools (see Chapter 27)
4}
mActivate/deactivate TruSmile (realistic rendering and display of tooth models). Right- 4}
m
clicking offers the Plaster option, which displays teeth (e.g. from a library) like a scanned
model. 5}
m
5}
m Show/hide Implant Control (see Chapter 26.2)
6}
mShow/hide Group Selector (see Chapter 26.1) 6}
m
7}
mShow/hide DICOM Control (see Chapter 5)
8}
mOpen user manual
7}
m
9}
mView preset buttons (see Chapter 24.7)
10}
m
8}
m
Smile Design View button (see Chapter 3.2.1)
11}
m View perspective buttons (see Chapter 24.1)
9}
m
10}
m
11}
m
Figure 25.1: Main toolbar
© 2017–2022 exocad GmbH page 183/222

25.2 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 workflow. Figure 25.2
shows the Expert toolbar at the end of the workflow with all available options.
1}
m 2}
m 3}
m
Figure 25.2: Expert toolbar
1}
mAccess worksteps
2}
mDelete implants (see Chapter 23.2)
3}
mDelete constructed parts (see Chapter 23.3)
25.3 Context Menu

To open the context menu, right-click the main view.
(a) Wizard mode (b) Expert mode
Figure 25.3: Context menu
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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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26 Controls
26.1 Group Selector

Show/hide the Group Selector by clicking Show/Hide Groups in the main toolbar (see Chapter 25.1).
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 workflow. Use the main view functions (see Chapter 24.1.1) to optimize your view on the
relevant scene objects.
The available scene objects depend on the progress in the 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 26.1: Group Selector
Show/hide groups/elements by clicking the arrows/eye symbols 1m

}.
Change the opacity for a group or 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 or 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 or prosthesis scan
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.
26.2 Implant Control

Using the Implant Control, you can select secondary views, arrange views, and view information about the placed implants,
drilling sleeves, anchor pins, and implant angles (including the topmost part angles). Show/hide the Implant Control by
selecting Implant Control in the main toolbar (see Chapter 25.1). The secondary views selection is only available if you have
selected CT data and defined the panoramic curve.
26.2.1 Implant Views Tab

Figure 26.2: Implant Control - Implant Views tab
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.
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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 24.2.1).
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
24.2.1), 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.
26.2.2 Implant Information Tab

The Implant Information tab shows model-related information about the positioned implant(s).
Figure 26.3: Implant Control - Implant Information tab
26.2.3 Sleeve Information Tab

The Sleeve Information tab shows model-related information about the positioned drilling sleeve(s).
Figure 26.4: Implant Control - Sleeve Information tab
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26.2.4 Anchor Pin Information Tab

If you have placed any anchor pins in the scene, the Anchor Pins tab shows model-related information about the positioned
anchor pins.
Figure 26.5: Implant Control - Anchor Pins tab
26.2.5 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°.
Figure 26.6: Implant Control - Implant Angles tab
The Implant Angles tab shows angles between the occlusal axes of the implants, as shown in Figure 26.6. In this example,
the angle between Implant 31 and Implant 32 is 58.3°. You can highlight angles between a specific implant and the other
implants by clicking a Tooth number. In the example, implant 44 is selected and the angles between implant 44 and implant
31, implant 32, implant 41, implant 45, and implant 46 are highlighted.
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26.2.6 Topmost Part Angles Tab

If there are at least two implants in the scene, the Topmost Angles tab shows the angles between the superstructures of the
implants.
Figure 26.7: Implant Control - Topmost Angles tab
The Topmost part Angles tab shows angles between prosthetic connections of used parts, as shown in Figure 26.7. If a nor-
mal titanium base or a normal stock abutment is used, the angles should not differ from the implant angles. However, if an
angled (multi unit) abutment or an implant with an angled prosthetic connection is used, there should be a difference to the
implant angles listed in the Implant Angles tab. In this example, the angle between the superstructure of Implant 31 and
Implant 32 is 72.4°. You can highlight angles between a specific implant superstructure and another implants’ superstru-
cure by clicking a Tooth number. In the example, the superstructure of implant 44 is selected and the angles between the
superstructure of implant implant 44 and implant 31, implant 32, implant 41, implant 45, and implant 46 are highlighted.
26.3 DICOM Control

See Chapter 5 for a description of the DICOM Control.
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27 Tools
Access the tools in the main toolbar (see Chapter 25.1) by clicking Tools.
The following tools are available:
Measurement Tool to measure distances, angles,

and bone density (see Chapter 27.1)
Add/Remove mesh to add/remove meshes

(see Chapter 27.2)
DICOM Control to open the DICOM Control

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

project notes
(see Chapter 27.3)
Show project in explorer to open the project direc-

tory (see Chapter 27.5)
Settings to access the general exoplan settings

(see Chapter 27.6)
About to view software information

(see Chapter 27.7)
27.1 Measurement Tool

Using the Measurement Tool, you can measure distances, angles, and bone density on scene objects in the main view and in
sectional secondary views.
In the panoramic view, you can measure distances/angles/bone density only in cut mode. Here, you can measure distances,
angles, and density 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 if you place them
in the main view.
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.
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NOTE
The accuracy of measuring distances, angles, and bone density depends on the accuracy of the
input data. When measuring distances/angles between CT data and mesh objects, the accuracy
depends additionally on the accuracy of the alignment.
1}
m 4}
m 5}
m
2}
m
6}
m
3}
m
7}
m
8}
m
9}
m 10m
}
Figure 27.1: Measurement Tool window
1}
mMeasure distances (see Chapter 27.1.1)
2}
mMeasure angles (see Chapter 27.1.2)
3}
mMeasure bone density (see Chapter 27.1.3)
4}
mScene object of starting point
5}
mScene object of end point
6}
mShow/hide arrows
7}
mDisplay scene objects semi-transparent (no effect on DICOM series visualization in main view)
8}
mEstimated Measurements
9}
mCreate annotations from the result (see Chapter 27.1.4)
10}
mClear all defined points
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27.1.1 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.
Figure 27.2: 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.
27.1.2 Measuring an Angle

Activate Angle and define the start and the end point for a measurement as described in Chapter 27.1.1. 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.
Figure 27.3: Angle measure
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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. When
measuring angles of the CT scan to other scene objects, the achievable accuracy additionally de-
pends on the quality of the alignment.
27.1.3 Measuring Bone Density

Activate Density and define the area to be measured by clicking the desired position on the DICOM data in the main viewer or
secondary views. A green sphere will be placed upon clicking a position on the DICOM data. To reposition the sphere, either
drag and drop it, or select the corresponding button at the top of the Measurement Tool window and click a new position.
exoplan will measure the average bone density (grey value from the surrounding voxels) within the sphere. Adjust the size
of the area you want to measure using the slider Sphere diameter in mm. When you haven’t placed the sphere on volume
data, the measurement shows “N/A”.
Figure 27.4: Density measure
WARNING
When measuring bone density, the loaded DICOM data set must be normalized to the Hounsfield
scale. If the loaded DICOM data set is not normalized to the Hounsfield scale, the measured values
will not represent a valid Hounsfield value.
27.1.4 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 27.8). See Chapter 27.3 for details
on annotations.
27.2 Add/Remove Mesh

Using this tool, you can add and/or remove meshes. It is only available in Expert mode.
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Clicking Add/Remove Mesh in the tools menu opens the Add/Remove Mesh window (see Figure 27.5).
Figure 27.5: Add/Remove Mesh window
27.2.1 Adding a Mesh

Step 1: Select the type of mesh you want to load from the Select mesh type dropdown list (see Chapter 28.8 for details
on mesh types).
Step 2: Click Load.
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 27.2.2).
Step 5: Click OK.
Alternatively, you can drag&drop the desired mesh into the main view. The Add/Remove Mesh window will be opened auto-
matically.
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 28.5). You must resolve the collision before you can close the Add/Remove Mesh window.
27.2.2 Mesh Placement Options

The Correct Placement section of the Add/Remove Mesh window (see Figure 27.5) 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 27.1: Mesh placement options
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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.
27.2.3 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 Antagonist as mesh type. You can position the plane using the mesh placement options (see Chapter 27.2.2).
27.2.4 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 9).
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27.3 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 27.6).
1}
m
2}
m
Figure 27.6: Annotation editor window
27.3.1 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 27.7).
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 27.7: Annotation
27.3.2 Editing Annotations

Select the Edit tab. It contains a list of all annotations (see Figure 27.8).
© 2017–2022 exocad GmbH page 197/222

Figure 27.8: Annotation editor window - Edit tab
Select the annotation from the list and change the annotation text/color/font size. You cannot edit annotations created in
the Measurement Tool (see Chapter 27.1). To delete an annotation, select it in the list and click Delete.
27.3.3 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.
27.4 Aligning Meshes

Using the Align Meshes tool, you can match floating meshes on fixed meshes. This is typically used to align pre-op scans
(floating mesh) to scan data (fixed mesh).
NOTE
Scan data that already has a defined insertion axis, an assigned construction, or an imported mar-
gin cannot be aligned to something else.
Click Align Meshes. This opens the Align Meshes window for the 3-point alignment (see Figure 27.10). Click alternating
points at same positions on the two meshes, as shown in Figure 27.9. exoplan displays the selected meshes in the Align
Meshes window as shown in 27.10.
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Figure 27.9: 3-point alignment
To undo an arrow, click Back 1}

m. When you have at least defined two point pairs, click Perform alignment 2}
m.
1}
m
2}
m
3}
m
6}
m
7}
m
4}
m
5}
m
Figure 27.10: 3-point alignment result
Check Show distance 5} mto display a color scale showing the remaining distance between the meshes (see Figure 27.11.
You can define an accepted and maximal distance.
The following functions help you improve the alignment result:
Using the slider Matching parts ratio 6}

m, you can set the ratio of the surface parts existing in both surfaces.
Define the maximum influence distance using the slider Maximum influence distance 7}
m. Only surface parts below
the specified distance will influence the matching.
You can further improve the alignment result by clicking Best fit matching 3}
m. Only use best-fit matching when you
have identically shaped meshes.
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Figure 27.11: Alignment after best fit matching
You can exclude mesh areas from best fit matching by checking Matching: Exclude selected parts 4}
m. This opens a Brush
tool window (see Figure 27.12).
1}
m
2}
m
3}
m
4}
m
5}
m
6}
m
7}
m
8}
m
Figure 27.12: Exclude selected parts - brush tool

Hold the left mouse button and drag to paint areas to be excluded from the matching. They will be colored blue.
Mesh selection 1}
m: Select the mesh you want to draw areas on.
Fit nowhere 2}
m: Marks the complete mesh. Best-fit matching will have no effect.
Invert markings 3}
m: Marks unmarked areas vice versa.
Fit everywhere 4}
m: Clears all existing markings.
Mark automatic 5m
}: Uses only a small area around the tip and tail of each arrow as matching region.
Radius for automatic marking 6}
m: Sets the radius of the mesh area at each arrow end.
Brush size 7}
m: Adjusts the size of the painting brush.
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Brush inverse 8}
m: Inverts the brush functionality. You can also hold SHIFT while painting to inverse the brush.
1}
m
2}
m 4}
m
3}
m 5}
m
6}
m
Figure 27.13: Align Meshes - Select floating parts
You can select additional floating parts to be included in the alignment process by activating the checkbox Select additional
floating parts 1} m . This opens the Selected floating parts window (see Figure 27.13). Hovering over a mesh in the main
view will highlight it in the list of floating parts.
Select all parts in the list by clicking All 2}

m.
Deselect all parts in the list by clicking None 3}
m.
Select all visible parts in the list by clicking All visible 4}
m.
Invert the current selection by clicking Invert 5}
m.
Select by click 6} mallows you to select individual parts by clicking them in the main view. Hold CTRL while clicking
to deselect a selected part.
27.4.1 Aligning Meshes Manually

You can manually move/rotate objects in the Manual tab of the Align Meshes window. Use this function to arrange meshes
for an easier alignment process or to correct the performed alignment manually.
© 2017–2022 exocad GmbH page 201/222

1}
m
2}
m
3}
m
4}
m
Figure 27.14: Aligning meshes manually
Move/Rotate in all directions 1}

m: Freely move/rotate the selected mesh by clicking and dragging it in the main
view.
Move in z direction 2m
}: Restrict movement to the z axis.
Move in xy-plane 3}
m: Restrict movement to the x and y axes.
Select additional floating part 4} m : Select additional meshes that you want to move/rotate together using the same
functions as described in Chapter 27.4.
27.5 Show Project in Explorer

Clicking Show project in explorer opens the file directory of the currently loaded project in an explorer window.
© 2017–2022 exocad GmbH page 202/222

27.6 Settings
Click Settings in the tools menu to open the Settings window (see Figure 27.15). In this window, you can view and change
general settings for your exoplan application. For applying certain changes, you must restart exoplan.
Figure 27.15: Settings window
System Information: Displays information on the exoplan installation and your computer system.
User Interface Language: Available languages for the user interface.
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User interface theme: Choose a theme for the exoplan user interface.
Dental notation: Tooth numbering system used in exoplan. FDI, Universal, Palmer or Palmer (Digital) are available.
Note that you need to restart exoplan after changing the dental notation.
Tooth library to use: Default tooth library for model teeth.
TruSmile on start: Check this box if you have TruSmile installed, so it is active by default with the launch of exoplan.
TruSmile-Lite (speed in favor of quality): A rarely used option for old, slow graphics cards to increase the real-time
responsiveness by decreasing the color accuracy.
Use Windows default cross hair cursor: A rarely used option for old, slow graphics cards to improve the quality of
the cursor image.
Show ruler: Check to display a mm/cm ruler on each side of the screen.
Show grid: Check to display a rectangular grid in the background of the main view, with mm/cm markings on it.
Allow sending of advanced statistics to improve products: Activate to allow exoplan to send advanced anonymous
statistics in order to improve products and service. No patient data or medical data will be transferred.
Cache implant library: Enable to cache the implant library for faster loading times.
Alignment iteration steps: Use this slider to adjust the step size when manually aligning CT Data.
Default safety distance: Use this slider to set the default safety distance.
Zip file password: Set a password for zip files created by exoplan.
DICOM default search directory: Define a default path under which the search for DICOM files should start when
the dialog box for loading DICOM data is displayed. If the path is not defined (default), the search starts in the current
project folder.
Show grid in secondary views by default: Adds a grid to secondary views.
Generate combined mesh with planning result files: exoplan creates and saves a combined mesh upon creating
the planning result files.
Generate mandibular canal meshes with planning result files: exoplan creates and saves nerve meshes upon
creating the planning result files.
Generate insertion channel meshes during generation of planning result files: exoplan creates and saves in-
sertion channel meshes upon creating the planning result files.
Display safety distance in implant planning report cross-sectional images: The implant planning report will dis-
play safety distances in the cross-sectional images.
Skip loading of optical scans: Skips the initial loading of an optical scan.
Deleting planning result files after altering sleeve setup: Never/Always delete: Already generated planning
result files will never/always be deleted if the sleeve setup is altered durig the implant planning workflow. Default set-
ting: Ask: exoplan displays a dialog prompting you to decide whether you want to delete or keep the already generated
planning result files.
Skip sleeve positioning in guided implant planning workflow: Activate to always skip the sleeve positioning step
when in Wizard mode.
Default edentulous guide design workflow: Select a default workflow for designing a tissue-supported surgical
guide.
Skip anchor pin positioning in guided implant planning workflow: Activate to always skip the anchor pin position-
ing step when in Wizard mode.
Prompt for density references definition: If checked, exoplan will promt you to define density references. If unchecked,
density references will be defined automatically.
Proposed insertion depth for anchor pins: Use this slider to set the proposed insertion depth for anchor pins.
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Default CT Alignment Workflow: Select a default workflow for aligning CT data.

Create fixation guide for edentulous cases: Never/Always create fixation guide: exoplan will never/always ini-
tiate the Workflow step to create a fixation guide. Default setting: Ask: exoplan displays an option to create a fixation
guide after merging the surgical guide.
Set default program for file types: Opens a message informing the user how to change default programs for file
types.
27.7 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 also contains the Unique Device Identifier (UDI) as per regulation (EU) 2017/745 and 21 CFR 801.50 as
well as country-specific labeling information.
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28 Appendix
28.1 System Exceptions
WARNING
If exoplan shows an exception dialog, it is highly advisable to discard the current planning and quit
exoplan. Scene 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.
28.2 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, or other image types, e.g., REFORMATTED, if the DICOM dataset has user-accepted
issues (see Chapter 1.11.1)
Series date: date by when the series was recorded
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For edentulous cases (Dual Scan Protocol), there is another tab Prosthesis Data. It contains the same information about
the loaded CT data set of the prosthesis as in the tab Patient.
28.3 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 24.1.1)
Generating axis-oriented secondary views (see Chapter 24.3)
Orientation of all secondary views (see Chapter 24.2)
View direction in worksteps: CT data alignment (see Chapter 9), panoramic curve definition (see Chapter 7), mandibular
canal definition (see Chapter 12), density threshold definition (see Chapter 6), implant positioning (see Chapter 16),
Planning result files (see Chapter 28.7): 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 14) and implant
positioning step (see Chapter 16)
NOTE
exoplan automatically defines axial and view direction. You can make manual adjustments in Ex-
pert mode.
28.4 Libraries
WARNING
Using a library not signed by exocad (delivered by a third party or another manufacturer) is made
at the risk of the user. exocad claims no warranty for cases which include libraries not signed by
exocad.
You can download additional libraries from the exocad website.
28.4.1 Implant Libraries

Available implant libraries depend on your exoplan installation and on the tooth number (libraries can be restricted to certain
tooth numbers).
WARNING
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 16.2) 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).
© 2017–2022 exocad GmbH page 207/222

HINT
Contact your reseller for a complete list of available legally marketed implants for your geograph-
ical region.
28.4.2 Drilling Sleeve Libraries

Available drilling sleeve libraries depend on your exoplan installation.
28.4.3 Anchor Pin Libraries

Available anchor pin libraries depend on your exoplan installation.
28.4.4 Tooth Libraries

The exoplan standard configuration includes the generic library. Which additional libraries are available in your exoplan in-
stallation depends on your provider.
28.5 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 27.6). You can change the safety distance in the implant positioning step (see Chapter
16.5.3).
Above the bone level, the safety distance can be locally greater than the defined safety distance value (see Figure 28.1). 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 28.1: Examples for a locally greater safety distance above the bone level (dotted line) with a defined safety distance of
2 mm.
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28.6 Implant Types

The implant types you define using the Change Implant Setup option (see Chapters 11 and 16.5.1) determine which parts you
can select for a specific implant in the implant positioning step (see Chapter 16.2).
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
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.
28.7 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 28.1 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)
© 2017–2022 exocad GmbH page 209/222

File Description
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 9.3.1). In addition to implant meshes, meshes for the
mandibular canal/s (if defined) and an stl file for the DICOM bounding box are created.
For edentulous cases (Dual Scan Protocol), an stl mesh extracted from the CT data of
the prosthesis is created.
Checklist PDF List of generated stl files with hash values for verifying purposes.
SHA256Checklist
Table 28.1: 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.
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 damage to the
planning scene data and jeopardize the patient’s health and safety.
NOTE
Do not distribute output data from exoplan in case of a compromised or potentially compromised
PC workstation.
28.8 Mesh Types for Loading in exoplan

You can load the following meshes in exoplan using the Add/Remove Mesh tool (see Chapter 27.2):
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 9)
© 2017–2022 exocad GmbH page 210/222

Jaw scan or prosthesis 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
16.5.3 and 27.6 for safety distance settings).
Gingiva Scan
Supported file formats: STL (Binary or ASCII), OFF (Binary or ASCII), OBJ ASCII, PLY.
28.9 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 28.2).
Figure 28.2: Saving mesh coordinates
28.10 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
© 2017–2022 exocad GmbH page 211/222

28.11 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 1.11.1 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. Alternatively, drag&drop it in the scene and import it as the requested mesh type.
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 of the patient (bone,
tooth roots, nerves, etc.). However, the surgical guide design will be based on the position and shape of the optical scan (i.e.,
jaw scan) or the prosthesis mesh (for an edentulous case). In order to place the implants precisely at the planned positions
during surgery, it is therefore crucial that the optical scan/prosthesis mesh and the DICOM data of the patient 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 CT alignment (CT-to-mesh or CT-to-CT alignment) is acceptable?

After performing the Best Fit Alignment (available only for CT-to-mesh alignment), the optical scan will be colored in a spe-
cific way, showing the deviation of the optical scan data from the surface of the visualized CT 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).
Furthermore, use the outline visualization of the optical scan or prosthesis mesh in the secondary views to evaluate the
matching accuracy regarding the underlying CT data of the patient. Use the manual alignment tool (see Chapter 9.2.2) to
correct the position of the extracted prosthesis mesh.
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 9.5 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
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).
© 2017–2022 exocad GmbH page 212/222

In CT-to-CT alignment workflow (i.e., dual scan protocol) I have loaded the prosthesis CT data, but the software is not
able to align the patient and prosthesis CT data.
Make sure that the radio-opaque markers are detected correctly in both datasets. Mark or edit them manually if it is not
done automatically. Use the manual alignment tool in CT-to-CT alignment step (see Chapter 10.2.1) to correct the position of
the extracted prosthesis mesh.
Loaded antagonist and jaw scan are not correctly aligned.

Use the align mesh tool (see Chapter 27.4).
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 27.1 for a detailed description of the measurement tool.
Automatically detected panoramic curve is not working.

Use the manual placement of curve points.
Sinus segmentation fails with error messages (e.g., “segmentation is too big”)
Adjust the threshold to a lower value to ensure that the sinus cavity and its direct neighboring regions are not connected by
the threshold visualization in the secondary views. See also the Show more button.
During the workflow, I decided I want to plan more/less implants than originally intended.
In Expert mode, open the Change Implant Setup window by clicking on Change Implant Setup 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 (CT-to-CT Data Alignment for edentulous cases) window by click-
ing on CT Data Alignment (CT-to-CT Data Alignment for edentulous cases) 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
9 (Chapter 10 for edentulous cases) for details about the alignment steps.
I accidentally deleted my planning results.

When the planning workflow 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.
After the planning, the Design surgical guide button is disabled.

Ensure that the CT alignment was finished with an acceptable evaluation. Ensure that a jaw scan or prosthesis mesh exists
in the scene. Check that the surgical guide module is activated on your dongle.
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.
© 2017–2022 exocad GmbH page 213/222

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 Attachments on Surgical Guide and slightly move any attachments that are present. Afterwards,
restart the step Merge and Save Surgical Guide and ensure the merging process can be finished.
Merge of surgical or fixation guide is not possible for an edentulous case.

See answer above. Additionally, ensure that the extracted gingiva contact surface is correctly defined in step Define Gingiva
Contact Surface (see Show more hints). Use the tools in the tab Mesh Editing to remove mesh artifacts from the prosthesis
mesh (see Chapter 20.4). Especially, remove floating or connecting mesh artifacts within the prosthesis mesh by using the
CT Mesh Editor tool. This is described in detail in Chapter 20.8.1.
Virtual tooth extraction: tooth is not correctly extracted (e.g, neighboring tooth is also extracted).
Use the funtions in the tabs Margin or Correct to adjust the detected tooth border (see Chapter 23.4.1).
I want to learn more about exocad’s exoplan. Where can I find more information?
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.
© 2017–2022 exocad GmbH page 214/222

28.12 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
It is suggested to use the version of the graphics adapter driver that was current when exoplan was
released. Furthermore, disable automatic driver updates to avoid newer drivers that could have
potential negative side effects to the performance and stability of exoplan. Modification and/or
corruption of the software installation may lead to dangerous results in the implant planning pro-
cess and the design of a surgical guide with hazardous 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).
© 2017–2022 exocad GmbH page 215/222

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 an-
terior palatine nerve and the maxillary sinus floor must be visible. Insufficiently visible anatomical
structures in the 3D CT data may lead to an erroneous planning process and thus may cause per-
manent 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.
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 9.2), and, if applicable, appropriate cropping of the CT mesh (see Chapter
9.5.1) and appropriate marking of feature regions (see Chapter 9.5.2). The alignment accuracy is
© 2017–2022 exocad GmbH page 216/222

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 9.4).
WARNING
If you perform the CT-to-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 10.1.2).
WARNING
In order to be able to mark the gingiva correctly, it is essential to use the proper threshold settings
when extracting the patient’s prosthesis.
WARNING
An incorrect definition of the mandibular nerve can cause a permanent injury of the patient
Skipping the process of defining the mandibular nerve canal might cause injury to the patient,
e.g., resulting in permanent impairment of the nerve.
WARNING
An incorrect definition of the sinus cavity can cause a permanent injury of the patient during
the surgical implanting procedure.

Skipping the process of defining the sinus cavity can cause a permanent injury of the patient
WARNING
An incorrect density threshold value definition can impede the recognition of suboptimal implant
© 2017–2022 exocad GmbH page 217/222

positions.
WARNING
Verify the correctness of the position and shape of the panoramic curve before proceeding in the
workflow.
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.
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.
Consider increasing the safety distance for the collision detection to compensate for the de-
creased precision of the surgical guide when working with edentulous patients in the dual
scan workflow.
© 2017–2022 exocad GmbH page 218/222

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.
The distance of the sleeve shoulder to the implant’s apical peak is calculated based on the
implant mesh provided by the implant manufacturer. In case this mesh does not perfectly
represent the real physical implant geometry, there will be a deviation.
WARNING
The implant planning report shows information regarding which anchor pins are used/placed
but neither the implant planning report nor the surgical protocol will detail information about
the drill (length/diameter) to use.
When a library with anchor pins is updated, the parts of the previous version of the updated li-
brary in saved scenes are not updated automatically. To update them in the scene, the anchor
pin step must start again with subsequent confirming to update the libraries.
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 missing canine and incisors.
Make sure that the design of the surgical guide does not contain sharp edges, ridges, or peaks
to avoid injuries of the patient’s soft tissue such as the tongue.
In case of edentulous cases, use anchor pins to guarantee a stable fit of the surgical guide.
© 2017–2022 exocad GmbH page 219/222

WARNING
The Minimum Base Thickness of a sleeve mount/anchor pin 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 ill-fitting sleeves in the surgical guide.
WARNING
The Offset value in the Block out Undercuts section is dependent on the material/printer com-
bination 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 (e.g., blocking or al-
lowing 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.
For tooth-supported surgical guides, do not include soft tissue (e.g., gingiva) in the design of
the surgical guide top while defining the surgical guide top margin line.
WARNING
Use the attachment function with care because it may impact the stability and fit of the surgical
guide.
© 2017–2022 exocad GmbH page 220/222

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
Verify the surgical guide before usage.
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.
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.
© 2017–2022 exocad GmbH page 221/222

WARNING
When measuring bone density, the loaded DICOM data set must be normalized to the Hounsfield
scale. If the loaded DICOM data set is not normalized to the Hounsfield scale, the measured values
will not represent a valid Hounsfield value.
WARNING
Ensure good contrast and visibility when changing the background color.
WARNING
If exoplan shows an exception dialog, it is highly advisable to discard the current planning and quit
exoplan. Scene files stored before the exception appeared may be reused to resume the ongoing
planning.
WARNING
Using a library not signed by exocad (delivered by a third party or another manufacturer) is made
at the risk of the user. exocad claims no warranty for cases which include libraries not signed by
exocad.
WARNING
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 16.2) 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 damage to the
planning scene data and jeopardize the patient’s health and safety.
© 2017–2022 exocad GmbH page 222/222

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4 Selecting a DICOM Series 20

6 Defining Density References 32

7 Defining the Panoramic Curve 37

8 Selecting a CT Alignment Workflow 46

© 2017–2022 exocad GmbH page 3/222

10.2 Evaluating the CT-to-CT Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

11 Changing the Implant Setup 70

12 Defining the Mandibular Canal 71

14 Initial Placement of Tooth Models (Backward Planning) 84

15 Precise Placement of Tooth Models (Backward Planning) 90

16 Implant Positioning 100

17 Sleeve Placement 111

18 Anchor Pin Placement 116

19 Generating Implant Planning Result Files 120

19.1 Step-by-Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

20 Creating Surgical Guides 126

© 2017–2022 exocad GmbH page 4/222

20.6 Designing the Surgical Guide’s Top . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

21 Saving a Scene / Closing a Project 154

22 Wizard Mode vs Expert Mode 155

23 Expert features 161

26.3 DICOM Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

© 2017–2022 exocad GmbH page 5/222

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1.0.1 Typographic Conventions

© 2017–2022 exocad GmbH page 7/222

1.2 Indications for Use / Intended Use

1.3 Clinical Benefit

1.4 Indications and Contraindications

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1.5 Safety Information

1.6 Units and Conventions

1.6.1 Measurement Accuracy

1.7 Hardware Requirements

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1.8 Software Requirements

1.9 Software Installation

© 2017–2022 exocad GmbH page 10/222

The exoplan user manuals are available on the exocad website.

1.10 Software Activation

© 2017–2022 exocad GmbH page 11/222

1.11 Input Data and Requirements

A DICOM series must contain at least two images.

© 2017–2022 exocad GmbH page 12/222

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Loading datasets with DICOM data issues

Figure 1.1: DICOM data issues detected

© 2017–2022 exocad GmbH page 14/222

Figure 1.2: DICOM Control - accepted DICOM data issues

1.11.2 Scan Data

1.12 Color Scheme

© 2017–2022 exocad GmbH page 15/222

Figure 2.1: exoplan startup screen

© 2017–2022 exocad GmbH page 16/222

3.1 Loading a Scene

3.2 Loading a Project

Figure 3.1: Loading a project with existing scene files

© 2017–2022 exocad GmbH page 17/222

3.2.1 Importing a DentalCAD tooth setup

Figure 3.2: DentalCAD scene file import dialog

3.3 Loading a Scan