Romexis Um

Planmeca Romexis ®
6.3
EN
user's manual
30025109
The manufacturer, assembler and importer are responsible for the safety, reliability and
performance of the unit only if:
- installation, calibration, modification and repairs are carried out by qualified
authorised personnel
- electrical installations are carried out according to the appropriate requirements such
as IEC 60364
- equipment is used according to the operating instructions.
Planmeca pursues a policy of continual product development. Although every effort
is made to produce up-to-date product documentation this publication should not be
regarded as an infallible guide to current specifications. We reserve the right to make
changes without prior notice.
COPYRIGHT PLANMECA
Publication number 30025109 Revision 6
Released 24 March 2022
Table of contents
1 Introduction................................................................................................................................................. 1
1.1 Indications for use.......................................................................................................................... 1
1.2 Introduction to digital imaging.........................................................................................................2
1.2.1 Dimensional accuracy.................................................................................................... 2
1.3 Securing image data.......................................................................................................................4
1.4 Image acquisition............................................................................................................................4
1.5 Recovering images.........................................................................................................................4
1.5.1 Recovering 2D images...................................................................................................4
1.5.2 Recovering 3D images...................................................................................................5
1.6 Archiving images............................................................................................................................ 6
1.7 Processing and restoring images................................................................................................... 6
1.8 Measuring images.......................................................................................................................... 6
1.9 Annotating images..........................................................................................................................6
1.10 Printing........................................................................................................................................... 6
1.11 DICOM support...............................................................................................................................6
1.12 Settings...........................................................................................................................................7
1.13 Usage data tracking........................................................................................................................8
1.14 Disclaimer.......................................................................................................................................9
2 Getting started with Planmeca Romexis...................................................................................................10
2.1 Activating Planmeca Romexis license..........................................................................................10
2.1.1 Manual activation......................................................................................................... 11
2.1.2 Installing license...........................................................................................................11
2.1.3 Updating license...........................................................................................................12
2.1.4 Managing license......................................................................................................... 13
2.1.5 Transferring license to another installation.................................................................. 15
2.2 Login.............................................................................................................................................16
2.3 Settings and support.....................................................................................................................17
2.3.1 Show/hide module icons.............................................................................................. 17
2.3.2 Customising toolbars....................................................................................................18
2.3.3 Access tutorial videos and user's manual.................................................................... 19
2.3.4 Check software version................................................................................................19
2.3.5 Mouse functions........................................................................................................... 19
2.3.6 Shortcut commands..................................................................................................... 20
3 Patients module........................................................................................................................................ 23
3.1 Adding patients.............................................................................................................................23
3.2 Opening patients.......................................................................................................................... 24
3.3 Searching patients........................................................................................................................25
3.4 Refreshing patients list................................................................................................................. 27
3.5 Image preview.............................................................................................................................. 28
3.6 Assign patient to user................................................................................................................... 28
3.7 Inactivate patient.......................................................................................................................... 29
3.8 Start image capturing................................................................................................................... 30
3.9 Find patient by image................................................................................................................... 31
3.10 DICOM Worklist (optional)............................................................................................................32
3.11 DICOM Query/Retrieve (optional)................................................................................................ 33
User's manual Planmeca Romexis 6

Table of contents
3.12 Cloud Management...................................................................................................................... 35

3.12.1 Exporting Cloud cases................................................................................................. 35
3.12.2 Replying to Cloud cases.............................................................................................. 39
3.12.3 Downloading Cloud cases............................................................................................41
3.12.4 Searching other Planmeca Online users......................................................................42
3.12.5 Cloud case sending options......................................................................................... 44
3.12.6 Cloud case status explanations................................................................................... 45
4 File module............................................................................................................................................... 46
4.1 Browsing patient files....................................................................................................................46
4.1.1 File tags explanation.................................................................................................... 47
4.1.2 Switching browsing mode............................................................................................ 47
4.1.3 Sorting images............................................................................................................. 48
4.1.4 Opening images........................................................................................................... 50
4.1.5 Setting comments on images.......................................................................................51
4.1.6 Moving image / study to other patient.......................................................................... 52
4.1.7 Inactivating images...................................................................................................... 53
4.2 Importing images for current patient.............................................................................................53
4.3 Starting image capture................................................................................................................. 54
4.4 Exporting files............................................................................................................................... 56
5 2D module................................................................................................................................................ 57
5.1 Overview.......................................................................................................................................57
5.2 Capturing panoramic images........................................................................................................57
5.3 Capturing SmartPan images........................................................................................................ 58
5.4 Capturing cephalometric images.................................................................................................. 59
5.5 Capturing intraoral X-ray images with Planmeca ProSensor....................................................... 59
5.5.1 Capturing single ProSensor images.............................................................................59
5.5.2 Capturing ProSensor images into study template........................................................60
5.6 Capturing intraoral images with Planmeca ProScanner............................................................... 61
5.6.1 Scanning single ProScanner images........................................................................... 61
5.6.2 Capturing images using Planmeca ProID reader.........................................................63
5.6.3 Imaging using Scanner List..........................................................................................66
5.6.4 Capturing images into study using ProID reader......................................................... 68
5.6.5 Recovering images...................................................................................................... 70
5.7 Capturing intraoral images with Planmeca ProScanner 2.0......................................................... 71
5.7.1 ProScanner 2.0 Options menu.....................................................................................72
5.7.2 Capturing single ProScanner 2.0 images.....................................................................73
5.7.3 Capturing ProScanner 2.0 images into study template................................................75
5.8 Capturing intraoral photos and videos with intraoral camera....................................................... 77
5.9 Capturing photos and videos with Planmeca Solanna Vision...................................................... 78
5.10 TWAIN scanning...........................................................................................................................78
5.10.1 Scanning to study template..........................................................................................78
5.11 2D image browser........................................................................................................................ 79
5.11.1 Opening images........................................................................................................... 80
5.11.2 Viewing locked 2D images and studies........................................................................80
5.11.3 Viewing options............................................................................................................ 81
5.11.4 Settings........................................................................................................................ 82
5.11.5 Image type categories..................................................................................................83
5.11.6 Image thumbnails.........................................................................................................84
5.11.7 Filtering images............................................................................................................85
5.11.8 Expanding image browser............................................................................................86
5.11.9 Adding comments on images.......................................................................................87
5.11.10 Exporting, inactivating and moving images to other patients....................................... 88
5.12 Opening images in floating window.............................................................................................. 89
Planmeca Romexis 6 User's manual

Table of contents
5.13 Setting layout................................................................................................................................90

5.14 Closing all open images............................................................................................................... 91
5.15 Working with study templates.......................................................................................................91
5.15.1 Creating new study...................................................................................................... 91
5.15.2 Arranging images in study............................................................................................91
5.15.3 Comparing studies....................................................................................................... 92
5.16 Image partitioning......................................................................................................................... 92
5.17 Adjusting, annotating and measuring 2D images......................................................................... 94
5.17.1 Histogram.....................................................................................................................95
5.17.2 Adjust........................................................................................................................... 95
5.17.3 Crop and rotate............................................................................................................ 96
5.17.4 Image Processing........................................................................................................ 96
5.17.5 View............................................................................................................................. 98
5.17.6 Measure....................................................................................................................... 98
5.17.7 Draw...........................................................................................................................101
5.17.8 Implant (Implant Library)............................................................................................ 103
5.17.9 Object Browser...........................................................................................................105
5.17.10 History........................................................................................................................ 107
5.17.11 Saving enhancements as defaults............................................................................. 107
5.17.12 Using image specific tools..........................................................................................107
5.17.13 Image properties........................................................................................................ 108
5.17.14 Adjusting alignment....................................................................................................110
5.18 Importing 2D images.................................................................................................................. 111
5.18.1 Importing DICOM image with patient......................................................................... 112
5.18.2 Importing DICOMDIR files with patients.....................................................................113
5.18.3 Importing photos from folder...................................................................................... 115
5.19 Copy to clipboard........................................................................................................................116
5.20 Moving image to other patient.................................................................................................... 116
5.21 Moving study to other patient..................................................................................................... 117
5.22 Assigning image as face photo...................................................................................................118
5.23 Inactivating images.....................................................................................................................119
5.24 Exporting images........................................................................................................................119
5.24.1 Export currently open images.................................................................................... 119
5.24.2 Export all patient images............................................................................................121
5.24.3 Export selected images..............................................................................................122
5.24.4 DICOM export............................................................................................................ 122
5.24.5 Exporting multiple patients with DICOMDIR.............................................................. 122
5.25 Sending 2D images by email......................................................................................................124
5.26 Printing images...........................................................................................................................125
5.26.1 Print page setup......................................................................................................... 126
5.26.2 Editing print pages..................................................................................................... 127
5.26.3 Save and adjust print layouts..................................................................................... 130
5.26.4 Adjusting images on layout........................................................................................ 132
5.26.5 Exporting print pages................................................................................................. 134
5.26.6 Printing images with DICOM printers (optional)......................................................... 135
5.27 DICOM storage...........................................................................................................................135
5.28 Cloud export............................................................................................................................... 136
5.29 Launching external application................................................................................................... 136
5.30 Cephalometric analysis.............................................................................................................. 137
5.31 Automatic cephalometric analysis.............................................................................................. 137
5.31.1 Creating account........................................................................................................ 137
5.31.2 Ordering analysis....................................................................................................... 138
5.31.3 Downloading analysis................................................................................................ 139
5.31.4 Manual tracing............................................................................................................140

Table of contents
5.31.5 Viewing account information and ordered tracings.................................................... 140

6 Smile design module.............................................................................................................................. 142
6.1 Capturing images for smile design............................................................................................. 142
6.2 Smile design workflow................................................................................................................ 143
6.3 Import smile image..................................................................................................................... 144
6.4 Align and crop smile image........................................................................................................ 145
6.5 Image calibration........................................................................................................................ 146
6.6 Select and position teeth silhouette............................................................................................147
6.6.1 Adjusting teeth silhouette........................................................................................... 149
6.6.2 Saving silhouettes to library....................................................................................... 151
6.6.3 Adjusting single tooth on silhouette............................................................................151
6.7 Define smile area........................................................................................................................152
6.8 Adjust photorealism.................................................................................................................... 154
6.9 Show comparison....................................................................................................................... 155
6.10 Create report.............................................................................................................................. 156
6.11 Aligning intraoral image with smile image (optional).................................................................. 158
6.12 Clone brush (optional)................................................................................................................ 159
6.12.1 Clone brush options................................................................................................... 160
6.13 Undo and redo changes............................................................................................................. 161
6.14 Automatic alignment................................................................................................................... 162
6.15 Draw & Measure.........................................................................................................................162
6.16 Maximizing design area..............................................................................................................163
6.17 Printing smile design images......................................................................................................164
6.17.1 Print page setup......................................................................................................... 164
6.17.2 Editing print pages..................................................................................................... 165
6.17.3 Save and adjust print layouts..................................................................................... 168
6.17.4 Adjusting images on layout........................................................................................ 170
6.17.5 Exporting print pages................................................................................................. 172
6.17.6 Printing images with DICOM printers (optional)......................................................... 173
6.18 Exporting smile designs..............................................................................................................173
6.18.1 Send by email............................................................................................................ 174
6.18.2 CAD/CAM export........................................................................................................174
6.18.3 Cloud export...............................................................................................................175
7 3D module.............................................................................................................................................. 176
7.1 Explorer module......................................................................................................................... 176
7.1.1 Slice and rendered views........................................................................................... 177
7.1.2 Adjust......................................................................................................................... 178
7.1.3 Tools.......................................................................................................................... 186
7.1.4 Annotation.................................................................................................................. 214
7.1.5 3D Rendering............................................................................................................. 223
7.1.6 Object Browser...........................................................................................................233
7.2 Panoramic module......................................................................................................................238
7.2.1 Panoramic.................................................................................................................. 238
7.2.2 Adjusting panoramic slices.........................................................................................243
7.2.3 Adjust......................................................................................................................... 246
7.2.4 Annotation.................................................................................................................. 249
7.3 Cross sections module............................................................................................................... 250
7.3.1 Cross section tools.....................................................................................................250
7.3.2 Editing dental arch..................................................................................................... 250
7.3.3 Adjusting slices in cross sections views.....................................................................252
7.3.4 Adjusting axial / panoramic slices.............................................................................. 252
7.3.5 Drawing nerve............................................................................................................ 253
7.3.6 Drawing root canal..................................................................................................... 255

Table of contents
7.4 Implant module (optional)........................................................................................................... 258

7.4.1 Step-by-step implant planning....................................................................................258
7.4.2 Implant settings.......................................................................................................... 261
7.4.3 Adjusting slices in implant centric view...................................................................... 266
7.4.4 Aligning implants........................................................................................................ 268
7.4.5 Implant tools...............................................................................................................269
7.4.6 Adding implants..........................................................................................................271
7.4.7 Implant library.............................................................................................................272
7.4.8 Implant verification..................................................................................................... 280
7.4.9 Guide design.............................................................................................................. 282
7.4.10 Implant report............................................................................................................. 292
7.5 TMJ module................................................................................................................................294
7.5.1 Synchronise sides...................................................................................................... 295
7.6 Superimposition module............................................................................................................. 296
7.6.1 Fitting CBCT images for superimposition...................................................................296
7.6.2 Superimpose tools..................................................................................................... 298
7.6.3 Adjust tools.................................................................................................................299
7.6.4 Annotation tools......................................................................................................... 299
7.6.5 3D rendering.............................................................................................................. 300
7.6.6 Object Browser...........................................................................................................300
7.7 Surface module.......................................................................................................................... 300
7.7.1 Surface view...............................................................................................................301
7.7.2 CBCT 3D rendering view........................................................................................... 301
7.7.3 Tools.......................................................................................................................... 302
7.7.4 Setting ProFace image as overlay for CBCT data..................................................... 313
7.7.5 Before and after treatment comparison......................................................................313
7.7.6 Fitting Planmeca ProFace image to CBCT volume....................................................319
7.7.7 Fitting two 3D models using bite piece.......................................................................321
7.7.8 Fitting two 3D models without bite piece....................................................................323
7.7.9 Creating set of ProFace snapshots............................................................................325
7.7.10 Importing surface images...........................................................................................325
7.7.11 Exporting surface images...........................................................................................326
7.8 3D Cephalometry module...........................................................................................................328
7.8.1 3D cephalometric analysis workflow.......................................................................... 329
7.8.2 Setting head orientation............................................................................................. 339
7.8.3 Adjust tools.................................................................................................................341
7.8.4 Object visibility........................................................................................................... 342
7.8.5 Object browser........................................................................................................... 342
7.9 Surgery module.......................................................................................................................... 343
7.9.1 Disclaimer.................................................................................................................. 343
7.9.2 Preparing case........................................................................................................... 344
7.9.3 Surgery module views................................................................................................344
7.9.4 Slice views................................................................................................................. 345
7.9.5 3D rendered view....................................................................................................... 347
7.9.6 Surgical planning, Step 1: Cephalometric analysis and landmark based
measurements....................................................................................................................356
7.9.7 Surgical planning, Step 2: Defining head orientation................................................. 361
7.9.8 Surgical planning, Step 3: Creating osteotomies....................................................... 361
7.9.9 Surgical planning, Step 4: Fitting target model.......................................................... 376
7.9.10 Surgical planning, Step 5: Moving segments and saving plans................................. 383
7.9.11 Surgical planning, Step 6: Designing splints.............................................................. 389
7.10 Jaw motion module.....................................................................................................................401
7.10.1 Visualising jaw movements in real time..................................................................... 401
7.10.2 Recording jaw movements.........................................................................................402

Table of contents
7.10.3 Recording workflow templates................................................................................... 403

7.10.4 Viewing jaw movement recordings.............................................................................407
7.10.5 Analysing recorded jaw movements.......................................................................... 410
7.10.6 Exporting jaw motion files.......................................................................................... 414
7.10.7 Creating and saving reports....................................................................................... 416
7.11 3D top toolbar............................................................................................................................. 417
7.11.1 Importing 3D images.................................................................................................. 417
7.11.2 3D capture..................................................................................................................418
7.11.3 3D model capture.......................................................................................................420
7.11.4 Artefact removal......................................................................................................... 422
7.11.5 Stitching volumes....................................................................................................... 423
7.11.6 Save view...................................................................................................................426
7.11.7 Restore view.............................................................................................................. 427
7.11.8 Save 2D snapshots.................................................................................................... 427
7.11.9 Virtual Ceph............................................................................................................... 429
7.11.10 Image properties........................................................................................................ 431
7.11.11 Inactivating 3D image.................................................................................................434
7.11.12 Exporting objects........................................................................................................434
7.11.13 Print images and edit layouts..................................................................................... 436
7.11.14 DICOM print............................................................................................................... 436
7.11.15 DICOM storage.......................................................................................................... 437
7.11.16 Launch in external applications..................................................................................439
7.11.17 Cloud export...............................................................................................................439
7.11.18 Exporting volumes......................................................................................................440
8 Model analyser module...........................................................................................................................447
8.1 Importing 3D models.................................................................................................................. 447
8.2 Starting scan...............................................................................................................................448
8.2.1 New scan................................................................................................................... 448
8.2.2 Continue scanning..................................................................................................... 448
8.3 Analysis view.............................................................................................................................. 449
8.4 Preparation tools........................................................................................................................ 449
8.4.1 Defining occlusion plane............................................................................................ 449
8.4.2 Trimming model......................................................................................................... 453
8.5 View tools................................................................................................................................... 455
8.5.1 Calculate contact map................................................................................................455
8.5.2 Calculate undercuts................................................................................................... 456
8.5.3 Colours.......................................................................................................................457
8.5.4 Taking 2D quickshot...................................................................................................458
8.6 Measurement tools..................................................................................................................... 458
8.6.1 Point-to-point measurement.......................................................................................458
8.6.2 Tooth width measurement..........................................................................................459
8.6.3 Arch length measurement.......................................................................................... 460
8.6.4 Curve measurement...................................................................................................463
8.6.5 LM-Activator arch length measurement..................................................................... 463
8.6.6 Drawing tooth margin................................................................................................. 466
8.6.7 Fine-tuning measurements........................................................................................ 468
8.6.8 Editing models in object browser............................................................................... 469
8.7 Analyses..................................................................................................................................... 470
8.8 Comparison tools........................................................................................................................470
8.8.1 Side-by-side comparison............................................................................................470
8.8.2 Superimposition......................................................................................................... 471
8.8.3 Sync camera.............................................................................................................. 472
8.8.4 Fit surface models......................................................................................................472
8.9 3D printing.................................................................................................................................. 473

Table of contents
8.9.1 Creating 3D printable models.....................................................................................473

8.9.2 Exporting 3D models with bases................................................................................474
8.10 Exporting models........................................................................................................................475
8.10.1 Opening cases in Planmeca Romexis OrthoStudio................................................... 475
8.10.2 Fill in lab order form................................................................................................... 476
8.10.3 Sim to Care export..................................................................................................... 476
8.10.4 Cloud export...............................................................................................................477
9 CAD/CAM module.................................................................................................................................. 479
9.1 Starting new scan....................................................................................................................... 479
9.2 Importing 3D models.................................................................................................................. 480
9.2.1 Importing CAD/CAM cases........................................................................................ 480
9.2.2 Importing CAD/CAM STLs for design........................................................................ 481
9.2.3 Importing CAD/CAM STL for milling...........................................................................482
9.2.4 Importing CAD/CAM patients..................................................................................... 483
9.3 3D model export......................................................................................................................... 484
9.3.1 Fill in lab order form................................................................................................... 485
9.3.2 Opening cases in PlanCAD Premium........................................................................ 489
9.3.3 Cloud export...............................................................................................................489
9.3.4 DDX export.................................................................................................................490
9.4 Opening CAD/CAM cases.......................................................................................................... 490
9.4.1 Open for scan and design.......................................................................................... 490
9.4.2 Open for design only.................................................................................................. 491
9.5 Viewing CAD/CAM case in 3D module.......................................................................................491
9.6 Inactivating CAD/CAM cases..................................................................................................... 492
10 Clinic module.......................................................................................................................................... 493
10.1 Search........................................................................................................................................ 496
10.2 Floorplan.....................................................................................................................................497
10.2.1 Maintenance scheduling and demands......................................................................504
10.3 Monitoring...................................................................................................................................506
10.3.1 Dental units................................................................................................................ 506
10.3.2 Milling units................................................................................................................ 512
10.3.3 X-ray units.................................................................................................................. 512
10.3.4 Sensors...................................................................................................................... 514
10.4 Logs............................................................................................................................................514
10.4.1 Viewing imaging parameters......................................................................................516
10.5 Summary.................................................................................................................................... 516
10.5.1 Dental units................................................................................................................ 518
10.5.2 Planmeca Promax, ProOne and ProX X-ray units..................................................... 521
10.5.3 Planmeca ProSensor HD intraoral sensors............................................................... 523
10.5.4 Milling units................................................................................................................ 523
10.6 Virtual Clinic simulation tool........................................................................................................524
10.6.1 Before first use........................................................................................................... 524
10.6.2 Using simulation tool.................................................................................................. 527
11 Report module........................................................................................................................................ 534
11.1 Report generation.......................................................................................................................534
11.2 Opening image and patient links................................................................................................ 535
11.3 Printing reports........................................................................................................................... 536
11.4 Export report...............................................................................................................................537
12 Order services........................................................................................................................................ 540
12.1 Launching 3D Diagnostix order service......................................................................................540
12.2 Launching 360Imaging order service......................................................................................... 541
13 Planmeca Romexis Viewer.....................................................................................................................543

Table of contents
14 Mobile applications................................................................................................................................. 544

14.1 Planmeca mRomexis..................................................................................................................544
15 DDX Cloud..............................................................................................................................................545
15.1 Exporting images to DDX Cloud.................................................................................................545
15.2 Importing case from DDX Cloud.................................................................................................546
16 System administration............................................................................................................................ 548

1 Introduction
1 Introduction
This manual describes how to use the Planmeca Romexis imaging software.
NOTE
Read this manual carefully before using the system.
NOTE
This manual is valid for the Planmeca RomexisTM software version 6.3 or
later. Please see the related manuals for availability of specific features.
NOTE
The Planmeca ProMax 3D X-ray units, other digital X-ray units and intraoral
video cameras have separate manuals, which should be used in conjunction
with this manual.
Planmeca Romexis is a registered trademark of Planmeca Company.

Planmeca Romexis imaging software fulfils the requirements of Directives
93/42/EEC and 2011/65/EU (RoHS).
NOTE
Federal law restricts this device to sale by or on the order of a health care
professional
Consult electronic instructions for use (Standard ISO 7000-1641).
1.1 Indications for use

Planmeca Romexis is a medical imaging software intended for use in
dental and medical care as a tool for displaying and visualizing dental and
medical 2D and 3D image files from imaging devices, such as projection
radiography and CBCT. It is intended for use by radiologists, clinicians,
referring physicians and other qualified individuals to retrieve, process,
render, diagnose, review, store, print, and distribute images of both adult
and pediatric patients.
Planmeca Romexis is also a preoperative software used for dental implant
planning. Based on the planned implant position a model of a surgical guide
for a guided implant surgery can be designed. The designed objects can be
exported to manufacture a separate physical product.
Planmeca Romexis is also a preoperative software for simulating /
evaluating surgical treatment options. Based on the simulation, models,
guides and splints can be designed for use in maxillofacial surgery. The
designed objects can be exported to manufacture a separate physical
product.
Planmeca Romexis is also intended to be used for monitoring, recording,
storing and displaying mandibular jaw positions and movements relative to
the maxilla.
Additionally, Planmeca Romexis includes monitoring features for Planmeca
devices for maintenance purposes. The software is designed to work as a
stand-alone or as an accessory to Planmeca imaging and Planmeca dental
unit products in standard PC.
The software is for use by authorized healthcare professionals. Use of
the software for implant planning requires that the user has the necessary
User's manual Planmeca Romexis 6 1

1 Introduction
medical training in implantology and surgical dentistry. Use of the software

for surgical treatment planning requires that the user has the necessary
medical training in maxillofacial surgery.
Indications of the dental implants do not change with guided surgery
compared to conventional surgery.
1.2 Introduction to digital imaging

Digital images are composed of small dots called pixels. Similarly, the 3D
images are composed of voxels, three dimensional pixels. The size of each
pixel sets an absolute upper limit on what can be observed. Refer to your
X- ray unit’s documentation for detailed information on maximum resolution,
image dimensions and exposure times.
For pixel sizes for Normal, Enhanced and High resolution, see your
Planmeca X-ray unit user's manual.
Each pixel in an image is represented by a numerical value in the computer
memory. Because of the numerical (non-physical) nature of the image, the
brightness and contrast of the image can be altered, and various image
enhancements can be performed. It is necessary to take into account
the effects of image enhancement when using manipulated images for
diagnosis. The numerical nature of the image sets an upper limit to the
detectability of contrast differences (e.g. in radio translucency) in digital
images. This contrast resolution is expressed in terms of number of bits
used in capturing and storing the image or in number of grey levels that the
system can record.
Most computer screens can display 256 (8 bit) grey levels or less and it has
been shown that the human eye can barely differentiate contrast differences
in the order of 1/32 - 1/64 (5/6 bits). However, the eye automatically adapts
to the lighting conditions, and this together with proper use of the light box
makes it possible to detect smaller variations in film contrast. It is therefore
necessary to capture and record images at a higher contrast resolution than
256 grey levels (8 bits). More contrast latitude also allows more variations in
exposure factors (kV/mA).
NOTE
IMPORTANT SAFETY NOTICE! Image processing can significantly alter the
visibility of both large and small structures (i.e. bone loss and caries), which
may result in either too many false positive or false negative findings, if care
is not taken.
1.2.1 Dimensional accuracy

For dimension accuracy check the pixel/voxel size from image properties.
The dimensional accuracy is the pixel/voxel size rounded off to the nearest
0.1 mm.
2 Planmeca Romexis 6 User's manual

1 Introduction
2D images
3D images

1 Introduction
1.3 Securing image data

Planmeca Romexis uses a database system for storing patient data and
image metadata. Image data is stored into the file system as individual files.
Both the database and the image data in the file systems must be backed up
and stored securely.
NOTE
Planmeca claims no responsibility for the end users’ data security or for any
malfunction in the computer system that may lead to loss of data.
Image data can be secured by backing up the folder C:/

romexis_images folder on Windows or /Applications/Planmeca/Romexis/
database/Romexis_images on MacOS.
NOTE
The locations mentioned above are default locations. Locations may have
been changed.
Secure the patient database using backup tools of the respective database
engine. It is recommended to regularly verify the integrity of backed up files.
NOTE
The storage and backup media containing database and image should be
appropriately encrypted either on the device or the file level, to protect them
from unauthorised access during storage or in case of theft.
If backing up database by using a copied file of the database, shut down the
service for the respective database engine before proceeding. Microsoft SQL
also supports Volume Shadow Copy Service (VSS) applications for backing
up a live database.
1.4 Image acquisition

The system is designed to automate the acquisition of images with minimum
intervention from the user. Provided that the user has selected the correct
patient in Planmeca Romexis software, the acquisition procedure and
archiving of the image(s) is almost exactly the same as with conventional
film-based imaging systems, except that archiving is fully automated and
no film processing is required. The employed exposure technique is
automatically stored with each image.
1.5 Recovering images

If the connection to the server was lost during imaging, try to
• re-establish the connection by clicking Try to reconnect

or
• exit Romexis
Although the connection to the server was lost, radiation continues to be
emitted and the exposure is being taken normally.
1.5.1 Recovering 2D images
About this task

2D images can be recovered as follows.

1 Introduction
Steps
1. Click the Windows + R key on your keyboard.
2. Type %temp% .
3. Click OK.
Results
Images can be recovered from temporary folder.
1.5.2 Recovering 3D images
About this task

3D images can be recovered as follows.
Steps
1. Open the patient whose images you want to recover.
2. Go to 3D module.
3. From the File menu select Capture > Redo 3D Reconstruction.
4. Select the correct imaging sequence from the list (based on the time of
exposure for example.)
5. Select whether to apply HU correction to the recovered 3D volume.
6. Choose the correct exposure and click OK.
Results
The 3D volume will be automatically downloaded and added to the Volumes
list.
NOTE
If you accidentally downloaded the wrong volume you can inactivate it and
try again. In case the correct volume cannot be found please contact your
local Planmeca technician as the exposure may still be recoverable by other
means.

1 Introduction
1.6 Archiving images

The images are archived by patient names and stored into file system. The
exposure values and basic patient data are stored in the database. Multiple
users can store and retrieve images to and from the system simultaneously.
For approximate disk space requirements, see your X-ray unit's user's
manual.
1.7 Processing and restoring images

Processing may radically alter the appearance and the diagnostic value of
the image. Images can be restored image to their original state by undoing
modifications one by one.
1.8 Measuring images

The measurement tools allow both geometric and relative intensity (i.e.
radio-translucency or brightness/contrast) measurements.
When performing geometric measurements, it should be noted that image
processing (even mere brightness/contrast adjustment) can alter the
apparent geometry of the objects in the image. Also because of the normal
distortions (most notably varying magnification) associated with normal
projection X-ray imaging the measurements must be based on known
reference objects in the image. For this purpose, a calibration tool is
provided in the Planmeca Romexis software.
When performing intensity measurements, it should be noted that after
certain image processing the relative intensities of the objects may be
affected by their neighbouring objects, which may affect the reliability of e.g.
bone density measurements with the help of a calibration step wedge. The
only image processing procedures guaranteed not to change the relative
intensities so that measurements are independent of the measurement
position, are the brightness/contrast and level adjustment. No guarantee can
be given between the intensity measurements of two different images.
1.9 Annotating images

Images can be annotated with markers and text. The annotations appear as
an overlay on the image and can thus be turned on and off as desired. The
annotations do not affect the actual image.
1.10 Printing
Planmeca Romexis supports DICOM and Windows compatible printers.
1.11 DICOM support

Planmeca Romexis supports the following DICOM (Digital Imaging and
Communications in Medicine) services:
• DICOM Storage / Storage Commitment SCU (optional),
see section "DICOM storage" on page 437
• DICOM Storage SCP (optional)
see Planmeca Romexis technical manual
• Radiation Dose Structure Reporting RDSR (optional)
• DICOM Query Retrieve SCU (optional),

1 Introduction
see section "DICOM Query/Retrieve (optional)" on page 33.

• DICOM Query/Retrieve SCP (optional)
• DICOM Worklist SCU (optional),
see section "DICOM Worklist (optional)" on page 32
• DICOM Modality performed procedure step MPPS SCU (optional),
see Planmeca Romexis Technical manual.
• DICOM Print SCU (optional),
see section "DICOM print" on page 436
• DICOM Import, single and multi-frame,
see section "Importing DICOM image with patient" on page 112.
• DICOM Export, single and multi-frame,
see section "DICOM export" on page 122.
• DICOMDIR Media Storage,
see section "DICOM storage" on page 437.
For Planmeca Romexis DICOM conformance statement, see https://
www.planmeca.com/software/downloads
1.12 Settings
Planmeca Romexis provides various user settings.
A range of parameters and other options can be set to permit control over
the main procedures. The default settings have been chosen for a typical
Planmeca Romexis environment. If required, they can be easily modified in
the Planmeca Romexis Configuration application, see Planmeca Romexis
Technical manual for further information.

1 Introduction
1.13 Usage data tracking

Planmeca Romexis collects anonymous user interface interactions such as
button clicks. Usage Data Tracking can be disabled/enabled in Romexis
Configuration Application, to decide when to share anonymous data. For
more information, see section "Configuration application" in Planmeca
Romexis technical manual.
For more information on data processing, please see Planmeca Romexis

Software Licence Terms.
Data Being Tracked

• System profile (operating system, available memory, license type and
content)
• Current location (country and city)
• Data about your interaction with the software (e.g. actions you perform)
Data NOT being tracked
• Personal or patient data (name, email address, file names, license
name, workstation name, IP etc.)
• Any user activity outside of the Planmeca Romexis application

1 Introduction
1.14 Disclaimer
NOTE
IMPORTANT SAFETY NOTICE! Planmeca claims no responsibility for the
end user’s data security or for any malfunction in the computer system that
may lead to data loss. User organization must take care of protecting the
computer and the network by using up-to-date virus and malware protection
software and fire wall.
Since image processing and digital subtraction radiography can significantly
alter the visibility of both large and small structures (i.e. bone loss and
caries), which may result in either too many false positive or false negative
findings, Planmeca claims no responsibility for the software use, actions or
diagnoses made by the end-user.
The qualities of the monitor can strongly affect image quality. The monitor
qualities change as it gets older.
To correct under/overexposed images adjust gamma and/or contrast/
brightness levels. Only in case these adjustments do NOT improve the
image take a new image with different exposure values.
Cone beam computed tomography (CBCT) imaging is based on complex
mathematical algorithms that produce high fidelity images. However various
sources may cause imaging artifacts that may lead to incorrect diagnoses if
not properly interpreted. Image interpretation should only be done by trained
professional familiar with CBCT imaging as well as limitations and artifacts of
Planmeca X-ray units.
NOTE
Please note that Planmeca mRomexis Mobile is a separate product and as a
generic viewing application is not approved for diagnostic use and shall not
be used as such.

2 Getting started with Planmeca Romexis

Starting Planmeca Romexis
Double-click this icon on your desktop or on Windows menu.
To activate your license, see section "Activating Planmeca Romexis license"
on page 10.
2.1 Activating Planmeca Romexis license

The functions in the Planmeca Romexis application are controlled by license
and user rights. In order to use the application, the license must be
activated.
NOTE
Depending on the installed license and user rights the functions described in
this manual can vary.
When Planmeca Romexis Client is started (until activated) after new and
updated Planmeca Romexis server installations a dialog requesting for
activation will pop up. A period of 30 days is given to activate the Planmeca
Romexis license.
When connected to the Internet, activate the license by filling in username
and email address.

2.1.1 Manual activation

When there is no fixed Internet connection available the license can be
manually activated using a mobile phone, for example. If manual activation
is selected the following dialog appears. Follow the instructions in the dialog
and web page.
NOTE
Use the end customer details, not the dealer’s.
2.1.2 Installing license
About this task

Follow these steps to install a license.
Steps
1. Click the Install License button.

2. A license installation dialogue opens and asks for the license file
romexis.lic.
3. Browse to the license file and click Open.
When the license has been successfully installed the following message
appears.
4. Click OK.
2.1.3 Updating license
About this task

Follow these steps to update a license.

Steps
1. From the File menu select Update License.
2. Click Install License button and browse to the .lic file.
When the license has been successfully installed the following message
appears.
3. Click OK.
2.1.4 Managing license
About this task

Follow these instructions to manage license.

NOTE
Only users with administrator rights have access to license management.
Steps
1. Select License management from the File menu.
The License management window opens.

In the window you can view:

• the number of Romexis clients currently using the license
• expiry dates
• list of current users:
To remove users from the list, select the user you want to remove
and click Drop Client.
• the software modules and features included in the license
2.1.5 Transferring license to another installation

If you are transferring license from one Planmeca Romexis server
installation to another it must first be released from the current workstation
by selecting Release license.

2.2 Login
Enter username and password and click OK.
NOTE
The appearance of the Login window may differ depending on the settings
configured by your administrator, see the Planmeca Romexis technical
manual.
The Planmeca Romexis application opens in Patients module.

The name of the current user is shown in the title bar on top of the window.
To login as different user click this button.
NOTE
If you are trying to log in while another user is currently logged in, all patient
records are closed but the current views will be stored and shown when the
patient is next accessed by the user. This allows authorized personnel to
view and modify patient status using their own credentials. If you log out no
views will be stored, and the patient data will be opened with default view
when accessed next time.
To logout click the Logout button. All currently opened files will be closed.

2.3 Settings and support
2.3.1 Show/hide module icons

To hide/show the names of the modules, click the arrow on the top right
corner.
The names of the modules are hidden while their icons stay visible.
To hide both the names and the icons of the modules click the lock button.
The default settings can be modified in Planmeca Romexis Configuration
application, see Planmeca Romexis Technical manual.

2.3.2 Customising toolbars
Hiding toolbars from the top toolbar area
Right-click on an empty area on the toolbar and select the toolbars to hide.
To restore the default settings, click the Reset Toolbars to Defaults.
Hiding individual icons from the toolbars
Right-click on the toolbar icon area, select Customize Toolbar and select the
icon to hide.
Icons can be hidden from the top toolbar and from the side toolbar.
Adjusting toolbars
There are 3 different options for toolbar appearance:
• With text labels.
This is the default option in the imaging modules.

• With group titles.
This is the default option in the Patients and File module.

• Without text labels and group titles.

To select the option, right-click on the toolbar button area and select the
desired option.
2.3.3 Access tutorial videos and user's manual
About this task

Follow these instructions to watch Planmeca Romexis tutorial videos or to
open user's manual, in Patients module.
Steps
1. Click the icons on the top right corner of the screen.
NOTE
For viewing the manual, a pdf reader is required.
2.3.4 Check software version
About this task

Follow these instructions to check software version.
Steps
1. Click File on the top left corner.
2. Select About.
The software version and other software related information is displayed.
3. Close the window by clicking OK.
2.3.5 Mouse functions

The following abbreviations are used in the short cut commands table:
• LMB= Left mouse button
• RMB= Right mouse button
• MMB= Middle mouse button
Mouse functions
Interaction Windows Mac OS

Change centre of interest (origo) RMB (if no tool RMB (if no tool
selected) selected)

Mouse functions
Interaction Windows Mac OS

Remove object or erase guide area Alt + LMB or Alt + LMB or
drawing or clean CBCT rendering Select and Del Select and Del
Zoom in/out Scroll mouse Scroll mouse
wheel wheel
Pan image LMB LMB
3D module commands
Rotate CBCT volume LMB LMB
Pan/move CBCT volume Alt + RMB Alt + RMB
Rotate 3D object/view RMB or/and LMB RMB or/and LMB
(if no tool (if no tool
selected) selected)
3D render crop Shift + RMB Shift + RMB
Add point, change centre of interest, LMB LMB
select object, move object, place
point of interest, place points in
fitting dialog, paint etc.
Move object (implant, crown, IO Ctr + Shift + LMB Shift + Ctrl +
scan) LMB
Alt+Shift + LMB
TIP
Moving of selected objects can be
prevented from the right-click menu.
Rotate object Ctrl + Shift + Ctrl+Shift+RMB
RMB
(implant, crown, IO Scan)
Alt + Shift + RMB
End task (etc. drawing polyline) RMB (or hit RMB (or hit
Enter) Enter)
Shortcut menu (right-click menu) RMB RMB
2.3.6 Shortcut commands

On Mac operating systems Ctrl + mouse commands are interpreted as right
mouse click. Thus, equivalent to Windows command Ctrl +Shift + mouse use
Ctrl +Shift +fn on Mac system.
Alternatively, the macOS mouse commands can be changed to equivalent of
those on Windows in macOS System Preferences.
General shortcuts
Interaction On Windows OS On macOS

Copy Ctrl + C Cmd + C
or
Ctrl + C
Paste Ctrl + V Cmd + V
or
Ctrl + V

General shortcuts

Cut Ctrl + X Cmd + X
or
Ctrl + X
OK Enter Enter
Cancel Esc Esc
Move Arrow keys & Arrow keys &
Page Up/Page Page Up/Page
Down Down
Delete selected annotation Delete (or Del) fn + Backspace
3D module shortcuts

General
Crop O O
Reset orientation R R
Reset view R + Shift R + Shift
Save view V V
Show/hide annotation overlay C C
Maximize/minimize image Space Space
Slice views
Zoom/slice while key down A A
Tilt RMB RMB
Manipulate volume/cross-hairs D D
Measure W W
Measure polyline W+Shift toggle W+Shift toggle
Add angle G G
Add text E E
Add arrow E + Shift toggle E + Shift toggle
Square B B
Cube B + Shift toggle B + Shift toggle
Ellipse L L
Ellipsoid L + Shift toggle L + Shift toggle
3D rendering
Increase/decrease the size of the Alt + mouse Alt + mouse
Paint ROI to trim tool wheel wheel
Rotate image while Paint ROI to trim RMB RMB
tool is selected
Re-centre volume on a new point RMB RMB
(surface rendering only)
Implant slice views

3D module shortcuts

Drag horizontally to rotate implant / RMB RMB
crown
Guide design
Undo Ctrl+z Cmd+z
Redo Ctrl+Shift+z Cmd+Shift+z
Fitted model import
Drag to pan/move surface model Alt + RMB Alt + RMB
Virtual ceph
Tilt volume Ctrl + RMB Ctrl + RMB
Adjust contrast (drag up/down) Alt + LMB Alt + LMB
Adjust brightness (drag left/right) Alt + LMB Alt + LMB

3 Patients module
3 Patients module
In the Patients module you can:
• Add new patients
("Adding patients" on page 23)
• Open patients ("Opening patients" on page 24)
• Search patients in Planmeca Romexis database ("Searching patients" on
page 25)
• Open image ("Image preview" on page 28)
• Start image capture ("Start image capturing" on page 30)
• Inactivate patient file ("Inactivate patient" on page 29)
• Assign patient to specific user ("Assign patient to user" on page 28)
• Find patient by image type, data or comment ("Find patient by image" on
page 31)
• Retrieve patients from DICOM Worklist (optional) ("DICOM Worklist
(optional)" on page 32)
• Query and retrieve images from DICOM PACS server (optional)
("DICOM Query/Retrieve (optional)" on page 33)
• Transfer data via Planmeca Romexis Cloud ("Cloud Management" on
page 35)
3.1 Adding patients
About this task

Follow these instructions when adding patients.

3 Patients module
Steps
1. Click Add Patient button.
2. Enter patient data (person ID, first name and last name are obligatory).
3. Click Save.
Results
The added patient opens in File module.
3.2 Opening patients

You can open patients by:

3 Patients module
• double-clicking the patient on the patient list
• selecting the patient and clicking Select patient in the preview dialog.
• right-clicking on patient and selecting Go to patient.

The patient opens in the File module (see section "File module" on page
46).
3.3 Searching patients
About this task

Follow these instructions to search patients.

3 Patients module
Steps
1. Enter name or patient ID into search field.
The software automatically returns patients corresponding to the typed
entry.
NOTE
Auto Find Patients (default setting) must be enabled in Romexis
Configuration application. With large databases the setting can be
disabled and Find must be clicked for the search to start.
To sort the search results by specific information, click on the columns.

3 Patients module
To display / hide columns from search view, click the + button on the top
right corner of the columns and select the columns.
3.4 Refreshing patients list
About this task

Follow these instructions to update the patient list after updating patient files.
Steps
1. Click the Refresh button.

3 Patients module
Results
The updated files now show on the list.
3.5 Image preview
About this task

Follow these steps to open an image with the help of the image preview.
Steps
1. Click on the patient on the list to view a preview of all patient's images.
The images are sorted by acquisition date.
2. Click the thumbnail of the image you want to open.
Results
The image opens automatically in the right Planmeca Romexis module.
3.6 Assign patient to user
About this task

Follow these instructions to assign a patient to a certain user.

3 Patients module
Steps
1. Right-click on a patient and select Assign patient.
2. Select the user to whom to assign the patient and click OK.
3.7 Inactivate patient
About this task

Follow these instructions to inactivate a patient so that they no longer appear
on the patient list.
NOTE
The patient is still stored in the image folder on the hard drive. To
permanently delete the patient, see section "Reactivate and empty trash"
in Planmeca Romexis technical manual.

3 Patients module
Steps
1. Right-click on the patient and select Inactivate.
2. Confirm by clicking Yes.

To cancel, select No.
3.8 Start image capturing
About this task

Follow these instructions to start image capturing or scanning.

3 Patients module
Steps
1. Right-click on patient on the list and select Capture.
The right imaging module opens automatically.

See instructions on image capturing in further sections.
TIP
Image capturing can also be started from File module (section "Starting
image capture" on page 54).
3.9 Find patient by image
About this task

Patients can be searched by image comment, image type, and date as
follows.

3 Patients module
Steps
1. Click Find by image in Patients module.
2. Enter or select the desired search term.

Use asterisk (*) as wildcard to find matches within comments.
3. Click Find.
Results
The patients matching the criteria appear in the list. You can open the found
patient by clicking.
3.10 DICOM Worklist (optional)
About this task

Follow these instructions to use DICOM Worklist to retrieve patient data from
DICOM Worklist server. DICOM information such as accession number is
automatically added to all images captured to patients opened or created via
DICOM worklist.
Steps
1. Click DICOM Worklist in Patients module.
2. Enter or select the criteria from the drop-down menus.

You can also search by:
• person ID
• first or last name
• date of birth, select the date from calendar
• worklist AE title, select the worklist AE title by clicking this button
• calling AE title
• scheduled AE title

3 Patients module
• accession number
• modality, select the modality from the drop-down menu
• date range, select the dates (from) and (to) by clicking the calendar
icons under Procedure
3. Click Find.
What to do next
When prompted (a near match is found) select how to proceed.
3.11 DICOM Query/Retrieve (optional)
About this task

Follow these instructions to query/retrieve images from PACS server.
Steps
1. Click DICOM Query/Retrieve.
2. Select the study for retrieval.
3. Enter person ID or last name (Q/R or Calling AE title).

4. Click Query.

3 Patients module
To retrieve the entire patient with images, select Retrieve.
To retrieve single images click Study and select the image(s) to retrieve,
then click OK.
5. To save the images on the study to Romexis database, click Retrieve.
The images are saved to the database.
What to do next
The saved images now show in the File module.

3 Patients module
3.12 Cloud Management

Planmeca Romexis Cloud is a subscription-based service integrated into
the Planmeca Romexis. It can be used to transfer images and documents
between Planmeca Romexis users. All transfers between accounts are
encrypted so that users cannot see cases of other users.
NOTE
For sending and receiving cases a Planmeca Romexis Cloud user account is
required. To create an account please visit:
http://online.planmeca.com
The first time you access the Planmeca Romexis Cloud functionality, the
Planmeca Romexis prompts you for username and password.
To change your account settings later, select Admin module > Resource >
Users > Update > Cloud tab in the Planmeca Romexis, for more information
see Planmeca Romexis technical manual.
Each Romexis module has a Cloud Export button for quick sending of the
currently open image(s).
NOTE
In addition to sending cases, the Cloud Management can be used to
download and manage cases that have been sent or received.
3.12.1 Exporting Cloud cases
About this task

Follow these instructions to export Cloud cases.
Steps
1. Click the Cloud Management in Patients module.

3 Patients module
2. Click the New Case button under the Cloud Management.
3. Search and select the patient from the appearing list.
4. Add the receiver for the case to the To field.
Add the receiver by:

• entering the email address in the To field,
• clicking the Select Contact button and searching the contact from
former recipients drop-down list,
or

3 Patients module
• clicking the ... button (with three dots) and searching the contact.
For more information on searching contacts, see section "Searching

other Planmeca Online users" on page 42.
5. Add any case related information in the Comment field.
6. Select the sending options.
For more information, see section "Cloud case sending options" on page
44.
7. Click the Select Images button.

3 Patients module
8. Mark the image(s) to be attached and click the Update Case button.
NOTE
When sending a case containing several types of data to Romexis
version older than 4.5, the data will appear in the case list as several
cases.
TIP
You can remove an image from the case by right-clicking the image and
selecting Remove.
In the Cloud export view, there are the used Planmeca Romexis Cloud
transfer quota (Quota) and the selected image export size estimate (Size
estimate) visible.
9. Click the Send button.
Results
The case is uploaded to the cloud and the recipient receives an email when
it is ready for download. The cases are stored in cloud and automatically
deleted after thirty days.

3 Patients module
The download/upload progress is shown on the list and an icon on the left
indicates the case status. For explanation of icons, see section "Cloud case
status explanations" on page 45.
You can continue using the Romexis while the case uploads.
3.12.2 Replying to Cloud cases
About this task

Follow these steps when replying to Cloud cases.
Steps
1. Click the Cloud Management in the Patients module.
2. Select the case to be replied to from the Cloud Cases list.
3. Click the Reply to Case button.
4. In the Comment field add any case related information.

5. Click the Select Images button.
6. Mark the image(s) to be attached.

3 Patients module
7. Click the Update Case button.
NOTE
When sending a case containing several types of data to Romexis
version older than 4.5, the data will appear in the case list as several
cases.
TIP
To remove an image added to the case, right-click over the image and
click Remove.
In the Cloud export view, you can see the used Planmeca Romexis
Cloud transfer quota (Quota) and the selected image export size
estimate (Size estimate).
The case is uploaded to the cloud and the recipient receives an e-mail
when it is ready for download. The cases are stored in cloud and
automatically deleted after thirty days.
The upload progress is shown on the list and an icon on the left indicates
the case status. For explanation of icons, see section "Cloud case status
explanations" on page 45.
You can continue using the Romexis while the case uploads.

3 Patients module
3.12.3 Downloading Cloud cases
About this task

The Cloud case data needs to be first downloaded to the local Romexis
server before opening the case.
TIP
The Planmeca Romexis can be set to automatically download new cases
from the server. For setup instructions, see Planmeca Romexis technical
manual.
Steps
1. Click the Cloud Management in Patients module.
2. Select the case on the Cloud Cases list.
3. Click the Download / Import in the case information field.
Results
The download progress and the case status are shown on the Cloud Cases
list.
For explanation of status icons, see section "Cloud case status explanations"
on page 45.

3 Patients module
What to do next
When download is complete, you can click on the Open Patient button in the
case information field to open the updated patient data.
• If the patient is not found in database, the Open Patient button is
disabled, and new patient is created. Wait for the data to load and click
Open Patient button when enabled.
• If the patient is found in the database, the Open Patient button is
enabled.
NOTE
If you click Open Patient before downloading the data, the patient is
opened without the new data.
3.12.4 Searching other Planmeca Online users
About this task

Follow these instructions to search Planmeca Online users.
Steps
1. Click the button with three dots.

3 Patients module
2. In the opening window enter search criteria and click Search.
3. Add the returned contact(s) to your contact list by selecting the

contact(s) and clicking Add to My Contacts.
Results
The added contact(s) now show in My Contacts.
NOTE
For the users to show for other Planmeca Online users they must
publish their account at Planmeca Online My Account page (http://
online.planmeca.com/ and check the option shown below.
After sending a case to a new recipient the recipient is automatically added

to My Contacts list.
If an account has several users, they share the account’s My Contacts list.

3 Patients module
3.12.5 Cloud case sending options

When exporting cases to the Planmeca Romexis Cloud, select between the
following options, depending on the type of the recipient.
Send to another Planmeca Romexis

Select this option to send the case to another Planmeca Romexis user.
• Backward compatibility for older than Romexis 4.5.R
Tick this option when sending to recipient using Planmeca Romexis
versions older than 4.5.R or to unknown versions, to enable backward
compatibility mode.
This option is disabled by default.
Send to recipient as email download link

Select this option to send a download link and password to the recipient’s
email address.
• 2D Image Format
The following options are available:
• Processed as shown on screen (PNG)
Select this option for best compatibility.
• Processed as shown on screen (DICOM)
Select this option to transfer patient information in the image DICOM
header.
• Original format
Select this option to send the 2D images in the original format
without any processing applied.
• CAD/CAM Case Format
If sending from the CAD/CAM module select the suitable export format:
• Native PlanCAD (all data)
• STL (3D models only as STL files)
• PlanCAD Premium files (.ply + .pts + .xml)
• 3Shape files (.3oxz + .xml)
NOTE
CAD/CAM export to 3Shape Dental System 2015 in .3oxz format is
compatible with 3Shape Dental System 2015 software version 15.5.0.
Ditching models in Planmeca PlanCAD Easy before export is required.

3 Patients module
NOTE
If Lab Files option is selected, the e-mail download link option is
automatically selected as lab files cannot be imported to Planmeca
Romexis by the recipient. However, the recipient can download the zip
and use Lab Files in 3rd party software.
• Include Romexis Viewer (Only for Windows)
Tick this option if the recipient does not have Planmeca Romexis
installed but wishes to use a copy of Planmeca Romexis Viewer to view
the case.
This option is closest to creating and sending a Planmeca Romexis
Viewer DVD. Note that including the Romexis Viewer increases the
quota used by the size of the viewer component. A viewer normally
needs to be included only once as it can be copied to recipient’s
computer and reused to open new cases.
Send to Planmeca mRomexis mobile application

By selecting this option the data is sent in mRomexis compatible format. As
mRomexis can only receive 2D images the exported images are converted
to 8-bit 2D images.
Reverse Charge Send

If the recipient has accepted the reverse charges sending option in
the Planmeca Online account settings, the Reverse Charge Send option
becomes active and the case to be sent is automatically counted towards
the recipient’s transfer quota instead of the sender’s.
Accepting reverse charges can be enabled on the Planmeca Online My
Account management page at http://online.planmeca.com.
3.12.6 Cloud case status explanations
Case has been downloaded to local Planmeca Romexis server

and is waiting to be opened.
Case sent/received unsuccessfully.
A new case sent to you is waiting on the cloud server to be

downloaded to local Planmeca Romexis server.
Case sent as a reply to a received case.
Received, opened case.
Sent case the recipient hasn't opened yet.
Sent case the recipient has opened.

4 File module
4 File module
In the File module you can:
• Import images for the current patient
• Start image capture and scanning
• Export patient files and images
• Browse all types of images in single browser
• Open images
• Sort images by tooth number, date and type
• Set comments on images
• Edit patient's personal information
These functions are described in detail in the following sections.
4.1 Browsing patient files

• Click the thumbnails (1) or the images on the list (2) to browse images
and attachments.
• Click the file type buttons (3) to select which image types to view.
• Click these icons (4) to select browsing mode.
• Click the dental map and date icons (5) to sort images by tooth number
or date

4 File module
4.1.1 File tags explanation

4D jaw motion image/case Smile design photo, image
(3D volume tag) imported for smile design,
smile design case
2D snapshot generated in CAD/CAM case
3D module
Scrollable stack of multiple Image added to study

images (e.g. smartpan)
Locked 2D image or study Image with ceph tracing

2D cephalometric image
has been used in external
2D ceph analysis module
(axceph) for analysis
3D volume with segmented Image with diagnosis
teeth Diagnosis can be viewed in
Image properties dialog
Intraoral scan 3D image
Model case Surgical case (3D volume

tag)
4.1.2 Switching browsing mode

Click the icons under Patient Data, to switch browsing modes.

4 File module
4.1.3 Sorting images
Sort by image type

Click the buttons (2D, 3D, CAM/CAM...) on top of the thumbnails to sort
images by type.

4 File module
After selecting the image type, you can further sort the images by clicking
the groups in the selected image type.
Sort by time
Click the wrench icon to sort the time of exposure by descending or
ascending order.
Sort by date
Check/uncheck the date boxes on the right side of the screen.

4 File module
Sort by tooth number

Click first the dental map icon on the right side of the screen, then the tooth
number on the opening dental map.
4.1.4 Opening images

Images opened from File module open directly in the imaging module by
their image type.
Opening by double-clicking
Double-click the thumbnail or the image/study on the list.

4 File module
Opening via right-clicking

Select Open to open the files in their own module.
4.1.5 Setting comments on images
About this task

Follow these steps to set comments on images.
Steps
1. Right-click the image on the list and select Set Comment.
2. Enter the comment and click OK.

4 File module
Results
The comment appears on the image list
4.1.6 Moving image / study to other patient
About this task

Follow these steps to move an image / study to other patient.
Steps
1. Right-click on the image/study on the list and select Move to other
patient from the pop-up menu.
The search option Find by ID is selected by default. You can also select
Find by name option from the drop-down menu.
2. Enter the name or ID of the patient to which you want to move the image
to and click Find.
3. Select the patient from the list and click OK.
TIP
To move several images simultaneously, see "Inactivating, exporting and
moving images" in section "2D image browser" on page 79.

4 File module
4.1.7 Inactivating images
About this task

Follow these steps to inactivate images.
Steps
1. Right-click on the image on the list.
2. Select Inactivate.
If you select Yes the image is deleted but it is still stored in Romexis
database.
TIP
To permanently delete images, see section "Reactivate and empty trash"
in Planmeca Romexis technical manual.
4.2 Importing images for current patient
About this task

Follow these steps to import images for current patient.

4 File module
Steps
1. Click the Import icon.
2. Select the type of import from the menu.
3. Select the file(s) to import.
4.3 Starting image capture

Select the suitable capture type by clicking the icon on the top toolbar.
Clicking the icon opens the Planmeca Romexis module by selected capture
type.

4 File module
2D image capture
For more information, see sections:

• "Capturing panoramic images" on page 57
• "Capturing cephalometric images" on page 59
• "Capturing intraoral X-ray images with Planmeca ProSensor" on page
59
• "Capturing intraoral images with Planmeca ProScanner" on page 61
• "Capturing intraoral images with Planmeca ProScanner 2.0" on page 71
• "Capturing intraoral photos and videos with intraoral camera" on page
77
• "Capturing photos and videos with Planmeca Solanna Vision" on page
78
• "TWAIN scanning" on page 78
3D and model capture, artefact removal and stiching
For detailed instructions, see sections:

• "3D capture" on page 418
• "3D model capture" on page 420
• "Artefact removal" on page 422
• "Stitching volumes" on page 423
CAD/CAM
For detailed instructions, see sections:

• "Starting new scan" on page 479
• "Model analyser module" on page 447
Models
For detailed instructions, see section:

• "Model analyser module" on page 447

4 File module
4.4 Exporting files
About this task

Images from File module are exported in original file format.
NOTE
Scanned models can only be exported from Model analyser module, see
instructions in section "Exporting models" on page 475.
Follow these steps to export currently selected files.
Steps
1. Select the image(s) to export.
2. Click Export on the top right corner of the window.
3. Browse to the folder where to export the file.

4. Enter file name, select file type and click Save.

5 2D module
5 2D module
5.1 Overview
1 2D top toolbar (import, scanning, browser, printing, export)

2 Opened images
3 Image browser
4 Adjustment, image processing, viewing, annotation and implant tools
and object browser
5.2 Capturing panoramic images
About this task

Follow these steps to capture panoramic images.
Steps
1. Start image acquisition by clicking Pan Exp on the top toolbar.
The X-ray unit goes to waiting for ready state and the message
Panoramic Exposure appears.
2. Prepare the patient for exposure and select exposure parameters.
3. Drive the X-ray unit to ready position.
Refer to your Planmeca X-ray unit’s user’s manual if uncertain.
4. When the message Waiting for Exposure appears take the exposure.
Results
The message Saving the image appears and the image is automatically
stored into the database.
What to do next
When all the exposures have been taken click Done.

5 2D module
5.3 Capturing SmartPan images
About this task

The SmartPan autofocus image is automatically generated using the
sharpest layer in each exposure segment. The autofocus image combines
the layers into one optimum image.
SmartPan images are stored as a stack of one auto-focus panoramic image
and of 9 panoramic images each with a different panoramic focal layer. The
layers can be reviewed after exposure and rejected in preference of the
autofocus image.
NOTE
For the 2D SmartPan images only the 127μm pixel size is available.
Follow these steps to capture SmartPan images.
Steps
1. Click the panoramic exposure button on the top toolbar.
The Panoramic Exposure window appears.

When the X-ray unit is in ready state the message Waiting for Ready
appears.
3. Drive the X-ray unit to ready position.
Refer to your Planmeca X-ray unit user’s manual for instructions.
When the X-ray unit is in the ready position the message Waiting for
Exposure appears.
4. Take an exposure.
Results
The middle layer is shown as a preview. All layers are automatically stored
for later viewing and processing.
The message Saving the image appears and the images are automatically

5 2D module
What to do next
When all the exposures have been taken click Done to return to 2D Imaging
module.
5.4 Capturing cephalometric images
About this task

Follow these instructions to capture cephalometric images.
Steps
1. Start image acquisition by clicking Ceph Exp icon on the top toolbar.
The X-ray unit goes to waiting for ready state and the message
Cephalometric Exposure appears.
3. When the message Waiting for Exposure appears, take the exposure.
Results
The message Saving the image appears and the image is automatically
What to do next
When all the exposures have been taken click Done.
5.5 Capturing intraoral X-ray images with Planmeca ProSensor
5.5.1 Capturing single ProSensor images
About this task

Follow these steps to capture single ProSensor images.
Steps
1. Start the exposure by clicking Intra Exp icon on the top toolbar.
The exposure message appears, and the X-ray unit goes to waiting for
ready state.
2. Take an exposure as usual.
After exposure the message Saving the image appears and the image is
automatically stored into the database.
3. Define the tooth numbers and sensor orientation and take the next
exposure.
What to do next
When all exposures have been taken click Done to return to the 2D imaging
module.

5 2D module
5.5.2 Capturing ProSensor images into study template
About this task

Follow these steps to capture ProSensor images into study template.
Steps
1. Click the Intra Study icon on the top toolbar.
2. Select the template from the list.
3. Follow the tooth numbering and sensor orientation as shown on the top
and predefined in the template.
Results
The captured images are saved, and the incomplete study is preserved for
later use.
What to do next
When all images have been captured click Done.

5 2D module
5.6 Capturing intraoral images with Planmeca ProScanner
5.6.1 Scanning single ProScanner images
Before you begin
NOTE
For the capture to start, the ProScanner Capture Enabled in the Admin
module’s Local settings tab must be selected, see Planmeca Romexis
technical manual for more information.
About this task

Follow these steps to scan single ProScanner images.
Steps
1. Start the exposure by clicking ProScn button.
The message Waiting for a scanner device appears.

5 2D module
At the top of the screen (from left to right) the following information is
displayed:
• Scanner status (Connected)
• Connection type (LAN)
• Resolution (HD)
• Imaging plate size (SIZE3)
• ProID status (not connected)
• Scanner serial number
2. Click Scanner List to select scanner.

3. When the message Ready for Scanning appears, start scanning.
4. Scan the image as instructed in Planmeca ProScanner user’s manual.

The image is transferred from scanner to Romexis.

5 2D module
5. Wait for Ready for scanning. message to appear and click Retrieve
Image to select next image for scanning.
When scanning several images, keep the capturing dialog open and
scan the images one by one. For each image, a preview will appear.
Select image type and orientation for each image and click OK.
6. When all images have been scanned, click Done.
Results
The scanned images open in 2D imaging view.
5.6.2 Capturing images using Planmeca ProID reader
About this task

Follow these steps to capture images using Planmeca ProID reader.
Steps
1. Click the ProScn button on the top toolbar.

5 2D module
2. The image capturing dialogue opens.
3. Show the image plate to the Planmeca ProID reader as instructed in

Planmeca ProScanner User’s manual.
When the image plate is successfully read, an imaging plate template
and the message RFID read with the serial number of the plate appears.
To scan multiple images in the same session, repeat with all plates. For
each scanned plate a new template appears on the screen.
Maximum of 6 templates can be displayed on the screen at a time. If
more RFIDs are read, the templates will be divided to several pages. To
move between pages, use the numbered buttons in the middle of the
screen.

5 2D module
An imaging plate can be scanned only once during one imaging session.
If a plate is read again with ProID, the template in question will blink in
blue.
4. Take the exposure as instructed in the Planmeca ProScanner User’s

manual and your intraoral X-ray unit’s User’s manual.
5. Scan the image as instructed in Planmeca ProScanner User’s manual.
As images are scanned, a preview of the image will appear on the
template.
6. When all images have been scanned and appear on the screen, click
Done.
7. In the opening window, select orientation and image type and click OK.

5 2D module
8. Click Done.
Results
The dialog window is shown to all scanned images one by one. The images
will appear in the Planmeca Romexis 2D imaging module.
5.6.3 Imaging using Scanner List
About this task

Follow these steps to use Scanner List.
Steps
1. Click the ProScn button.
The Scanner List opens automatically.
NOTE
If you have only one scanner and one workstation, the ProScannerApp
will automatically connect to the scanner.
2. Select the scanner to use for reading the imaging plates and click
Connect.
The message Waiting for a scanner device... appears.

5 2D module
3. When the message Ready for Scanning appears start scanning.
4. Take exposures as instructed in the Planmeca ProScanner user’s

manual and your intraoral X-ray unit’s user’s manual.
5. Scan the image as instructed in the Planmeca ProScanner user’s
manual.
The image is transferred from scanner to Planmeca Romexis.
6. Wait until a preview image and the message Ready for scanning
appears.
7. Scan the next image.

When scanning several images, keep the image capturing dialog window
open and scan the images one by one. For each image, a preview will
appear on the screen.

5 2D module
8. Enter the orientation and the type of the image and click OK.
9. When you have scanned all images, click Done.
Results
When the imaging window is closed the scanner is automatically
disconnected.
The images open in the 2D imaging module.
5.6.4 Capturing images into study using ProID reader
About this task

Follow these steps to capture images into study using ProID reader.
Steps
1. Click the ProScn Study button.
2. Select an empty study template or an existing previous study from the

list and click OK.
The imaging window opens. For the explanation of status messages on

top of the window, see section "Scanning single ProScanner images" on
page 61.

5 2D module
3. Show imaging plates to the RFID reader when the message Show the
imaging plate to the ProID reader appears.
For detailed instructions see Planmeca ProScanner User’s manual.
While using study Planmeca Romexis browses through the template in a

predefined order. The dark blue colour around a slot indicates where the
currently read plate will be placed. If you want to change slot click on the
desired slot before reading the plate.
When the plate has been read the text RFID read will appear on the slot
and the colour of the slot changes to light blue.
If the wrong slot was selected, click on the desired slot and read the
plate again. The plate will be moved to the selected slot.
4. Take exposures as instructed in the Planmeca ProScanner user’s
The study appears in Planmeca Romexis 2D imaging module. If you
want to continue capturing images later into the same study, restart
imaging and select the study from the list.
NOTE
Image capturing window must remain open on the same workstation
where the imaging plates are read with Planmeca ProID until all images
have been scanned. Never close the image capturing window before all
images appear on the screen.

5 2D module
5. Scan the image as instructed in the Planmeca ProScanner user’s

manual.
The image is first transferred from scanner to Planmeca Romexis.
The scanned images appear in the imaging window on the correct slots.
Once the image has been scanned it appears on top of the old one in the
selected slot. The number of images in the same slot will be indicated
with a number in the lower left corner of the slot.
6. To continue click Done.
5.6.5 Recovering images
About this task

Follow these steps to recover images manually.
For automatic recovery, see section "TWAIN auto recovery" in the Planmeca
Steps
1. Select the patient and open ProScanner imaging window.
2. Click the Retrieve images button.
A list of images on the scanner opens.
3. Select an image from the list and click OK.

5 2D module
Results
The image is retrieved from the scanner and appears in the imaging window.
NOTE
Make sure the retrieved image belongs to the selected patient.
5.7 Capturing intraoral images with Planmeca ProScanner 2.0
NOTE
If the ProScanner 2.0 capture is not enabled check the ProScanner 2.0
Capture Enabled check box in the Admin module’s Local settings tab, see
Planmeca Romexis technical manual for more information.
In the scanning view the following information is shown.
1 Device name (can be configured using Planmeca Device Tool)

2 Device serial number
3 Number of scanned images
4 Patient name and date of birth
5 Browsing buttons for preview images
6 Orientation of image plate
7 Mirror: Flip images
8 Dental map

5 2D module
9 X-ray parameters (can be entered for each scanned plate)

10 Options:
Settings for X-ray parameters
Entry to Erase mode
5.7.1 ProScanner 2.0 Options menu

Via Options menu by selecting Settings you can access the exposure
parameter settings and enter the imaging plate erasing mode.
The menu is on the top right corner of the image capturing window.
5.7.1.1 Settings
Select whether the parameters (kV, mA, exposure time and DAP) are shown
in the ProScanner 2.0 imaging window by checking/unchecking the Show
input fields for exposure values option.
Define the default exposure values by entering the appropriate values and
check the Use default exposure values as inputs for X-ray parameter fields.
The values are automatically saved in the properties of each image.

5 2D module
The exposure parameters can be adjusted in the imaging dialog after having
scanned the imaging plate.
NOTE
The values must be inside the permitted range.
5.7.1.2 Erasing imaging plates

ProScanner 2.0 imaging plates can be erased with the scanner's erase
mode. For detailed instructions see Planmeca ProScanner 2.0 user's
manual.
5.7.2 Capturing single ProScanner 2.0 images
About this task

Follow these steps to capture single ProScanner 2.0 images.
Steps
1. Click ProScanner 2.0 Capture button.
The message Connecting to the scanner appears.

5 2D module
2. Take exposures as instructed in the Planmeca ProScanner 2.0 user’s

3. When the message Ready for Scanning appears start scanning by
inserting imaging plate to the scanner.
4. Scan the imaging plate as instructed in the Planmeca ProScanner 2.0

user’s manual.
The image is transferred from scanner to Planmeca Romexis.

5 2D module
5. Wait until the preview image and the message Ready for scanning
appear before scanning the next imaging plate.
6. Scan the next plate(s).

When scanning several images, keep the image capturing dialog window
open and scan the plates one by one.
For each image, a preview image appears on the screen. Click the
arrows button on both sides of the preview image to browse the scanned
images.
If necessary, change the orientation and select the teeth from the dental
map. Note that orientation and teeth are selected separately for each
image. You can also add image specific exposure parameters for each
image.
If the plate was exposed from the wrong side, you can flip the image by
checking the option Flip horizontally.
7. After having scanned all images, click Done.
Results
The images open in Planmeca Romexis 2D imaging module.
5.7.3 Capturing ProScanner 2.0 images into study template
About this task

Follow these steps to capture ProScanner 2.0 images into study template.
Steps
1. Click the ProScanner 2.0 Study icon on the top toolbar.

5 2D module
2. Select the template from the list.
3. Follow the tooth numbering and imaging plate orientation as predefined

in the template.
If necessary, the properties of the image currently shown in the Image

preview window can be changed. You can:
• change the orientation of the image by clicking on the circles in the
Orientation section.
• flip the image by selecting Flip horizontally (in case the imaging plate
was exposed from the wrong side)
• change tooth numbering by clicking on the right teeth on the dental
map.
• add exposure parameters individually for single images by entering
the correct values in the X-ray parameters boxes.
Preview image can be changed by clicking the study slots.
TIP
You can change the place of images in the study slots by dragging them
from one slot to another.
4. When all imaging plates are scanned click Done.
Results
The images captured from scanned plates are saved and the incomplete
study is preserved for later use.

5 2D module
5.8 Capturing intraoral photos and videos with intraoral camera
About this task
NOTE
For detailed instructions for installing and using the intraoral camera, see
Planmeca dental units and intraoral camera user’s manuals.
Steps
1. Start the camera by clicking IntraCam on the top toolbar.
2. Move the camera in the mouth to capture intraoral video.
At the bottom of the screen, click Freeze to stop capturing, and Resume
to restart the camera.
Click Save to save the frozen views to patient data.
3. When finished click Done.
Results
The saved images can be viewed in File and 2D modules.

5 2D module
What to do next
To restart camera, click Intra Cam button.
5.9 Capturing photos and videos with Planmeca Solanna Vision
About this task

To capture photos and videos with Planmeca Solanna vision:
Steps
1. Start the camera by clicking the Solanna Vision button on the top toolbar.
For detailed instructions, see Planmeca Solanna Vision user's manual.
5.10 TWAIN scanning
About this task

To start TWAIN scanning:
Steps
1. Click the TWAIN icon.
For scanning instructions, refer to the user’s manual of your device.
5.10.1 Scanning to study template
About this task

Follow these instructions to scan to study template.

5 2D module
Steps
1. Click New Study.
2. Select an empty study template or a previous study from the list and click
OK.
3. Start TWAIN scanning.
5.11 2D image browser

The 2D image browser is shown in the 2D imaging module at the bottom of
the screen.
To hide/show image browser click the Browser button on the top toolbar.
TIP
If the study you want to view is not visible you can drag the browser from its
top border or use the scroll bar on the right side of the image browser.
The tooth chart shows the number of images for each tooth.

5 2D module
5.11.1 Opening images

Double-click the thumbnail or select the image and click View selected.
To clear the selection, click Clear selection.
5.11.2 Viewing locked 2D images and studies

2D images and studies can be set to lock automatically after a certain
number of hours after taking exposure or creating study.
NOTE
Only admin or other permitted users can lock/unlock images. For more
information on how to enable/disable locking, see Planmeca Romexis
technical manual.
The locked images and studies cannot be modified, inactivated or moved.

The images can be adjusted while viewing, however the adjustments (such
as brightness and contrast) are not saved.
The locked images and studies are marked with the lock symbol on their
thumbnail and in the table view browsing mode.

5 2D module
The locked images that opened in 2D module are tagged as Read Only.
To unlock an image or a study, right-click on its thumbnail and select Unlock.
The image stays unlocked until the end of the current session. When the
session is closed the image is automatically re-locked.
5.11.3 Viewing options

Click these buttons to select thumbnail viewing options.
• All images in table format

5 2D module
• All images
• Category Images grid
5.11.4 Settings
Click the Settings icon to:

5 2D module
• Sort images by time descending/ascending

• Adjust image thumbnail size
• Close Browser on Double Click option
Closes image browser automatically when image is opened.
• Don’t Close Open Images When Capturing option
Keeps images open while new ones are captured.
5.11.5 Image type categories

To sort images by category, click the image type icons.
Studies images attached to a template

Pan panoramic and SmartPan exposures and scans
CBCT 2D snapshots generated in 3D module
Ceph cephalometric exposures and scans, including virtual
cephalometric images
Photo intraoral video camera images, scans and imported camera
photos
Intra bitewing and periapical exposures and scans with specified
tooth sites under Periapical and Bitewing groups
images with no specified tooth sites under Other

5 2D module
5.11.6 Image thumbnails
1 Thumbnail symbol (see descriptions below)

2 Specified tooth sites
3 Add comment: Move the cursor on top of image and click Add
comment
4 Exposure date
Thumbnail symbols
A scrollable stack of multiple images (e.g. SmartPan)
Image stored in Long Time Archive. Restore from the archive for
viewing
Image added to study
Locked image or study
2D cephalometric image used for an analysis in the external 2D

ceph analysis module (Axceph)
2D snapshot generated in 3D module
Smile design photo / image imported for smile design / smile design
case
Image with an attached diagnosis showing in image properties

5 2D module
5.11.7 Filtering images
Filtering by tooth number

Click the tooth chart icon and select the tooth number(s) from the tooth chart.
Images containing the selected teeth show in the image browser.
Filtering by tooth type

Click the tooth chart icon and check the appropriate tooth type boxes
(Bitewings, Periapicals or Other) .
Images containing the selected tooth type show in the image browser.

5 2D module
Filtering by date
Click the calendar icon and select the date(s). Images captured on the
selected date show in the image browser.
5.11.8 Expanding image browser
About this task

To expand/collapse the browser:
Steps
1. Click the arrow button on the lower/upper right corner of the browser.

5 2D module
5.11.9 Adding comments on images
About this task

Follow these instructions to add comments on images.
Steps
1. Select All images
or
Category view.
2. Move the cursor on top the image and click on Add comment.
3. Enter the comment (Periapical in the example).

5 2D module
TIP
Comments can also be added as described in section "Image properties"
on page 108.
5.11.10 Exporting, inactivating and moving images to other patients
About this task

Follow these instructions to export, inactivate or move images to other
patients.
Steps
1. Select the image(s) to export, move or inactivate.
2. From the right-click menu select Export selected images, Export all
images, Move to other patient or Inactivate.
The search option Find by ID is selected by default. You can also select
Find by name option from the drop-down menu.
3. Enter the name or ID of the patient to which you want to move the
image(s) to and click Find.
4. Select the patient from the list and click OK.

5 2D module
TIP
To move several images simultaneously, see "Inactivating, exporting and
moving images" in section "2D image browser" on page 79
TIP
On how to inactivate image, see section "Inactivating images" on page
53.
5.12 Opening images in floating window
About this task

Images can be opened in a floating window as follows.
Steps
1. Double-click an open image.
Results
The image opens in a floating window, from where it can be dragged to
another display or viewed e.g. in 3D module.

5 2D module
Also, multiple images can be opened and compared side by side.
5.13 Setting layout
About this task

The opened and captured images automatically appear in the screen in their
maximum size. Follow these instructions to arrange images opened in the
Viewer into a temporary layout.
Steps
1. Click the Set Layout button.
The layout settings can be used to position multiple images for print
layout.

5 2D module
5.14 Closing all open images
About this task

To close all open images:
Steps
1. Click Close All on the top toolbar.
5.15 Working with study templates
5.15.1 Creating new study
About this task

A study is based on a study template where tooth numbers and exposure
order can be defined. Follow these steps to create a new study.
Steps
1. Click New Study.
2. Select a template from the list on the left and click OK.
3. Add image(s) to an empty slot by double-clicking the image thumbnails

in the image browser.
5.15.2 Arranging images in study
About this task

Follow these instructions to arrange images in a study.
Steps
1. Select the study and click View study.
2. Drag and drop images from one slot to another.
• Select Move to move the image to an empty slot.

5 2D module
• Select Swap Images to replace an existing image in the target slot.
To navigate between different images in a slot use the scroll bar.
5.15.3 Comparing studies

It is possible to open multiple studies in one view to assist in comparison.
Opening a second study will place it above the study that was opened first.
Each study is closed separately.
5.16 Image partitioning
About this task

The partition image tool is intended for partitioning a 2D image in smaller
images based on a selected template. A new study with sub-images copied
from the original image based on the layout of the selected study template,
zoom and overlay parameters, and the smile line control points is created.

5 2D module
For example, a panoramic image can be partitioned to images that resemble

intraoral images.
Follow these instructions to partition images.
Steps
1. Open the image to partition.
2. Click the Partition image icon.
3. Select template and click OK.
The template appears on top of the image centred horizontally and

vertically in relation to the smile line.
4. Position the smile line to match the occlusal plane by dragging the
control points.
A single image of the template is rotated according to the angle of the
smile line.
What to do next
Adjusting partitioning
For adjusting the partitioning of the image, you can use the following options:
Move template with smile line
• To centre the smile line to the image, deselect it.
• To centre the image to the smile line, select it.

5 2D module
Zoom
• To link horizontal and vertical zoom level sliders to maintain aspect ratio
of all images, check the Link option.
• To scale the chosen template, use the Horizontal and Vertical Zoom
Level sliders.
Overlap
• To link horizontal and vertical sliders for Overlap to maintain the aspect
ratio of all images, check the Link option.
• To control the amount of overlap of single images inside template, use
Horizontal and Vertical Overlap sliders.
To save the current settings locally for the selected client, click Set as
defaults.
5.17 Adjusting, annotating and measuring 2D images
NOTE
IMPORTANT SAFETY NOTICE!
If care is not taken adjustments may significantly alter the visibility of both
large and small structures (i.e. bone loss and caries) resulting in false
positive or negative findings.

5 2D module
5.17.1 Histogram
Adjust contrast, brightness and softness by dragging the rectangles and
vertical lines.
5.17.2 Adjust
Adjust contrast, brightness and softness by moving the sliders.
Click to undo the latest adjustment.
Click to redo the latest adjustment.
Click to revert image to original state (right after

exposure).

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5.17.3 Crop and rotate
Adjust rotate
Freely rotate the image with left mouse drag.
Rotate left 90°

Select to rotate the image 90 degrees to the left.
Rotate right 90°

Select to rotate the image 90 degrees to the right.
Adjust crop
Crop the image using the highlighted edges.
Mirror horizontally
Select to mirror image horizontally.
Mirror vertically
Select to mirror image vertically.
A red exclamation mark symbol indicates that the crop and rotate tools have
been used on an image.
5.17.4 Image Processing

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CLARIFY filter
Use the filter to adjust image contrast locally. The filter improves depth and
clarity of all 2D radiographs.
Local contrast is applied to the image on top.
Despecle (noise removal)

Use the despecle tool to remove small defects due to dust or scratches as
well as moiré effects on images.
Select the area where to apply the filter to avoid unwanted overall changes.
The filter replaces each pixel with the median pixel value within the specified
area.
Optimize contrast
Use this tool to optimize contrast in a specific region of interest in a
radiograph.
Select the reference point within the brightest area of a radiograph, NOT in
a filling. The ideal reference point is in the sound enamel of the brightest
tooth. If there is a brighter area in the radiograph than the enamel, e.g. the
compact bone, select the reference point in that area.
NOTE
Other areas than the region of interest may be destroyed with respect to the
diagnostic image quality as no radiograph can be optimized simultaneously
in all regions and for overall brightness. For multiple diagnostic tasks,
recalculate the radiograph with respect to the different regions of interest.
Invert image
Use this tool to invert the colours of the image.
Adjust sharpness
Use the sliders or move the mouse cursor on top of the image.

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Apply Ceph filter

Use the filter to show more facial soft tissue.
To specify the affected area, adjust the green vertical lines.
To adjust the strength of the filter, adjust the Gain value: with higher values
more tissue is shown.
To apply filter on the left edge of the image, enable the Left option.
5.17.5 View
Zoom to fit
Click to fit images to viewing window
Actual pixels
Click to view images in their actual size
Uniform scaling for all images

Scales images to same size.
Magnifier
Magnifies the image twice its size.
1. Check that the Pan tool is inactive.

2. Move the mouse over the area on the image you want to magnify.
3. Right-click on top of the image and select the suitable filter:
Magnify Invert Equalize Sharpen Emboss
5.17.6 Measure
5.17.6.1 Calibrate for measurement
About this task
NOTE
Do not use the tool on CBCT snapshots as they are automatically calibrated.

5 2D module
Follow these instructions to calibrate for measurement.
Steps
1. Click the Calibrate for measurement button.
2. Draw the calibration line by dragging with the left mouse button.
3. Finish the line by releasing the mouse.
4. Enter the length and click OK.
5.17.6.2 Measure angle
About this task

Follow these instructions to measure angle.
Steps
1. Click Measure angle.
2. Draw a line on the image.

3. Release the mouse and draw a second line starting from the end of the
first line.
The lines are combined and the measurement appears on the image and
in the object browser.
5.17.6.3 Measure length
About this task

Follow these steps to measure length.

5 2D module
Steps
1. Click the Measure length button.
2. Select Single measurement to measure length between 2 points (default)

or Polyline measurement over multiple points.
3. Draw the line by dragging with the left mouse button and release to
finish.
TIP
For setting colour for measurements, see "Setting colour for annotations
and measurements" in section "Object Browser" on page 105.
TIP
The measurements are stored as saved views, click Open Saved View
to view the saved measurements.
The measurement label can be dragged freely on the view (unless

disabled in the default settings). Fix the label in place by clicking.
5.17.6.4 Line profile
About this task

Follow these instructions to draw a line on a 2D image and view a grey scale
profile of the line.
Steps
1. Click the Line profile button.
2. Select Minimum, Maximum, Average or StdDev (standard deviation)

profile.
By checking the Relative values option the approximate grey scale
values are emphasized.

5 2D module
5.17.6.5 Show histogram
About this task

A histogram displays a grey scale distribution in the image/area and is by
default drawn in square root scale.
Follow these instructions to open the histogram of the open image / selected
region of interest.
Steps
1. Click the Show histogram button.
2. To enable linear scale, check the Linear scale checkbox.

3. Select Minimum, Maximum, Average or StdDev (standard deviation)
profile.
5.17.6.6 Show / hide measurements
Steps
1. Select to show/hide measurements.
5.17.7 Draw
Draw line

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Click to select single or polyline.

Draw Line - draw line by dragging with the mouse and release.
Draw Polyline - draw line by dragging with the mouse and draw another line
starting from the end of the firs line and release.
Draw horizontal line
Draw vertical line
Add arrow
Draw curve
NOTE
Sketched lines are not saved or stored and are lost when image is closed.
Draw rectangle
Draw ellipse
Add text
Click this button and click on the image where to add annotation.
Enter the annotation and click OK.

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Select annotation
To edit annotation, click Select annotations and double-click the annotation.
Delete selected
Select the annotation/measurement to delete and click this button.
Show/hide annotations
To show/hide annotation, click the eye icon in the object browser. Note that
also the hidden annotations are saved with the image.
5.17.8 Implant (Implant Library)
NOTE
The 2D Implant Library is optional and available on license.
NOTE
Modifications in the 2D Implant Library, such as adding or deleting implants
also affect the 3D Implant Library.
Use implant tools to visualize realistic implant models on 2D images.
NOTE
In panoramic imaging mode, magnification of object may appear uneven
depending on its position and angle in relation to the focal plane. Use
panoramic or other 2D images prudently in treatment planning.
5.17.8.1 Adding implants
About this task

Follow these instructions to add an implant to the plan.
Steps
1. Click the Implant library button.

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2. Select the appropriate implant and properties from the library and click
Add to Plan.
A box corresponding to implant insertion depth appears next to cursor.

3. Add an implant to the image by placing the box in the implant site and
clicking the left mouse button.
5.17.8.2 Editing implants

• To rotate or move an implant, activate it by clicking it with the left mouse
button.
• To rotate an implant, drag the implant from its control points.
• To move an implant, drag the implant with the mouse. When the implant
library is open, and the implant is activated the corresponding implant
type is displayed in the library.
• To replace an implant, select another implant from the library and click
Replace.
• To delete an implant, select the implant and click Delete Annotation or
Delete key on your keyboard.
5.17.8.3 Implant properties
About this task

Follow these steps to view and edit the properties of the selected implant.
Steps
1. Click the Implant properties tool.

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2. Enter the properties.
3. Save by clicking Close.
5.17.9 Object Browser
5.17.9.1 Show/hide annotations

• To show/hide all annotations or measurements, click the eye icon next
Annotations or Measure group.
• To show/hide single annotation or measurement, click the eye icon next
to it.
5.17.9.2 Setting colour for annotations and measurements
About this task

Colour can be set for single annotation or measurement or for a whole
group.

5 2D module
Steps
1. Select one of the following options.
• To set colour on single annotation or measurement, check the box
next to it and click the Choose color icon.
• To set colour all annotations/measurements, check the box next to
the group and click the Choose color icon.
2. Click the desired colour from the Choose color menu.
or click on the + icon and select a colour from the swatches.

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5.17.10 History
All adjustments applied on images are listed under History.
Click on an adjustment on the list to revert the image to that state.
5.17.11 Saving enhancements as defaults

To apply the same enhancements to all new exposures of the same image
type, click File menu and select Capture > Save image enhancements as
default enhancements .
For more information on reviewing and adjusting default enhancements for

new exposures, see Planmeca Romexis technical manual.
5.17.12 Using image specific tools

These tools are located on the top bar of each open image. They affect the
currently selected image only.
Scale the image 1:1
Zoom to fit
Zoom in
Zoom out

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Show image properties

Opens the General tab under Image properties window where tooth
numbers (for intraoral images) can be defined, the image can be rotated/
flipped and the image file info and exposure parameters can be viewed.
Show image diagnosis
Opens the image diagnosis for editing. The maximum number of characters
is 5000.
Maximize
Maximizes the image when more than one image is open.
Maximize to full screen
Close image
5.17.13 Image properties

To access the properties of a single image check that the Pan tool is inactive
then right-click on the image and select Show properties.
General tab
The General tab shows general properties for selected image including
exposure information. In image properties you can define image type, sensor
orientation, exposure date, tooth numbers, and image comments.
If an image has been mirrored or flipped horizontally there is a small dual in
the image status bar.
If added comments are shown in the image title bar you can search images
by comments in the Find by Image tab, see section "Find patient by image"
on page 31.
X-ray quality value

5 2D module
The quality value is to follow up possible changes of the exposure level over
time. The value indicates changes after system start-up and approval when
a reference value may be recorded. The quality value is not an absolute
measure of dose and should only be used per system. The value also
depends on many image processing settings as well as on user.
Therefore no exact recommendations are given.
The value mathematically measures the logarithmic average of signal
intensity behind the bone tissue using image histogram.
Diagnosis tab
In the Diagnosis tab a diagnosis of up to 2500 characters can be entered.
When finished click OK.

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All parameters tab

Displays image parameters in detail.
5.17.14 Adjusting alignment
About this task

Follow these steps to adjust alignment.
Steps
1. Check that the Pan tool is inactive.
2. Right-click on an image and select Alignments.

5 2D module
3. Select alignment settings and click OK.
The alignments settings affect placement of image on screen and the

option Export / All images in one file.
5.18 Importing 2D images
About this task

Images can be imported in JPG, TIF, DCM (=DICOM), PNG and BMP file
formats.
Follow these steps when importing 2D images.
Steps
1. Click Import button.
2. Browse to the image folder and select the images to import.

To select several images, press and hold down the Shift or Ctrl key while
selecting files.
3. Select image type, tooth numbers (optional), orientation/mirror setting

(optional) and exposure date (optional).
If necessary rotate and crop the image, see below for details.

5 2D module
If you are importing multiple images you are prompted separately for
each image:
• If you click Cancel to skip a single image when importing multiple
images, Planmeca Romexis will ask: “Continue importing images?”.
• To continue importing the rest of the images select Yes.
• To ignore all adjustments click Reset.
If you want to apply same settings for multiple images, check the Apply
all checkbox.
4. Start import by clicking OK.
Results
The imported images will appear in the image browser.
What to do next
Crop and Rotate
• Apply a grid on the image by clicking Align option to help with rotation.
• Freely rotate the image by clicking the Crop & Rotate button and
dragging the image. Use the alignment axes to help with horizontal and
vertical alignment.
• To adjust the crop region drag it from the borders of the image.
Apply cropping by re-clicking the Crop & Rotate button.
• Realign the image by clicking the Align button and dragging from the
control points of the alignment axes.
Apply the new alignment by re-clicking the Align button.
• To reset the image to its original state click Reset.
5.18.1 Importing DICOM image with patient
About this task

Follow these instructions to import DICOM image with patient.

5 2D module
Steps
1. Select Import > DiCOM with patient from the File menu.
Results
A new patient is automatically created based on the information in the
DICOM file and image is imported under the new patient.
5.18.2 Importing DICOMDIR files with patients
About this task

With DICOMDIR multiple patients with their patient information and images
can be imported from DICOMDIR into Romexis.
Follow these instructions to proceed.
Steps
1. Select DICOMDIR with patients from the File menu.

5 2D module
2. Click the Browse button to select the DICOMDIR file to import.
A tree list opens showing each patient in the DICOMDIR file and the
images it contains.
A tree list opens showing each patient in the DICOMDIR file and the
images it contains.
The DICOM tags of the selected image are displayed at the bottom of
the window and its thumbnail highlighted on the right.
Select the images to import

5 2D module
3. Click Import.
If a patient with the same name is already found in the database, you will
be asked whether to import the images to the existing patient or create a
new one. Verify that you have the correct patient before continuing.
If necessary new patient entries are created and the selected images are
imported to them.
All images in the database that have an image UID (Unique Identifier)
will be rejected unless Allow duplicate UIDs option has been enabled.
To import SmartPan images as stacks instead of separate images check
the option Stack single frame CT images.
5.18.3 Importing photos from folder
About this task

Follow these steps to import photos from a folder.
Steps
1. Open the patient file to which you want to import photos.
2. Go to 2D module.

5 2D module
3. Select Import > Import images from folder From the File menu.
4. Select the folder from where to import the images.
Results
All photos in the selected folder are imported and saved to the image
browser under Photos.
5.19 Copy to clipboard
About this task

Follow these instructions to copy an image to the Windows clipboard.
Steps
1. Right-click on the image.
2. Select Copy to clipboard from the pop-up menu.
5.20 Moving image to other patient
About this task

Follow these instructions to move an image to other patient.

5 2D module
Steps
2. Select Move to other patient.
3. Define the patient to receive the image using the Search dialog .
TIP
For moving several images, see section "Exporting, inactivating and
moving images to other patients" on page 88.
5.21 Moving study to other patient
About this task

Follow these steps to move a study to other patients.
Steps
1. Right-click on the study in the image browser.
2. Select Move to other patient.

5 2D module
3. Search for the patient by name or ID.
4. Select the patient on the list and click OK.
5.22 Assigning image as face photo
About this task

Follow the instructions if you want to use a face photo in patient's
information.
NOTE
Only photographs can be assigned.
Steps
1. Right-click on the photograph you want to assign.
2. Select Assign as Face Photo.

5 2D module
Results
The photo will now show in the File module.
5.23 Inactivating images
About this task

Follow these instructions to inactivate images.
Steps
2. Select Inactivate.
Results
When the image is inactivated it disappears from view in Romexis but
remains in the image folder on the hard drive.
To permanently delete images, see section "Reactivate and empty trash" in
Planmeca Romexis technical manual.
5.24 Exporting images
5.24.1 Export currently open images
About this task

Follow these instructions to export currently open images.

5 2D module
Steps
1. Select the image(s) or study/ies to export.
2. Click Export.
3. Select the export file type, location and, if necessary, Viewer option, see
below for details.
Export options
Export file type

• Processed images (as they appear on screen)
Export image(s) in 8 bit with all enhancements applied.
Select the image format from drop-down menu.
• Original images
Export original image(s) (8 or 16 bits, depending on the original
capturing mode).
Regenerate 2D DICOM Headers: DICOM header is re-written as
Planmeca Romexis image using current information instead of
original.
• All images in one file
Export multiple open images or a study as a single file.
When exporting as multiple files (with option not selected) a
sequence number and file extension are automatically added to the
file name.
NOTE
By default, the File name field is empty. To change the default
setting, see Planmeca Romexis technical manual.
NOTE
To export all images, select the view All images in table in the
image browser, see section "Viewing options" on page 81 or use
DICOMDIR Export, see section "Exporting multiple patients with
DICOMDIR" on page 122.

5 2D module
• Do not create patient and image information file

No patient related text file is created.
• Anonymize file(s): any identifying information in the file headers
is cleared (patient ID, name, date of birth and accession and
study numbers).
• “Burn” patient information to the export file
Image information is attached directly on the exported image.
Export image to
• Folder: Data is exported to a folder
• Disc image (.ISO): Data is exported to a CD/DVD disc image that
can be written to a media using 3rd party CD/DVD writer software
• CD or DVD: Data is written directly to a CD/DVD if a CD/DVD writer
is installed.
Select burning speed from drop-down menu.
Viewer options
• Include Viewer: Select to include Planmeca Romexis Viewer in the
export.
• Skip Viewer launcher: When exporting single image select for the
Planmeca Romexis Viewer to open without displaying the patient
selection dialog in the launcher.
Platform
• If you know on which platform the Viewer is to be used, select the
platform from the drop-down menu to optimize Viewer size.
Viewer language
Set the default language for exported Planmeca Romexis Viewer.
4. Click OK to start the export.
5.24.2 Export all patient images

See section "Exporting, inactivating and moving images to other patients" on
page 88.

5 2D module
5.24.3 Export selected images

See section "Exporting, inactivating and moving images to other patients" on
page 88.
5.24.4 DICOM export
About this task

Follow these instructions for DICOM export.
Steps
1. Open the images or study to export.
2. Select DICOM Exp. on the top toolbar.
3. Select export options, export folder and enter file name.

See "Export options" in section "Export currently open images" on page
119 for details.
4. Click OK to start the export.
5.24.5 Exporting multiple patients with DICOMDIR
About this task

DICOMDIR Export can be used to export multiple patient files with patient
data and images into a DICOMDIR file structure.
A DICOMDIR Directory information file is saved as specified in the Export
To dialog and all exported DICOM image files are stored into its adjacent
sub-folder entitled \images.

5 2D module
Steps
1. With no patients selected, select Export > DICOMDIR from the File
menu.
2. Click the Export to button to select the DICOMDIR file.
3. Browse to the correct folder and enter file name.

4. Click Add Patient.

5 2D module
5. Add patient to DICOMDIR file by clicking on patient and clicking OK.
Results
The added patients with studies and images now show in the list.
To include or exclude options from the final DICOMDIR file check/uncheck
the box next to each item.
To add additional options, click Additional options at the bottom of the dialog.
5.25 Sending 2D images by email
About this task

Follow these instructions to send 2D images by email.
NOTE
Sending by email only works with Windows operating system.

5 2D module
Steps
1. From the File menu select Email > Send 2D images by email.
2. In the following window select the appropriate export options and click
OK.
Results
The email service that has been set as your default email will open and the
images will be automatically added as attachments.
5.26 Printing images
About this task

Follow these instructions to print images.
Steps
1. Open the images to print.

5 2D module
2. Select Print on the top toolbar.
The images open in the Print editor.

Arrange images to desired location and adjust their size by dragging
from the corners.
3. When finished, click Print Page.
5.26.1 Print page setup
About this task

Follow these instructions to make adjustments in the printout.
Steps
1. Click Page Setup button.
In the opening window you can:

• Browse for logos to be added to the printout
• Hide or show the header and footer, set them visible, editable and
define their height. To reset the default settings click Reset.
• Define page margins
• Set page orientation, size, and define the custom width and height of
the pages.

5 2D module
2. Click OK.
5.26.2 Editing print pages
Add images to print layout

Click Image browser.
Select the image(s) by double-clicking.
Adjust images on layout

Adjust images by dragging and dropping.
To resize, drag the image it from its corners.

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To open a shortcut list for layout adjustments, right-click the image.
Add new pages to layout

Click the Add New Page button and select:
• an empty page with no predefined image slots
or
• a copy of the current page with its predefined image slots.
Browse pages
Use the scroll bar or click the thumbnails.
Save pages as snapshots

Click Save Print.
The snapshots appear in 2D Imaging module in the image browser under
Photo category.

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Add text box

Click this button.
Select from the following text box types:

• Add Free Text Box to Layout – a freely editable text box.
• Add Image Implant List to Layout – a list of implants (only for 3D print).
• Add Image Diagnosis to Layout – a copy of the image diagnosis
if entered in the Image Properties dialog (only for 2D images or
snapshots).
Crop images
Select the desired image and click Adjust crop.
Draw the crop region with mouse, right-click on the image and select Apply
Crop Region.

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To cancel cropping, right-click on the image and select Reset Crop Region.
To show / hide annotations from the printout, click the Show Annotations
button.
Fit image to view

To fit the image to the view, click the Zoom To Fit button.
5.26.3 Save and adjust print layouts

To save layouts:
Click Save Layout and
select Save as Default Template or Save as Named Template option.
The default layout will open every time the Print editor is opened whereas
the named layout can be restored from the layout list. The image is inserted
into a template slot for the respective image type if existing in the layout.
To open a saved layout, click the Select Layout button and select the layout
from the list.
To add images into a template, double-click the images from image browser.
To delete a layout, click the Delete layout button and select the layout to be
deleted from the list.

5 2D module
The print layout can be zoomed in and out by using the Zoom In and Zoom
Out buttons.

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5.26.4 Adjusting images on layout

The vertical toolbar can be used to adjust the size, position and labels of the
images. As the adjustments in the vertical tool bar are image specific it only
shows when an image is selected.

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Scale
To scale the image, select the appropriate scale value from the drop-down
menu.
Position and size

To change the position of an image on the layout drag the image to a
suitable position or type/select the desired location (X, Y) from the Position
and Size menus.
Image border
Borders can be added to each image in the print layout.
To change the border size, type or select the desired width (W) and height
(H).
To change the border fill colour, click BG and select the desired colour. To
change the border edge colour, click the FG field.
The borders can be rounded by typing / selecting the desired radius (R).
Moving images in layout

By selecting Snap to area / or object edges the image is attached to its
nearest edges on the print area.
With Scale image with slot option the new image is automatically scaled with
the slot.
Labels
The labels can be hidden by deselecting the Show Labels option.
Image labels can be added, edited and deleted from the Contents table. To
add a label to a new label row, click the Add button and select the label type
from the drop-down menu.
The text field includes text that is added to the layout after the image
property data of the selected label. i.e the text field of the label Img Exp
mA adds the string “mA” after the image exposure mA, e.g. “10 mA”.
To add a line break after the label row, click the LB field on the label row.
The line brakes can be used if several labels are added to the same area on
the layout.
To delete a row select it and click Del.
To move a row up and down in the table, select the row and click Up or
Down.
When the label is selected from the Contents table, its opacity, background
(BG) and foreground colour (FG), text font and relative position in the layout
can be defined.
To select the relative position in the layout, click on the grey fields of the
layout preview.
The changes in the labels show on the print editor layout.

5 2D module
Editing font
1. Click the square button next to the Font field.
2. Select the suitable font, font style and size and click OK.
5.26.5 Exporting print pages
About this task

Follow these steps to export print pages.
Steps
1. Click this button to export the layout as a regular image to the hard disk.
2. Select screen resolution, image format, print resolution and export folder.
3. Enter file name.

4. Click OK.

5 2D module
5.26.6 Printing images with DICOM printers (optional)

With DICOM Print license images can be printed with DICOM compatible
printers. DICOM Print needs to be configured in the Admin module before
the DICOM printer can be used, see section “DICOM printer setup” in the
5.27 DICOM storage
About this task

With DICOM Full license images can be sent to a remote DICOM
application, i.e. DICOM image archive PACS.
NOTE
DICOM Storage needs to be configured in Admin module before use, see
section "DICOM storage setup" in Planmeca Romexis technical manual.
Follow these instructions to use DICOM storage.
Steps
1. Open the image you want to store.
2. Click DICOM storage on the top toolbar.
3. Click OK.
The storage status can be checked in Image Properties dialog.

DICOM Storage is also shown in Image Properties next to the storage
status. When DICOM Storage is enabled, storage of a single image can
be cancelled in the Image Properties dialog.

5 2D module
NOTE
For setting automatic storage after capturing, see sections "DICOM
configuration" and "External communication" in Planmeca Romexis
technical manual.
5.28 Cloud export
About this task

Follow these steps to export images to the Planmeca Romexis Cloud.
Steps
1. Open the image you want to export.
2. Click the Cloud Export button on the top toolbar.
3. Select Create new case or Continue existing case (if there is existing
case).
4. Fill the To field with the recipient's email address and add optional
message to the Comment field.
5. Select Cloud case sending option, see section "Cloud case sending
options" on page 44.
What to do next
For more information on the Planmeca Romexis Cloud management, see
section "Cloud Management" on page 35.
5.29 Launching external application
About this task

To launch images in an external application:
Steps
1. Open the image to launch.
2. Click Launch ext. app on the top toolbar.
Results
Image is launched to the 3rd party application.
NOTE
The 3rd party application to be used and its parameters can be specified in
the Admin module.

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5.30 Cephalometric analysis
NOTE
The Planmeca Romexis Cephalometric analysis module has a separate
user's manual.
In the Planmeca Romexis Cephalometric Analysis module, cephalometric

analyses and superimpositions can be composed of 2D cephalometric
images, facial photos and views of the dental arch. The analyses are
used e.g. in orthodontic growth analysis, diagnosis, treatment planning and
monitoring as well as in treatment outcome evaluation.
If you have the Ceph module licence, the button shows on the top tool bar in
the 2D Imaging view.
Patient information (date of birth, gender) in Planmeca Romexis is
automatically transferred to Ceph module the patient files are saved in
Planmeca Romexis database when Ceph module is closed.
5.31 Automatic cephalometric analysis

The automatic cephalometric analysis service can be used to order
cephalometric tracing and related analyses.
The service is provided by CephX Ltd.
To use the service, you need a 2D lateral cephalometric image or a virtual
ceph.
On how to capture or import cephalometric images, see sections "Capturing
cephalometric images" on page 59 and "Importing 2D images" on page 111.
An account is required for using the service.
5.31.1 Creating account
About this task

Follow these instructions to create an account.
Steps
1. Click the AI CEPH button on the top toolbar.

5 2D module
2. Fill in your username (email address) and password.
3. Click Create Account.

4. Click OK.
What to do next
With the free account you have access to 3 tracings and related analyses.
To set up a payment method after 3 tracings, click Go to My Account to
access the settings.
5.31.2 Ordering analysis
About this task

To order cephalometric analysis:

5 2D module
Steps
1. Fill in your username and password and click on the Order Analysis
button.
2. Agree to the terms of use and privacy statement by checking the box
and clicking OK.
Results
You are redirected to the online portal where automatic tracing and analyses
are available.
What to do next
To download analyses, see section "Downloading analysis" on page 139.
5.31.3 Downloading analysis

In the online portal the automatic tracing is shown on the left and a list of
available analyses on the right.
• To fine-tune the tracing click on the Edit Tracing button under the traced
image.
• To download an analysis in PDF format select the analysis from the list
on the right and click Download analyses.

5 2D module
It is recommended to log out of the service when finished.
5.31.4 Manual tracing

If automatic tracing cannot be done, the image is queued for manual tracing
which is completed by CephX as a service.
When the manual tracing is ready, you receive an email notification.
To open the tracing, open the image in Romexis and click Automatic tracing.
When the image is in manual tracing queue, it appears as In Review in the
patient list.
5.31.5 Viewing account information and ordered tracings
About this task

Follow these instructions to view account information and to order tracings.
Steps
1. Click the AI Ceph icon on the top toolbar.

5 2D module
2. Fill in your user name and password and click Go to My Account.
3. Log in to the service at https://planmeca.cephx.com/.
• To open tracings select the desired tracing and click Trace button on
Patients list.
• To download an analysis, click Download.

6 Smile design module

Planmeca Romexis Smile Design is a digital smile design tool. A patient's
smile image and tooth silhouettes are used to design a new smile.
A retractor image can be aligned with the smile image for gumline and tooth
dimensions design.
The finished design can be exported on top of CADCAM or Ortho software
and sent to a dental lab using Planmeca Romexis Cloud service or printed
out.
6.1 Capturing images for smile design

A frontal smile photograph is needed for digital smile design. If the gum line
is not visible in the smile photograph a retractor image is also recommended.
The patient should be positioned near the wall or imaging background to
eliminate shadows.
Capture images from the same angle from the front of the patient so that
the camera is perpendicular to the patient's face. The use of a camera stand
is strongly recommended. Direct the face of the patient straight towards the
camera so that both ears remain equally visible.
The distance between the camera and the patient depends on the camera
and objective used – it is recommended to capture photographs including
the whole face.

Save images in JPG, PNG, TIFF or BMP format.
6.2 Smile design workflow
About this task

Follow these instructions to start the Smile design workflow.
Steps
1. Click Wizard at the bottom left of the screen.

2. Start smile design by selecting Smile Design from the Workflow Wizard
menu.
What to do next
The following sections describe the different smile design steps and use of
smile design tools.
6.3 Import smile image
About this task

Follow these instructions to import smile image.
Steps
1. Click Import on the Smile design wizard or on the top left corner of the
screen.

2. Browse to the folder where the patient smile images are stored, select
the image and click Open.
Results
The image opens in Smile design module.
6.4 Align and crop smile image
About this task

Align the smile image using any two points in the image, e.g. pupils as
follows.

Steps
1. Click Align and crop button in the wizard or under Smile Design tools on
the right side of the screen.
To view the instructional video, click the Play button on the wizard.
2. Position the red and blue control points by dragging or double-clicking.

3. Double-click the green control point in the middle to align.
4. Drag the borders of the image for cropping.
5. Start dragging the lower green dot until the three horizontal grid lines
below the dot are aligned as follows:
• The highest line aligned with the upper border of the upper lip,
• The middle line with the lower border of the upper lip,
• The lowest line with the upper border of the lower lip.
The silhouette is now correctly positioned.
6. Finish by double right-clicking on the image.
6.5 Image calibration
About this task

An image can be calibrated e.g. using the width or height of the object
selected for calibration. The calibration affects the teeth dimensions
visualized in the teeth silhouette and measurements made using the
measuring tools.
Follow these instructions to calibrate by measuring the incisor width.

Steps
1. Click Calibrate in the wizard or on the right side in Smile Design group.
2. Measure the incisor by dragging with the left mouse button from the left
edge to the right edge of the incisor.
3. Enter the width of the physical incisor in millimetres and click OK.
6.6 Select and position teeth silhouette
About this task

Follow these instructions to select and position teeth silhouette.

Steps
1. Add a teeth silhouette on image by clicking the Teeth button on the
wizard or on the toolbar on the right.
The default silhouette opens on top of the smile image.
2. Position the silhouette on teeth by dragging the blue dot in the middle.
• To select a different silhouette:

Click the pink corner of the teeth button and select silhouette from
the list.
6.6.1 Adjusting teeth silhouette

Move the mouse over the teeth design so that a blue rectangle appears
around it.
To adjust the width or length of all teeth simultaneously place the mouse
cursor on the blue rectangle and hold down the left mouse button while
dragging.
• To translate drag the design from the blue control point at the centre.
• To rotate drag from the red control point at the bottom.
• To bend and scale drag from the lateral blue control points.

Visualizing designs
By right-clicking on an individual tooth you can:
• Mirror one tooth to opposite side
• Mirror all teeth on one side of the midline to the other side
• Hide the selected tooth
• Show all teeth
• Reset the selected tooth
• Hide all other teeth
• Reset all teeth
Visualizing teeth proportions

You can also switch between showing individual teeth proportions (width /
height) and showing width proportions compared to tooth 22 (FDI) / 10
(ADA).
To change the percentage ratio to proportions ratio, right-click on the design
and select Show proportions to tooth...
The percentage values change to proportions values.

The golden proportions in relation to tooth FDI 22 (left 2nd incisor) are the
following: 1st incisor = 1,6; 2nd incisor = 1 and canine = 0,6.
The proportion value shows the width of each tooth in relation to the left
maxillary lateral incisor.

6.6.2 Saving silhouettes to library
About this task

After creating a teeth silhouette you can save it in the teeth library for later
use as follows.
Steps
1. Right-click on top of the silhouette and select Save teeth design to
library.
2. Enter a name for your silhouette design and click OK.
Results
The designed silhouette appears on the teeth silhouettes list and can be
used in the same way as the default silhouettes.
To delete a silhouette from the library, right-click on it and confirm the
deletion by clicking Yes.
6.6.3 Adjusting single tooth on silhouette

Start by clicking on the tooth you want to adjust.
The selected tooth is surrounded with a blue box.

• To lengthen the tooth drag from the bottom or top of the box that is
around the tooth
• To widen the tooth drag from the sides of the box that is around the tooth
• To reshape drag from the blue control points on the tooth outline
• To add or remove control points double-click on the outline
• To rotate the tooth drag from the red control point above the tooth
NOTE
The design of the selected tooth shows as mirrored to the other side.
To hide the design click the eye icon in the Silhouette group.
To adjust the transparency of the design use the transparency sliders.
6.7 Define smile area
About this task

The smile area needs to be defined so that the teeth can be hidden behind
the lips.

Steps
1. Click the Smile area button on the wizard or on the toolbar on the right.
2. Move the smile area as necessary by dragging.

Adjust the area by dragging the blue control points on the line.
Add or remove dots by double-clicking.

3. Hide the teeth under the lips by re-clicking the tool.
To show / hide smile area, click the eye button.

Use the sliders to adjust:
• Whitening
• Lip shadow
To delete the selected smile area, click the Delete selected icon.

6.8 Adjust photorealism
Use the sliders to adjust:

• Teeth transparency
• Texture transparency
• Simulated texture colour temperature
• Highlights
• Brightness
• Opacity shadow
To delete the selected silhouette, click the Delete selected icon in the upper
right corner.
To set the teeth shade select the desired shade from the shade map. The
available shades are as determined in the VITA Classical shades guide
including bleached shade.

To select shade for single tooth, right-click the tooth and select shade from
the menu.
To pick a shade from a tooth on the design, click Pick colour and then click
the tooth with wanted teeth colour.
The selected shade is set to all teeth.
View tools
Fit image to viewing window.
Move image on the screen
Adjust contrast and brightness

When enabled, vertical movement affects contrast and horizontal movement
brightness. Drag the sliders or move the mouse on the image while holding
down the left mouse button.
6.9 Show comparison
About this task

Show comparison of original imported image and of current design as
follows.

Steps
1. Clicking the button on the wizard or from the right-side toolbar.
Results
What to do next
To exit the comparison view, click any key or mouse button.
6.10 Create report
About this task

This section describes how to create a standard smile design case report in
PDF format.
NOTE
To create custom reports see "Selecting print layout" in section "Printing
smile design images" on page 164.
Steps
1. Click the Create report button on the wizard or on the toolbar on the
right.
2. Type the case information in the fields of the dialog box.

3. Click the Browse button.
4. Select the destination folder and enter the name for the report file in the
File name field.
5. Click Save.

Results
The report is saved in the selected folder and opens automatically.
6.11 Aligning intraoral image with smile image (optional)
About this task

The alignment is done by placing two dots on same places in two images.
The alignment can be fine-tuned by adjusting intraoral image transparency.
Steps
1. Click the Intraoral image import button.
2. Select a retractor image.

3. Click Open.

4. Align the intraoral image by right-clicking and dragging the coloured dots
to same position in both images.
The image can be moved by left-clicking and dragging.
If necessary, fine-tune the alignment by adjusting transparency and the
placing of the dots.
5. Save by clicking OK.

6. To adjust the alignment or to change the intraoral image return to step 1
to import intraoral image.
IO image
Use the transparency slider to adjust the visibility of matched images.
To delete the selected IO image, click the Delete selected icon in the
upper right corner.
6.12 Clone brush (optional)
About this task

The clone brush can be used to make photorealistic changes in the image
for example for adjusting the gumline. Also, minor adjustments elsewhere in
the image can be made.
Steps
1. Select Clone brush tool.
If necessary, adjust the size and softness of the brush.

2. Right-click on the area to clone.

The area you are about to copy shows as a dashed circle in the image.
The mouse cursor automatically turns to a continuous light-blue circle.
3. Move the cursor over the area where you want to clone the selected
area.
4. Clone the area by clicking once the mouse left button.
Use clone brush e.g. to remove stains from teeth. Select an area with
good shade and clone it on top of a stain.
To clone a larger area from around the area you are about to copy hold
down the left mouse button while dragging.
The tooth can also be shortened by cloning, for example by dragging
with the left mouse button.
Results
The image on the left illustrates the situation before and the image on the
right the situation after cloning.
6.12.1 Clone brush options

Size
To adjust the size of clone brush:
• Use the size slider in the dialog box in the upper right corner of the
image.
or
• Hold down the right mouse button while dragging to up-left and down-
right over the image.
Softness
To adjust the transparency of the border of the cloned area, drag the Soft
slider in the dialog box. The greater the softness value, the more transparent
the cloned area. Minimizing softness produces a sharper cloning result.
The size and softness adjustments apply also for warp brush.
Warp brush
The warp brush can be used for stretching or moving tissues and for
straightening teeth.
To activate the tool
Select Warp brush option.
Drag with the left mouse button to stretch the image area inside the dashed
line circle. On the left before and on the right after warping.
Mirror
NOTE
The mirror option cannot be used with Warp brush.
Use mirror to copy a mirror image of an area to another one for example for
creating symmetrical teeth and gumline on both sides of the teeth or to copy
a missing tooth. On the left before and on the right after mirroring.
6.13 Undo and redo changes

Undo, Redo and Revert work for clone and warp brush adjustments made
during the same session even if the tool has been inactive for a while. All
changes will be reverted. For re-opened images only Revert work.

Click Undo to cancel the latest change.
Click Redo to redo the latest change.
Click Undo history and select the changes to undo or redo.
6.14 Automatic alignment

Use the Auto Align button for automatic alignment, cropping and teeth
silhouette alignment.
The center of the eyes is automatically recognized and the image is aligned
according to this data.
6.15 Draw & Measure
Implant
To add an implant on top of the image click Implant.
To move implant, drag with the left mouse button.
To rotate implant, drag from the squares on top and at the bottom of implant.

The annotations and measurements appear in the object browser where

their properties can be adjusted.
For detailed instructions on using:
• measurement and drawing tools, see sections "Measure" on page 98
and "Draw" on page 101
• annotations and measurements in object browser, see section "Object
Browser" on page 105.
6.16 Maximizing design area
About this task

To maximize the design area:
Steps
1. Press the arrows button on the top right corner of the design window.
Results
To return to default view mode press the Esc button on your keyboard.

6.17 Printing smile design images
About this task

Follow these instructions to print smile design images.
Steps
1. Open the image to print.
The image is printed as it appears on the screen.
2. Click the Print button on the top left corner of the window.
3. Select the image to print.

The image opens directly in the Print editor.
4. When finished start printing by clicking Print.
6.17.1 Print page setup
About this task

You can make adjustments in printouts as follows.
Steps
1. Click Page Setup button.
In the following window you can:

• Browse for logos to be added to the printout
• Hide or show the header and footer, set them visible, editable and
define their height. To reset the default settings click Reset.
• Define page margins.

• Set page orientation, size, and define the custom width and height of
the pages.
2. Click OK.
6.17.2 Editing print pages
Add images to print layout

Click Image browser.
Select the image(s) by double-clicking.
Adjust images on layout

Adjust images by dragging and dropping.
To resize, drag the image it from its corners.

To open a shortcut list for layout adjustments, right-click the image.
Add new pages to layout

Click the Add New Page button and select:
• an empty page with no predefined image slots
or
• a copy of the current page with its predefined image slots.
Browse pages
Use the scroll bar or click the thumbnails.
Save pages as snapshots

Click Save Print.
The snapshots appear in 2D Imaging module in the image browser under
Photo category.

Add text box

Click this button.
Select from the following text box types:

• Add Free Text Box to Layout – a freely editable text box.
• Add Image Implant List to Layout – a list of implants (only for 3D print).
• Add Image Diagnosis to Layout – a copy of the image diagnosis
if entered in the Image Properties dialog (only for 2D images or
snapshots).
Crop images
Select the desired image and click Adjust crop.
Draw the crop region with mouse, right-click on the image and select Apply
Crop Region.

To cancel cropping, right-click on the image and select Reset Crop Region.
To show / hide annotations from the printout, click the Show Annotations
button.
Fit image to view

To fit the image to the view, click the Zoom To Fit button.
6.17.3 Save and adjust print layouts

To save layouts:
Click Save Layout and
select Save as Default Template or Save as Named Template option.
The default layout will open every time the Print editor is opened whereas
the named layout can be restored from the layout list. The image is inserted
into a template slot for the respective image type if existing in the layout.
To open a saved layout, click the Select Layout button and select the layout
from the list.
To add images into a template, double-click the images from image browser.
To delete a layout, click the Delete layout button and select the layout to be
deleted from the list.

The print layout can be zoomed in and out by using the Zoom In and Zoom
Out buttons.

6.17.4 Adjusting images on layout

The vertical toolbar can be used to adjust the size, position and labels of the
images. As the adjustments in the vertical tool bar are image specific it only
shows when an image is selected.

Scale
To scale the image, select the appropriate scale value from the drop-down
menu.
Position and size

To change the position of an image on the layout drag the image to a
suitable position or type/select the desired location (X, Y) from the Position
and Size menus.
Image border
Borders can be added to each image in the print layout.
To change the border size, type or select the desired width (W) and height
(H).
To change the border fill colour, click BG and select the desired colour. To
change the border edge colour, click the FG field.
The borders can be rounded by typing / selecting the desired radius (R).
Moving images in layout

By selecting Snap to area / or object edges the image is attached to its
nearest edges on the print area.
With Scale image with slot option the new image is automatically scaled with
the slot.
Labels
The labels can be hidden by deselecting the Show Labels option.
Image labels can be added, edited and deleted from the Contents table. To
add a label to a new label row, click the Add button and select the label type
from the drop-down menu.
The text field includes text that is added to the layout after the image
property data of the selected label. i.e the text field of the label Img Exp
mA adds the string “mA” after the image exposure mA, e.g. “10 mA”.
To add a line break after the label row, click the LB field on the label row.
The line brakes can be used if several labels are added to the same area on
the layout.
To delete a row select it and click Del.
To move a row up and down in the table, select the row and click Up or
Down.
When the label is selected from the Contents table, its opacity, background
(BG) and foreground colour (FG), text font and relative position in the layout
can be defined.
To select the relative position in the layout, click on the grey fields of the
layout preview.
The changes in the labels show on the print editor layout.

Editing font
1. Click the square button next to the Font field.
2. Select the suitable font, font style and size and click OK.
6.17.5 Exporting print pages
About this task

Follow these steps to export print pages.
Steps
1. Click this button to export the layout as a regular image to the hard disk.
2. Select screen resolution, image format, print resolution and export folder.
3. Enter file name.

4. Click OK.

6.17.6 Printing images with DICOM printers (optional)

With DICOM Print license images can be printed with DICOM compatible
printers. DICOM Print needs to be configured in the Admin module before
the DICOM printer can be used, see section “DICOM printer setup” in the
6.18 Exporting smile designs
About this task

Export current image as follows.
Steps
1. Click the Export button on the top toolbar.
2. Select export file type:

• Processed images
Export image(s) in 8 bit with enhancements applied. Select the
image format from the drop-down menu.
• Original images
Export image(s) in 8 or 16 bits depending on capturing mode.
• Smile design project
Export smile and retractor images with teeth design
Create a zip-file, which can be imported to another Smile Design
workstation
• Export tooth silhouette as STL file
• “Burn” patient information to the export file

3. Click OK.
6.18.1 Send by email
About this task

Current image can be sent in email as follows.
Steps
1. Select Send 2D images by email from the File menu.
6.18.2 CAD/CAM export
About this task

With CAD/CAM export the teeth silhouette can be exported on top of any
image on any software.
Steps
1. Click CAD/CAM Export.
2. Open the dental model (e.g. intraoral scan) in CAD/CAM software.

Adjust the silhouette on top of the dental model or other image and use
the following tools as necessary:
• Lock silhouette - the silhouette cannot be scaled, translated, rotated
or edited.
• Adjust transparency of the silhouette with transparency slider.

3. When finished, click the cross on the top right corner to close the dialog
and the silhouette.
6.18.3 Cloud export
About this task

Export images to Planmeca Romexis Cloud as follows.
Steps
From the drop-down menu select Smile Design export type (Image as
shown on screen or Project to another Planmeca Romexis Smile Design
user).
If the recipient has accepted the reverse charges sending option in the
Planmeca Online account settings, the Reverse Charge Send option
becomes active and the case to be sent is automatically counted
towards the recipient’s transfer quota instead of the sender’s. Accepting
reverse charges can be enabled on the Planmeca Online My Account
management page at http://online.planmeca.com.

7 3D module
7 3D module
The images can be viewed and adjusted in the following 3D modules:
• Explorer
• Panoramic
• Cross sections or Implants (optional) if implant license is installed
• TMJ (optional)
• Superimposition (optional)
• Surface (optional)
• Jaw Motion (optional)
• Surgery (optional)
To move between views, click these buttons on top of the screen.
7.1 Explorer module

7 3D module
7.1.1 Slice and rendered views
A/P, L/R (anterior/posterior, left/right) orientation indicators

The anterior, posterior, left, and right anatomies are indicated by the letters
A/P/L/R. These are automatically updated to denote the nearest anatomy to
the edge.
HU (Hounsfield unit)
When moving the mouse cursor on top of an image, a Hounsfield Unit (HU)
value shows at its bottom right corner.
The value is an average of 3 x 3 pixel area under the mouse cursor.
Maximize
Click Maximize to maximize the selected view. Re-click to open the view in
full size.
Click Decrease to return to default size.
Mirror
Reorients volume in the view as follows:
• Coronal: Anterior vs. Posterior
• Sagittal: Lateral vs. Contra-lateral
• Axial: Upper vs. Exterior
• Axial view: From above / below
• Coronal view: From front / back
• Sagittal view: From left / right
Slice view scroll bar

Adjust the slice view by scrolling the bars at the right side of the axial,
coronal and sagittal slice views.
For example, scrolling the bar in coronal view moves the coronal plane in
anterior/posterior direction when the volume is in its default orientation.
The orientation lines in the other views and the orthogonal plane in the 3D
rendered view are adjusted accordingly.

7 3D module
TIP
To browse the layers by scrolling the mouse wheel after deactivating the
zoom mode, see section "Toggle Zoom" in"Adjust" on page 178.
Quick shot
Take a 2D snapshot of the slice view by clicking the quick shot icon. The
snapshot is saved as a 2D CBCT image in 2D module, see section "Save 2D
snapshots" on page 427 for more information.
Show viewport settings

Click Show viewport settings on the top right corner of the slice view.
Select the number of images, layer thickness and layer distance for each
view (coronal, sagittal, axial).
7.1.2 Adjust
7.1.2.1 Thickness
Select thickness of the slice from the drop-down menu.
NOTE
This setting overrides view specific layer thickness.

7 3D module
7.1.2.2 Contrast, brightness and sharpness

Adjust contrast, brightness and sharpness of the coronal, sagittal and axial
view by dragging the sliders.
The adjustments are saved when the image is closed.
7.1.2.3 Toggle zoom/layer browsing

Select the tool to zoom in/out the image.
Deselect to scroll through the image layers.
TIP
To zoom in/out when the tool is deselected, hold down the Ctrl key while
scrolling the mouse wheel or the scroll bars next to the images.
TIP
The rendered volume can be zoomed in and out in both modes.
7.1.2.4 Move/rotate volume

Select the tool to enable volume navigation.
Deselect to enable plane navigation.
NOTE
The annotations and measurements can only be selected and edited in
plane navigation mode.
Volume navigation
You can move and rotate volumes so that the orthogonal planes remain at
right angles while moving/rotating the volume. This way the volume can be
positioned so that the point of interest shows in other MPR views.
• To move the volume, use the left mouse button.
• To rotate the volume use the right mouse button.
Plane navigation
With plane navigation the volume remains static while the orthogonal planes
are moved and rotated inside the volume. This can be used for arbitrary
oblique slicing without moving the actual anatomy.
The orthogonal planes can be reoriented as follows:
• To move the intersection of planes click and drag on a MPR slice using
the left mouse button. This way the intersection of the orthogonal planes
can be positioned so that to the point of interest shows in the other MPR
views.
• To rotate the 2 planes perpendicular to the current slice around their
intersection click and drag on a MPR slice using the right mouse button.
(In the example below the 2 planes show on the current slice.)
This tool can be used for placing the planar intersection along the axis
of a tooth and to rotate the planes in the Axial view (on the left) while

7 3D module
observing the tooth’s anatomy in Coronal (in the middle) and Sagittal (on
the right) views.
On how to rotate the volume coronally, for example to straighten the occlusal
plane, see section "Export view to other tabs" on page 183.
7.1.2.5 Reset orientation

Click to reset orientation of orthogonal planes to default without affecting
other settings.
7.1.2.6 Show / hide annotation overlay

To hide all annotations, labels and orientation lines from views, click the
Show/Hide Annotation Overlay button.
7.1.2.7 Adjust levels

If necessary the automatic adjustments can manually be fine-tuned.

7 3D module
Click the tool to open a graphic representation of the intensity distribution.

Adjust the gamma curve by moving the green line in the histogram. The
value is displayed under the histogram in the middle field.
Adjust contrast and brightness by cutting the histogram from both ends by
moving the red lines.
To bring out the details scale the histogram up and down by clicking the the
arrows.
Restore the original scale by clicking the 1:1 button.
7.1.2.8 Crop volume for 3D rendering
NOTE
The cropping affects the 3D rendered view only, not the slice views.
TIP
To create a separate cropped volume, select the option Export cropped at
export.
TIP
To store the volume into the database and add the volume for the same
patient, select As new image to database in the Export dialog.
1. Click the Crop button and then click and drag on any slice view.
The rectangle appears in all slice views as a reference for defining the
cropping area.

7 3D module
2. Define the cropping area by dragging.

The cropped area is automatically centred.
To adjust the cropping, drag the crop box from its corner points.
If the volume has not been rotated a preview of the cropped volume is
shown.
3. Finish cropping by right-clicking on the view.
7.1.2.9 3D Noise filter (noise removal)
About this task

Follow these instructions to use the 3D Noise filter.
Steps
1. Click the 3D noise filter button.
2. Set the filtering strength by scrolling the Strength slider and select the
appropriate settings.
3. Apply sharpening filter by checking the Sharpen check box.
4. Select whether to:
• filter the volume without storing the results to the database
or
• create a new filtered volume.
NOTE
Noise filtering and sharpening may alter the diagnostic quality of image.

7 3D module
5. Click Filter.
What to do next
To remove the filtering close and reopen the volume.
7.1.2.10 Export view to other tabs

Click the tool to export the volume orientation to Panoramic tabs where it can
be further processed.
Use the tool for example to align the volume coronally before generating a
panoramic view.
7.1.2.11 Default settings

Click Default settings to adjust the default values and to show / hide
elements on images.

7 3D module
General
In the General tab the default colours, contrast, brightness and sharpness
can be adjusted.
The changes of colours are applied only for new but not for currently
selected annotations, nerves and cylinder implants.
The changes of contrast, brightness and sharpness are applied for both
currently open and for new and reset images.
Explorer (overlay, rotation and slice settings)

In the Explorer tab overlay preferences and slice settings can be adjusted.
Overlay preferences
In this field the following elements can be set visible or hidden:
• Rulers (millimetre scale)

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• Values - when view contains multiple images, they are balanced with
values in other views.
• Axial Line - focus line
• Secondary axial lines
• Sagittal line - focus line
• Secondary sagittal lines
• Coronal line - focus line
• Secondary coronal lines
The secondary lines are reference lines of possible multiple images of
other views.
In the axial view image below:
• The focus lines in the sagittal and coronal views are set visible (green
and red arrow).
• Both sagittal and coronal views have four images each of which
secondary lines of sagittal view is visible.
• As the secondary lines in the coronal view are hidden only the green
sections of the line are visible (circled in brown).
• The image values are set to be shown (blue circles).
Slice settings
The thickness, distance and grid size for each view can be adjusted. These
settings are applied for currently open, new and reset images.
Rotate volume around cross

To apply this option use plane navigation mode by enabling Move/Rotate
volume button.

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When disabled the volume rotates around the centre of the slice view (left in
the image below).
When enabled, the volume rotates around the intersection of planes (right in
the image below).
The arrow points the centre of rotation.
7.1.3 Tools
7.1.3.1 Volume reslicer
About this task

With volume reslicer you can create a new set of projections to send them to
DICOM storage as a 2D image stack. This allows a more convenient viewing
of volumes in 3rd party DICOM viewers where free reorientation of data in
axial, sagittal and coronal views is not possible.
For example, a stack of slices perpendicular to the mandible can be stored
into PACS instead of a stack of axial slices or of a stack created with reslicer
tool. The stacks can be saved to 2D imaging module.
Follow these instructions to use the volume reslicer.
Steps
1. Open the 3D volume to reslice.
2. Click the Volume reslicer tool.

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3. Select the projection for the new stack from the Source drop-down
menu.
The new slices are perpendicular to the axial source allowing generation
of coronal and sagittal slices.
4. To define a line or arc as a direction for the re-sliced stack click Draw arc
and Edit arc tools.
In the preview, the distance, width and thickness of the slices as well as
the mirroring of the slices can be adjusted.
You can also:
• Include source view in (final) stack
• Color image
• Send (stack) to (DICOM) Storage (queue)
• Save stack as 2D snapshots
7.1.3.2 Jaw segmentation
NOTE
Jaw segmentation is available on license.
Jaw segmentation is used to separate the lower jaw from the rest of the skull
in a CBCT image and to create surface models of the upper and lower jaws.

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NOTE
When segmentation is complete the painted areas, starting point and
threshold value are saved. If the segmentation needs to be adjusted, the
previously selected areas and values are automatically suggested but can
be altered if necessary.
7.1.3.3 Selecting segmentation method

• To segment the jaw without the 4D Jaw Motion procedure click Jaw
Segmentation button and continue to "Adding anatomical landmarks for
jaw segmentation" on page 191.
• To segment the jaw as part of 4D Jaw Motion procedure, click 4D Jaw
Segmentation and continue to section "Selecting maxillary and
mandibular marker centre points" on page 188.
7.1.3.4 Selecting maxillary and mandibular marker centre points
About this task

Follow these instructions to select maxillary and mandibular marker centre
points from the image.
Steps
1. Click the 4D Jaw Segmentation button.
2. Scroll in the three slice views until the maxillary markers appear on the
image.
The axial view shows the most markers simultaneously.

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Use the scroll bars to move up or down in the slice views.

3. Click at the centre of any of the markers.
You have hit the centre of the marker when its outline is consistent with
the pink outline of the marking tool.
NOTE
After a centre point has been indicated by the user, the software
automatically calculates the optimal position. This calculation can take
several seconds. Click on the next point only after the added centre point
appears on the screen.

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To unselect a centre point, hover your mouse over the marker. When the
marker colour turns solid, click anywhere inside the marker.
If a marker cannot be selected, click the same marker in another slice
view.
• If it still cannot be selected or if it is positioned partly outside the
image, or to fine-tune its position, click the centre point of the marker
while holding down the Alt key.
4. Continue to place all five maxillary markers.

5. Mark the centre points of all mandibular markers in the slice views as
with maxilla markers.
The mandibular markers appear in green.
6. When selection is complete, either continue:

• with segmentation by clicking the arrow button and proceeding to
section "Adding anatomical landmarks for jaw segmentation" on
page 191.
• without segmentation by clicking Skip Jaw Segmentation.
The Jaw Motion module opens but the models are not shown on the
screen. However, you can follow the marker movements in the 3D
view and preview windows. This option is useful for reducing patient
time.

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NOTE
In order to visualise the jaw models in the Jaw Motion module, complete
the segmentation
7.1.3.5 Adding anatomical landmarks for jaw segmentation
About this task

Anatomical landmarks are added to roughly paint red the areas that belong
to the lower jaw and connect with the upper jaw, i.e. the condyles and the
lower teeth.
Before any landmarks have been added, Condylion Left is selected on the
list, i.e. highlighted with the blue colour.
Follow these steps to add landmarks.
Steps
1. Click on the image to place the Condylion Left landmark.
To better view the area where to add the landmark, use the scroll bar
next to the slice view.

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The condyle is painted red and the landmark name turns grey. The next
landmark is automatically selected on the list.
To change the location of the landmark, reselect the landmark from the
list and click on the image.
2. Repeat the step for Condylion Right.
3. Define the occlusion plane by placing the right, front and the left
occlusion points in the upper jaw.
Click on the 3D rendered view to place the landmarks. The skull will
be turned automatically to view it from the right, front or left when the
corresponding landmark is selected on the list.
Make sure the right and left points are as far back and the front point as
far front as possible.
Once the landmarks have been placed, the lower teeth are painted red.
4. Click the arrow button to continue.
What to do next
Continue to section "Fine-tuning painted areas" on page 192 .
7.1.3.6 Fine-tuning painted areas
About this task

Using a paint brush tool, manually fine-tune the segmentation. Check and
paint the condyles and the lower teeth red.

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Fine-tuning is in general not required for surgical planning.
Steps
1. Check and fine-tune the paintings of the condyles.
• Paint an area to include it to the lower jaw.
• Use the scroll bars to move in the slice views.
• Adjust the size of the brush tool by holding down the Alt key while
scrolling with the mouse wheel.
• Erase painting using the right mouse button. To erase the entire area
click Clear.
• If necessary, click the Expand button on the top right corner of the
slice views.

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2. Check and fine-tune the paintings of the lower teeth.

Slice through the occlusion so that only the lower teeth are painted red.
3. Click the arrow button.
What to do next
Continue to section "Selecting starting point for region growing" on page 194
below.
7.1.3.7 Selecting starting point for region growing
About this task

Follow these instructions to select a starting point for region growing.

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Steps
1. Click on the lower jaw on an area of high bone density.
Using the starting point and the painted areas, the software will now
segment the jaws. The upper jaw will be painted pink and the lower jaw
green.
The image on the left shows an example of good seed point and the
image on the right of inadequate seed point.
2. Click the arrow button.
What to do next
Continue to "Adjusting threshold value" on page 195.
7.1.3.8 Adjusting threshold value
About this task

Adjust the HU-value threshold for the segmentation.

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Steps
1. Adjust the slider to select threshold value.
The image in the middle presents an example of a good threshold
setting.
• If the value is set too low, as on the image on the left, the jaw
segmentation fails.
• If the value is set too high, as on the image on the right, some bone
surface may be lost.

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All data above the selected threshold value (Hounsfield unit) is included
in the segmented jaw bone surface. Automatic segmentation starts after
adjusting the slider.
NOTE
If you continue to Surgery module after segmentation, use as low values
as possible to retain as much information as possible.
NOTE
If the threshold is set too low, the mandible segmentation can extend to
maxilla.
2. Select appropriate option:
• Click Finish to complete the segmentation.
• Click the arrow button to proceed to cleaning the jaw models.
Proceed to section "Cleaning jaw models" on page 197.
7.1.3.9 Cleaning jaw models
About this task

Using a paint brush tool, manually define the areas to be removed from the
upper and lower jaw models.
Steps
1. Define the areas to be removed from the upper jaw model.
• Paint an area to remove it.

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• Adjust the size of the brush tool by holding down the Alt key while
• Rotate the model using the right mouse button.
Use these buttons to redo/undo previous brush stroke or to revert to

original models.
2. Click the arrow button to repeat the same for the lower jaw model.
3. Click Finish.
Results
The jaw models will be shown in Explorer module or opened in Jaw Motion
or Surgery module depending on the selected segmentation type.
NOTE
It is the responsibility of the user to ensure that the created models
represent the patient’s anatomy and therefore suitable for further analysis
and planning.

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What to do next
Continue to "Surgery module" on page 343 or "Jaw motion module" on page
401.
7.1.3.10 Extracting airways
About this task

Follow these instructions to extract airways.
Steps
1. In the Sagittal view drag the image so that the cross-hairs are
approximately in the middle of the airways.
2. Click the Extract airways button in the Adjust tools group.

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3. Start drawing a line by clicking along the middle of the airway.
4. Click Done.

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The airways shown in all views with the axial plane in the rendered view.
5. Click in the middle of the airway.

A yellow circle appears on the narrowest portion of the airway.
• To move along the airway drag the yellow circle in the middle of the
airway.
The views are updated and e.g. in the axial view the cross-section
surface area is visualized.
• To fine-tune the airway, select it in the object browser.

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The activated airway is marked with green square.
• To adjust the form of the airway and re-perform the extraction, delete
the airway from the object browser and start from the beginning.
• To readjust the segmentation threshold, select the airway and click
the Extract airways button in the Adjust tools group.
Click Redo to recalculate the segmentation.
To draw a new airway, deselect the current airway and click Extract
airways.
To adjust e.g. the form of the spline, delete the airway from the
object browser and re-start the segmentation.
7.1.3.11 Tooth segmentation
About this task

Tooth segmentation is used to segment one tooth or several teeth from
CBCT volume. All segmented teeth are numbered and can be exported as
STL files.
NOTE
Tooth segmentation is best suited for volumes with voxel size between
150-200um.
Tooth segmentation is done as follows.
Steps
1. Click the Tooth Segmentation tool.

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2. Select the tooth from the chart.
3. Orientate the 2D planes parallel to the tooth axis by holding down the
Ctrl key and click on the centre of the tooth.
To rotate the planes parallel to the tooth, hold down the Ctrl key while
dragging with the right mouse button in Sagittal and Coronal views.

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4. Paint by dragging with the left mouse button e.g. first in sagittal and then
in coronal view.
Fine-tune by scrolling along the tooth axis in axial view.
For best fitting, use the slice views. Disable the Zoom tool to scroll
through the slices using the mouse wheel.
Decrease the size of the paint brush by holding down the Alt key while
scrolling the mouse wheel.

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Use the viscosity slider to adjust the way the paint fills the tooth:
• With 0% viscosity only the area inside the brush is painted
• With 100% viscosity a large area around the brush is painted.
To remove paint from unwanted areas use the right mouse button.
5. When done, click Finish on the Tooth Chart.

To centre the views on another tooth repeat the process from step 2.
The segmented teeth show in Object Browser under Upper and Lower
teeth.
When clicking the implants or segmented teeth in the Explorer module,

in the 2D views or in Object Browser, the views are focused on the
clicked implant or tooth.
What to do next
For exporting, select Include segmented teeth option, see section "Exporting
volumes" on page 440 for more information.

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7.1.3.12 Fitting digital dental model in stl file format onto image
About this task

Follow these instructions to fit a digital dental model in stl file format onto
image.
NOTE
It is recommended to capture CBCT in open bite using a cotton roll or other
positioning aid to make the fitting easier.
NOTE
For best cross arch accuracy use full arch intraoral scan.
Steps
1. Open the image on top of which to fit a digital intraoral scan or a model
scan of impression.
2. Click Fit model.
To fit a model,
• not yet stored in Romexis, select Browse.
• already stored in Romexis, click Select.
3. Position the CBCT volume and surface model to parallel positions with
the following tools.
• setting Direction

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• cropping anatomy used for fitting with Set Crop sliders
• setting Threshold for CBCT rendering bone surface for better

visualization and removal of artefacts
• Rotate by dragging with the right mouse button

• Pan/move the surface model by dragging with the right mouse
button.
• Pan/move the CBCT volume by dragging with the middle mouse
button.
• Zoom in/out by scrolling the mouse wheel.
4. Place a point on the dental model image by clicking on the model.

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5. Add the same point on the CBCT image by clicking on the corresponding
area.
Place at minimum three points. For best possible fit, place the points as
far away from each other as possible.
• If you need to reposition a point click the arrow button on top right
corner to remove the point and then replace it.

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6. Place a point on the dental model image by clicking.

7. Add the same point on the CBCT image by clicking on the corresponding
area.
TIP
Be aware of teeth with artefacts on the CBCT image.
NOTE
Do not place points on soft tissue or gingiva, as they do not show clearly
on CBCT images.
TIP
Adding more than three points does not improve the fitting when using
Fine Tune Match option, which is recommended usually giving best
result.
NOTE
If there is hardly any common surface on the CBCT and model deselect
Fine Tune Match and place more than three points. The model is placed
based on these points.
The first three landmarks are indicated with:

• 1st landmark: red sphere
• 2nd landmark: green cylinder
• 3rd landmark: blue cube
When the number of points on the lower right corner is highlighted in
green the placing is accurate.
8. Select whether to use the options Allow scaling and Fine Tune Match.
• To scale the 3D model to match with the landmark distances in the
rendered volume, select Allow scaling (off by default).
• If fitting with Fine Tune Match is not successful, select either Use
Automatic Match or retry the fitting.
9. Click Done.

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10. Check the fitting result.

• The soft tissue in the model shows in red as the surfaces in the two
models are not equal.
• The crown surfaces appear similar and in even green colour.
• If satisfied with the result, click Use Automatic Match.
• To fit with a different set of landmark points, click Retry.
The dental model is now fitted with the CBCT data.
11. Repeat the steps for fitting the upper model or predesigned crowns.
The upper model is automatically fitted to the upper jaw and the lower
model to the lower jaw but if necessary, the fitting can be reversed.
• If the models were created or exported with same coordinates an
existing match is found and you can select Use Existing Match.
• However, if, for example, the CBCT was taken mouth open and
the upper and lower models are in bite the models cannot be fitted
correctly.
NOTE
Always check the automatic match.

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If necessary, refit the models manually with 3 points as described

above.
When both the lower and the upper model have been fitted, they appear
in CBCT data in the Object Browser under Fitted models.
12. Verify that the models are linked to correct jaw by showing and hiding
them using the eye button.
• The lower model to the lower jaw: the arrow in front of the model is
pointing downwards.
and
• The upper model to the upper jaw: the arrow in front of the model is
pointing upwards.
NOTE
If necessary, you can change the linked jaw from upper to lower or lower
to upper by clicking the arrow in front of the model.
What to do next
For instructions on renaming, changing colour or deleting models, see
section "Object Browser" on page 233
7.1.3.13 Selections
Allow Scaling

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When enabled, the surface model is stretched to better fit with the CBCT
volume.
NOTE
This option may alter proportions of the surface model.
Fine Tune Match

When enabled the software prompts the user to verify the fitting with the
deviation map.
When disabled, the deviation between control points in each data is
minimised to get the closest fit with no additional analysis.
When enabled, the anatomy around each control point is analysed and the
actual anatomy is used for best possible fit.
• To accept the automatic fitting result select Use Automatic Match.
• To readjust the fitting select Retry and replace the points using the Undo
function on the top right corner of the dialog and when satisfied click Use
Automatic Match.
Import without matching

When enabled the model is imported but not matched.
Type
Select whether to import dental model or crown. This choice will separate the
two model types in object browser under Fitted models group.
The crown will be automatically placed into the exact same area where
it was placed in the crown planning software if the proposed option Use
existing match is selected.
Lower/upper jaw
Select whether to import the model for lower or upper jaw or leave
unspecified.

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Adjusting positioning of fitted STL surface models

To adjust a fitted model, check that it is not locked in the Object browser:
• when unlocked the model shows in white
• when locked the model shows in light grey
Moving models with mouse

In sliced views
• Check that the move/rotate tool is inactive and drag with the left mouse
button.
In rendered view
• Drag with the left mouse button
Rotating models with mouse

In sliced views
• Check that the move/rotate tool is inactive and drag with the right mouse
button.
In rendered view
• Drag with the right mouse button while holding down the Ctrl + Shift keys
Adjusting positioning of models in Properties dialog

Click on the wrench button on the row.
Select the Move tab in the dialog that opens.

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To adjust the rotation (in degrees) or the translation of the fitted model in all
three dimensions enter the value into the field or click the arrow buttons.
You can also change the rotation angle using the slider.
The models are moved in millimetres (between -100 and +100) in relation to
the coordinates of the models.
The model rotates around its x- y- and z axis between -180 and + 180
degrees.
If the dialog is reopened after having made these changes all values are
reset to zero.
To reset the fitted model to the position in which it was fitted with Fit Model
tool, click Reset to original position.
7.1.4 Annotation
Annotation tools can be used to add text annotations and measurements on
3D slices as well as segment specific areas in images.
All added annotations including region growing results are stored as saved
views.
7.1.4.1 Measure length
About this task

Length can be measured as follows.
Steps
1. Click Measure length and select Single measurement or Polyline
measurement.
(Use long mouse press to select between Single measurement or

Polyline measurement).
2. Draw a measurement line by dragging with the left mouse button.
The measurement label can be moved freely on the image (unless
disabled in the default settings). Fix the label in place by clicking.
Results
The measurements are stored as saved views.
What to do next
TIP
To view the saved measurements, click the measurement in the Object
browser.

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To select colour for measurements, see section "Setting colour for

annotations and measurements" on page 105
7.1.4.2 Measure angle
About this task

Angle can be measured as follows.
Steps
1. Click Measure angle.
2. Draw a line on the image.

3. Release the mouse and click on the image to mark the second line.
Results
The lines are combined, and the measurement appears on the image and in
the object browser.
7.1.4.3 Add text
About this task

Add text as follows.
Steps
1. Click Add text.
2. Click on the image where to add the annotation.

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3. Enter the annotation and click OK.
7.1.4.4 Draw arrow
About this task

Draw arrow as follows.
Steps
1. Select Draw arrow tool.
2. Click on the image to indicate a point of interest.

3. Enter text and adjust the location of the label if necessary.
7.1.4.5 Draw rectangle
About this task

Create a rectangle as follows.
Steps
1. Select the Draw Rectangle tool.

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2. Click and drag on the image.
NOTE
All area and volume measurements also display ROI statistics for the
specified shape.
7.1.4.6 Draw ellipse
About this task

To draw an ellipse:
Steps
1. Select the Draw Ellipse tool.
2. Click and drag on the image.
7.1.4.7 Measure cube
About this task

Use this tool to measure a cubic area in the image.
Steps
1. Select the Measure Cube tool.
2. Draw while holding down the left mouse button.

To draw an ellipsoid of same size in all views, hold down the Ctrl key
while drawing.
7.1.4.8 Measure ellipsoid
About this task

Use this tool to draw and measure an elliptic area in the image.
Steps
1. Select the Measure Ellipsoid tool.
To draw an ellipsoid of same size in all views, hold down the Ctrl key
while drawing.
7.1.4.9 Region growing tool

The region growing tool can be used to segment a region with uniform
density (grey scale values) in 3D image.
It works best in areas where there is a distinct border in between the
anatomies e.g. air and soft tissue or soft tissue and bone. It can be used
e.g. to estimate volumes of sinus lifts, to determine the amount of bone or
soft tissue in the defined area or to measure the dimensions of an airway

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or root cavity. The volume is calculated based on grey scale values in the
image using the threshold value and the seed point specified by the user.
The measured volume is displayed in cubic centimetres in a ROI info box.
The area of region cross section is shown in each slice view in square
millimetres.
NOTE
The region growing result can only be modified when its bounding 3D
measurement is parallel to a slice view. This is reached easiest by restoring
the original REGION measurement view from the Select View list. If the
bounding 3D measurement is displayed in dotted line it is not parallel and
cannot be modified.
To toggle between minimised/maximized state of the ROI info box double-

click on it.
7.1.4.10 Defining region growing area
About this task

Define the region growing area as follows.
Steps
1. Measure cube or ellipsoid.
2. Click 3D region growing tool.
3. Select the suitable preset (bone, soft tissue or root tissue) to determine
the amount of bone in the area in question.

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4. Click inside the measured cube or ellipsoid.

5. Check the result and if necessary, adjust the threshold value in the
Settings dialog.
6. Click Redo to calculate new result.
What to do next
To modify an existing region grow result; double-click on its 3D
measurement to open the Settings dialog and to change its size.
7.1.4.11 3D region growing settings
Presets
There are four presets for the region growing tool:
• Bone for determining the amount of bone in the area in question
• Soft Tissue for measuring the amount of soft tissue
• Air cavity for measuring the dimensions in the air cavity
• Root cavity for measuring the dimensions in the root cavity
Threshold
Voxels with values differing (either higher or lower) from the seed point less
than the Threshold setting are included in the region.
Solid color
Choose the solid color that should be used to highlight the shape of the 3D
region.
Coloured by area
Choose and adjust the colour range that should be used to highlight axial
areas in the 3D region. This option can be used to colour an airway so
that narrowest passages with smallest area will be highlighted in red for
example. After the region grow has been executed the exact slice specific
area measurement (in square mm) will be shown in each axial, sagittal and
coronal slice respectively.
Additionally minimum and maximum axial areas will be shown above the
color bar in the Region Grow dialog.

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7.1.4.12 Advanced options
Pre-smooth data
Use this option to filter voxel data before region growing for less noisy result.
NOTE
This setting may cause very small features to be lost.
Always include lower

Include voxels with values lower than the seed point value in the region
regardless of the threshold setting. Use this setting for segmenting air
cavities.
Always include higher

Include voxels with values higher than the seed point value in the region
regardless of the threshold setting. Use this setting for segmenting bone.
Post-smooth region grow result

Use this tool to remove noisy voxels from the region grow result. This setting
may cause very small features to be lost.
NOTE
The settings Always include lower / higher should not be used together since
this selection would always include whole volume in the result.
Use local threshold / local threshold scroll bar

This setting is useful for segmenting areas with slow gradients, if the current
voxel value is outside of the Threshold range but very similar to the previous
neighbouring voxel included in the region (difference is less than the Local
Threshold setting).
This setting prevents false contours in the segmentation result caused by
slow gradients.

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The following are examples of region growing results.
The following measurement are shown in the images:

• Vol: volume of the ellipsoid/cube
• w,h,d : width, height and depth of the ellipsoid/cube
• Avg: average HU value in cube/ellipsoid
• StdDev: standard deviation of HU values in cube/ellipsoid
• R: [minimum HU value in cube/ellipsoid, maximum HU value in cube/
ellipsoid]
• Region vol: region volume
• Area: region area in the current slice

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7.1.4.13 Free region growing tool
About this task

The free region growing tool can be used to approximate the area and
volume of a freely selectable region. It can be used e.g. for evaluating shape
and volume of areas that cannot be differentiated of their surrounding areas
by the greyscale values.
The software calculates the volume based on the defined outlines. The
measured segmented volume is displayed in cubic centimetres in a ROI info
box. The area of region cross section is shown in each slice view in square
millimetres.
NOTE
The result cannot be modified after the region has been created.
To toggle between minimized/maximized state of the ROI info box double-

click on it.
Steps
1. Click Free region growing tool.
2. Define a region by clicking on 2D view and complete by double- or

right-clicking.
3. Move in the view’s slices and draw at least another outline.
The outlines will act as the limits for the measurement. The area
between different outlines is interpolated.
NOTE
The outlines for one segmented area can be drawn only to one view.

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The outlines are listed in the manual segmentation tool dialog and each
outline can be edited and deleted until the region is created. The number
for each outline represents the slice number where the outline has been
drawn.
4. When finished click Create region.
7.1.5 3D Rendering
The 3D rendering tools are intended for adjusting the rendered volume.

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Hold down the left mouse button and drag to rotate the rendered volume.
To move the volume press the mouse wheel or hold down the left and right
mouse buttons while dragging the image.
To re-centre the rendering right-click on the new centre point.
To slice or de-slice the volume, use the slider on the rendered view. You can
also slice the volume by holding down the Shift key and dragging with right
mouse button.
When in the default non perspective mode, hold down the right mouse
button and move the mouse up and down to produce a slicing effect in which
the anatomy is sliced out as you move the mouse up. This effect can be
used to slice of thin layer of the anatomy or to clear obstructing anatomy
from the view for example.
7.1.5.1 Setting 3D rendering contrast, brightness, cut-off threshold and transparency

To adjust 3D rendering contrast, brightness, cut-off threshold and
transparency move the 3D rendering sliders. Hard tissue must be selected
from the drop-down menu to change the values for 3D rendering.

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1 Contrast
2 Brightness
3 Cut-off threshold
4 Transparency
7.1.5.2 Selecting 3D rendering preset
About this task

Select a suitable 3D rendering style as follows.
Steps
1. Click the Set Rendering Options icon on the rendering view toolbar.
2. Select the suitable rendering style.

• MIP (Maximum Intensity Projection)
• X-ray
• X-ray shaded (default)
• Shaded
• Shiny
• Surface
• B&W (Black & White) X-ray
• Soft tissue
The selected style thumbnail is circled in white.
To create a new rendering style with the selected adjustments, click Add
and name the rendering style.
To delete the selected preset, click Del.
If Preview is deselected, the rendered volume remains unblurred also
while being turned and zoomed in.
Select BG to change the background colour for the 3D rendering.

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To set a new default rendering style, right-click on the desired style and
select Set as default preset.

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To change the resolution of the 3D rendering, click on the current

resolution and select a new resolution from a drop-down list.
TIP
For more information on 3D rendered texture quality, see section “Local
settings” in the Planmeca Romexis technical manual.

7 3D module
7.1.5.3 Adjusting levels for 3D rendering

If the default adjustments of the 3D volume rendering are not satisfactory,
the adjustments can be done manually.
NOTE
The following settings are only applicable to 3D rendering. For the other
levels adjustments see section "Adjust levels" on page 180.
Adjusting threshold
The black line increases or decreases the threshold and consequently has
the same function than the slider Set 3D rendering cut-off threshold.
Adjusting pseudo colour

The gamma value buttons F and R modify the pseudo colours.
The F fits the colour range to the different grey values present in the image.
The R button resets the pseudo colour settings.
To manually adjust the position and range of a specific pseudo colour drag
the handles above the histogram to left or right.
To change the colour of a specific range, double click on its handle to show
the colour picker.
To select ready made colour maps for 3D rendering click the arrow button.

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7.1.5.4 Rendering orientation tools

The rendered volume view has three coloured planes indicating the coronal,
sagittal, and axial planes. These planes help you in orienting the three slice
views in relation to the 3D rendering and actual anatomy. The planes can be
shown/hidden by pressing the corresponding buttons at the right side of the
rendered volume views as follows:
Show/hide annotation overlay

Shows/hides annotation overlay in rendered view only.
Show sagittal plane (red)
Show coronal plane (green)
Show axial plane (blue)
Show/hide all planes
Show/hide volume boundaries

3D volumes are by default surrounded by a volume boundary box that may
in some cases help in orientating the 3D volume.

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Show/hide perspective in 3D rendering

To turn on linear perspective that provides a more natural view of the
anatomy click this button. By default the rendering is shown in an isometric
style that has no perspective effect.
7.1.5.5 Rendering enhancements
Rotate light direction

Available only in Surface style rendering.
Smoothing
Applies a smoothing filter on the 3D rendering.
Enhanced depth
Applies depth perception enhancing filter on the 3D rendering view.
7.1.5.6 Soft tissue overlay
About this task

The soft tissue overlay can be used to enhance the informative value of the
3D rendering e.g. by colouring the soft tissue and airways as follows.
Steps
1. Click the Show soft tissue tool.
2. Make adjustments.
Adjust transparency and threshold from the sliders as follows:

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• Transparency – Specify the level of transparency of the overlay

against the rendering.
0% is for fully opaque and 100% for fully transparent.
• Threshold – Specify the grey-scale value to be colourized (0 - 4095).
To view the outline of the soft tissue click the Show soft tissue outline
button.
The soft tissue positioned in relation to bone is shown.

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In this image only the soft tissues are shown. The volume has been cut
in order to show the intra-cranial air cavities.
To select soft tissue colour click Select Soft Tissue Color and select the
colour from the appearing colour map, for more information see section
"Object Browser" on page 105.
7.1.5.7 Clean rendering

The Clean Rendering tool can be used to clean artefacts or for creating
cutaways in the 3D rendering.
To remove material drag with the left mouse button on the image.
To adjust the size of the removal cursor, hold down the Alt key while
To rotate the 3D rendered model while the tool is active drag with mouse
right button.
To undo the latest change click Undo, to redo it by click Redo.
To revert the rendering to the original state click Revert. The revert
command works even after having closed and reopened the patient.

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The object browser shows all elements added to the image including
annotations, nerves, implants, fitted models, segmented teeth, views and
ProFace.
The object browser can be scrolled up and down with mouse wheel or using
the arrow buttons. All the subgroups can be collapsed by double- clicking the
group title.
Annotations and views shown depend on the current module/view, other
objects are the same for each module/view.
The elements in the object browser can be controlled separately by checking
the box next to the desired element. To select all elements in the group (for
example all annotations) check the box on the Annotations title row.
The element activated on the volume shows in bold in object browser.
Selecting an annotation, a nerve, implant or fitted model in object browser
activates it in all the views as well.
When an annotation or view is selected from object browser the orientation
of the volume is restored to the view where the annotation was added or
the view saved. When an implant or segmented tooth is selected from object
browser the 2D views are centred to that object.
7.1.6.1 Object browser tools

The tools on object browser can be used to
Show/hide an item or a group of items on images.
Delete selected item.
Change colour of items in a group. To change colour of a single object click

the colour box next to the object.
Check/uncheck the box to select/deselect items
Opens properties dialog

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Locks the selected objects. The locked objects cannot be activated or

moved in the image. The locked objects shown in grey in Object Browser.
Fitted models, implants, fixation pins and segmented teeth can be locked
one by one. To lock an object check the object and click the lock icon.
7.1.6.2 Object browser groups
Annotations
Shows length and angle measurements, added texts, arrows, 2D and 3D
ROIs, regions and free regions of selected module sorted by the views.
When an annotation line is clicked in the object browser the corresponding
annotation is set visible by restoring the 2D slice views to the view where the
annotation was created.
Segmented teeth
Shows segmented teeth in all modules. The segmented teeth are
automatically divided into upper or lower teeth groups in Object Browser.
In the Explorer sub-module when clicking on implants or segmented teeth in

2D views or Object Browser, the 2D views are automatically focused on the
clicked implant or segmented tooth.
Nerves
Shows nerves and tooth nerves added in Implants module in all modules.
The value shown is the diameter of the nerve.

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Implants
Shows in all modules the implants and crowns added in the Implants sub-
module. The abutment and/or sleeve attached to the implant are shown
below the implant. The values in the first row are product line and model
and in the second row catalog diameter, catalog length and comment. If
the implant library is not updated to version 4.0 the old diameter and length
values are shown. An implant/crown can be activated by clicking.
In the Explorer sub-module when clicking on implants or segmented teeth in
2D views or Object Browser, the 2D views are automatically focused on the
clicked object.
To hide a single implant click on the eye icon of the implant you want to hide.
To lock an implant check the implant's check box and click the lock icon.
To align implant(s) check the implant's check box and click the alignment
icon. See section "Adjusting slices in implant centric view" on page 266 for
further information.
Group implant with crown
To group an implant with a generic crown, select both items in the Object
Browser by checking the boxes, and click on the chain icon in the upper bar
of the group. Grouped implant and crown can be moved together.
Fixation pins
Shows in all modules the fixation pins added in the Implants sub-module.
Implant guides
Shows implant guides added in the Implants sub-module in all modules.

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Fitted models
Shows the imported crowns and dental models in all the modules. Click on a
model to activate it.
The arrow next to the model indicates whether the scan belongs to the upper
or lower jaw. Click on the arrow to change the indication.
The crown/dental model division can be defined in the Fit model dialog see
section "Fitting digital dental model in stl file format onto image" on page
206 .
Views
Shows the saved views. Clicking on a view element restores the 2D slice
views to where the view was saved in.
ProFace

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Select colour for ProFace profile line showing in 2D slice views.

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7.2 Panoramic module

In the Panoramic module panoramic images can be generated from the 3D
volume data and adjusted.
TIP
On how to scroll panoramic, sagittal and axial layers, see section "Toggle
zoom/layer browsing" on page 179.
TIP
On how to print and export current views, see sections "Printing images" on
page 125 and "Save 2D snapshots" on page 427.
The image range, thickness and panoramic curve can be defined.
7.2.1 Panoramic
7.2.1.1 Draw panoramic curve
About this task

Panoramic curve can be drawn as follows.
Steps
1. Click Draw panoramic curve.
2. Draw curve by clicking on the axial view.

• To add a point between two points, hold down the Ctrl key and click
between them.
• To remove a point, hold down the Ctrl key and click on any of the
added points. The cursor changes into a pen with a minus sign.

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3. Complete the curve by right-clicking.
Results
Panoramic curves are saved and can be viewed by clicking Select
panoramic curve.
7.2.1.2 Delete current panoramic curve
About this task

Delete the currently displayed curve as follows.
Steps
1. Click Delete current panoramic curve
The standard curves (see section "Select panoramic curve" on page

240) are not deleted.
7.2.1.3 Edit panoramic curve
About this task

To edit a panoramic curve:
Steps
1. Click Edit panoramic curve.
2. Edit the curve by:

• dragging points on the curve using the mouse.
• moving curve by dragging between points.

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• adding new points by holding down Ctrl key and clicking between
points or at the end of the curve.
• deleting points by holding down the Ctrl key and clicking on a point.
A minus on the cursor indicates removal.
3. Finish by clicking Edit curve.
7.2.1.4 Select panoramic curve
About this task

To view a list of all panoramic curves:
Steps
1. Click Select panoramic curve.
The curves are saved and named according to their date and time of
creation.
2. Select curve from the list.
3. Re-click Edit curve to show the curve on image.

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7.2.1.5 Panoramic autofit
About this task

This tool is best suited for volumes with dental arch.
To add a panoramic curve (focal layer) on the volume:
Steps
1. Click Panoramic Autofit.
Results
The occlusal level is identified, and the panoramic curve placed on the
dental arch.
The Panoramic Autofit tool also adjusts the maxillary and mandibular ranges
of the panoramic view so that they resemble typical panoramic image
dimensions.
TIP
For manual adjustment, see section "Define data range" on page 247.
7.2.1.6 Panoramic autofocus

Panoramic autofocus shapes the panoramic layer so that it follows the
anatomy of CBCT image in all three dimensions and creates a clear
overview of the whole denture. When used with the Panoramic auto-fit tool, a
detailed panoramic view can be generated.
The view on the left shows the image without, and the view on the right with
autofocus.
NOTE
The neighbouring panoramic slices may seem identical when the tool is
used.
7.2.1.7 Changing rendering mode and layer thickness of single slice
About this task

The rendering mode and layer thickness of a single slice can be changed as
follows.

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Steps
1. Right-click on top of the slice you want to adjust.
2. In the opening menu adjust the slice thickness by moving the slider.
3. Select the desired rendering mode from the drop-down menu.
7.2.1.8 Rendering settings
About this task

The settings of a panoramic slice can be adjusted as follows.
Steps
1. In the 3D rendering menu select the desired panoramic slice.

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2. Use the rendering adjustment sliders to adjust the appearance of the

selected slice.
NOTE
Only the rendered slices are shown on the list.
7.2.2 Adjusting panoramic slices
NOTE
These settings apply to all panoramic layers and override all other settings.
7.2.2.1 Panoramic curve radius
About this task

The radius of the panoramic curve can be adjusted as follows.
Steps
1. Scroll the bar on the right side of the panoramic view.
Results
The panoramic curve shifts on the dental arch inwards or outwards and the
panoramic view is automatically updated.
7.2.2.2 Adjusting panoramic layers
NOTE
These settings apply to all panoramic layers and override all other settings.

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TIP
To adjust a single slice, see section "Changing rendering mode and layer
thickness of single slice" on page 241.
To adjust the number of panoramic images, layer thickness and the distance
between the layers, click the Show viewport settings icon on the top right
corner of the panoramic view.
To set the layout for all open panoramic slices click the squares on the grid.
7.2.2.3 Rendering modes
About this task

To select the rendering mode:

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Steps
1. Click Rend mode and scroll to the desired rendering mode.
NOTE
The rendered panoramic slices are generated from the middle layer.

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7.2.2.4 Panoramic auto adjustment

Use auto adjustment to enhance contrast and sharpness of panoramic
layers in order to create an image with a closer resemblance to a standard
panoramic image.
7.2.3 Adjust
For defining data range, see section "Define data range" on page 247.
For showing/hiding renderer, see section "Show/hide renderer" on page 247.
For other tools in Adjust group, see section "Adjust" on page 246.

7 3D module
7.2.3.1 Define data range
About this task

The data range can be defined as follows.
Steps
1. Click Define Data Range.
2. Define the area of interest using the sliders.

Use the left slider to adjust the area from above and the right slider to
adjust from below.
7.2.3.2 Show/hide renderer

Click to show/hide 3D rendered view.
7.2.3.3 Panoramic default settings
About this task

The panoramic default setting can be adjusted as follows.
Steps
1. Click the Default settings button.
2. In the Panoramic tab, select the overlays to show / hide.

other views.
You can show/hide the following overlays:
• Rulers (centimetres)
• Rulers (millimetres)

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• Values. Views with multiple images are separated with labels in other
views.
• Axial Line - Focus line
• Secondary axial lines
• Sagittal Line - Focus line
• Secondary Sagittal lines
• Panoramic Line - Focus line
• Secondary Panoramic lines
• Panoramic contour
• Panoramic autofocus line
• Panoramic autofocus layers
3. When finished click Close.
Results
The ruler (circled in green), values (circled in blue), panoramic lines (orange
arrow) and panoramic contour (brown arrow) are set visible.
In the sagittal view the thickest of the red lines (number 2) is the focus line
and the thinner ones are secondary lines.

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In this example the panoramic autofocus line is coloured in magenta and the
autofocus layers in cyan.
7.2.3.4 Slice settings

In the Slice settings field the thickness, distance and grid size for each view
can be adjusted. These settings are applied for currently open, new and
reset images.
7.2.3.5 Adjusting 3D volume rendered view

For more information on 3D rendered texture quality, see section “Local
settings” in the Planmeca Romexis technical manual.
7.2.4 Annotation
For detailed description on Annotation tools, see section "Annotation" on

page 214.

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7.3 Cross sections module

Cross sectional slices can be generated from 3D data.
7.3.1 Cross section tools
Browsing and moving slices

To move the slices to right or left use the scroll bar.
If the option Cross section lines is enabled in user preferences (see section
"Volume reslicer" on page 186), the cross sections will also show in the axial
and panoramic views. The middle section is indicated by a red line and a red
ruler in the cross sections view.
• To move cross sections voxel by voxel, click on the end arrows.
• To move the cross sections freely around drag the scroll box.
• To move cross sections in increments of the distance between the slices
click between the scroll box and end arrows
NOTE
Full Arc mode will modify the behaviour of the cross sectional scroll bar.
7.3.2 Editing dental arch

In the full arc mode the entire dental arch can be specified by the panoramic
curve to be processed as single cross sections. It can be used to create a
printout of cross sections covering the entire jaw.
The differences in editing between the normal and full arc mode are listed in
the following table.
Normal mode Full arc mode

Moving cross sections Free Limited to intra slice
increments

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Normal mode Full arc mode

Printing and 2D Maximum number of All cross sections
snapshots cross section reference reference lines can be
lines shown in Axial shown.
and Panoramic view is Maximum number is
what is currently shown defined by length
in the Cross Section of panoramic curve
browser. and distance between
slices.
Cross section Previous setting is Ordinal numbering is
numbering remembered used by default
Typical use case 3D image diagnostics Complex printouts
done in Planmeca where measurements
Romexis only must be available on all
or most cross sections.
7.3.2.1 Workflow in full arc mode
About this task

Workflow in full arc mode is as follows.
Steps
1. Align volume optimally for best compromise between Panoramic
coverage and Cross Sectional alignment.
No volume re-alignment should be done after this point to prevent
existing measurements from not being shown on Cross Sections.
2. Turn on full arc mode to limit cross sections movement.
This ensures cross section measurements remain visible.
3. Use Save View to restore the selected volume alignment in case volume
needs to be re-aligned between measurements.
4. All cross sections are processed, and measurements added on them
where required.
5. When finished, print them out in multi-page printout.
7.3.2.2 Workflow in normal mode
About this task

Workflow in normal mode is as follows.
Steps
1. Browse and rotate volume freely to detect findings.
2. Use views and measurements to indicate findings.
3. Use saved views to return to findings and measurements when
necessary.

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7.3.3 Adjusting slices in cross sections views
NOTE
Adjustment in Cross sections view will also affect the settings in Panoramic
and vice versa and sagittal or axial rotation of the volume in the Panoramic
view shows in the Cross sections view.
To mirror the cross sections, click this button.
To mirror the cross-sections at the apex of the panoramic curve, click this
button.
Adjusting spacing, width, thickness and number of slices

Click this button on top of cross section slices.
To adjust the spacing (the left-hand slider on the image below), width (the
middle slider on the image below) and thickness (the right-hand slider on the
image below) of the slices, move the sliders up or down.
To define the number of slices, move the mouse cursor over the slices to
select the number of slices (the grid on the image below).
If the section lines are activated (see section "Volume reslicer" on page 186)
the adjustment shows in yellow lines in the axial view. The cross sectional
view is automatically updated.
7.3.4 Adjusting axial / panoramic slices

Click this button on the upper right corner of the axial / panoramic view.

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In the opening dialog the number and thickness of the slices and the
distance between them can be adjusted.
7.3.5 Drawing nerve
About this task

Draw nerve as follows.
Steps
1. Click Draw nerve under Annotation tools.
2. Add points to nerve channel by clicking either in the panoramic or cross

sectional view.
3. Right-click to complete the nerve.

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Results
The nerve channel is displayed as a coloured line in the panoramic view and
as dots of the same colour in the cross sectional views.
7.3.5.1 Nerve properties
About this task

Nerve properties are adjusted as follows.
Steps
1. Click the nerve properties button under Nerves.
In the opening window you can name the nerve, adjust its colour or
diameter.

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2. To adjust the shape of the nerve, select the nerve and drag from the
clicked points.
3. When finished click OK.
7.3.6 Drawing root canal
About this task

Follow these steps to draw a root canal.

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Steps
1. Adjust the view so that the root canal is clearly visible.
2. Select Draw root canal tool on the Annotation tool group.

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3. Start drawing a line by clicking along the middle of the root canal.
If necessary, you can adjust the view while drawing to find the optimum
view to the canal.
4. Finish drawing by right-clicking on the image.

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Results
The root nerve with diameter and length information appears in the object
browser.
7.3.6.1 Root canal properties
About this task

Rename the root canal or adjust its colour as follows.
Steps
1. Click the nerve properties button under Nerves.
In the opening window you can name the nerve, adjust its colour or
change the root canal's diameter by dragging the slide.
2. When finished click Close.
3. To adjust the shape of the nerve, select the nerve and drag from the
clicked points.
7.4 Implant module (optional)
NOTE
Implant module is available on license.
The Implant module provides tools for 3D implant planning.
7.4.1 Step-by-step implant planning
About this task

Step-by-step implant planning explained below.

7 3D module
Steps
1. Click Wizard module on the left and select Implant Planning.
Follow the steps on the wizard to match dental models and digital
restoration designs to CBCT image, create virtual panoramic view, select
implant from library and adjust implants’ position.
2. Click the Open CBCT icon to open the CBCT image (if not already
open).

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3. Click Play to watch the clip and click on the tool on the wizard to map the
digital dental model with the CBCT to create a virtual patient.
4. Use the same tool as in the previous step to match the digital restoration
design(s) with the CBCT.
5. Click Play to watch the clip and click on the tool on the wizard to draw
panoramic curve.
6. Click on the tool and select implant from the library.
Click Add to Plan and click on any 2D view to place the implant.

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7. Click Play to watch the clip and click on the tool on the wizard to adjust
the implant's position in the implant centric view.
The implant is always orientated in the middle of the two perpendicular
images as you position the implant.
What to do next
If needed continue to implant guide design ("Guide design" on page 282).
NOTE
Guide design requires license.
7.4.2 Implant settings
About this task

Implant default setting can be adjusted as follows.

7 3D module
Steps
1. Click this button to open the Default settings view.
Overlay preferences
You can show/hide the following overlay preferences:

• Rulers (centimetre scale)
• Rulers in millimetres
• Values - when view contains multiple images, they are separated
with labels in other views.
• Axial Line - focus line
• Secondary Axial line
• Panoramic line - focus line
• Secondary Panoramic lines
• Panoramic contour
• Panoramic autofocus line
• Panoramic autofocus layers
• Cross section lines
• Secondary Cross section lines
• Show every fifth section – when selected only every fifth layer line is
shown in full length on top of the views. The lines for the rest of the
layers are shown in half-length lines in axial view and in short lines in
panoramic view.
• Panorama referenced / Ordinal cross section labels - when selected,
cross section label represents the distance of cross section from the
start of the panorama curve in millimetres.
• Show implant extension
• Show implant safety area
other views.

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The ruler (circled in green), values (circled in blue), panoramic lines

(orange arrow) and panoramic contour (brown arrow) are set to be
shown.
The thicker blue line (number 2) is the focus line for the sagittal view and
the thinner ones are secondary sagittal lines.
The panoramic autofocus line is shown in magenta and the autofocus

layers in cyan.
Slice settings
In this field the thickness, distance and grid size for each view can be
adjusted. These settings are applied for currently open, new and reset
images.

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Implant adjustments
NOTE
If implant license is missing the Implant adjustments field is hidden
and the Implants module name changes to Cross sections. The implant
related visibility settings are also hidden.
• The default settings for safety distance between implants and

between implant and nerve can be adjusted.
• The default length and diameter of implant extension can also be
adjusted.
Implant safety distance
The implant safety distance indicates when implants are too close to
each other or to a nerve.
The distance between implants or implant and nerve can be defined.
When implants and nerves are placed in a way that their distance is less
than defined, a collision is detected, a warning dialog pops up and the
background of the corresponding elements in the object browser turns
red. Only the part of the implant that is placed inside bone is included in
safety calculations.
The safety area between implants is shown as a transparent cylinder
in 2D projections and in the 3D rendered image. Between implant and
nerve the safety limit is not shown unless collision is detected in which
case it is shown as a dashed line around cylinder in 2D projections.

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In these images, safety areas between the two implants are visible. In
the image on the left the red line around the safety area indicates that
the implant is too close to the nerve.
The safety distance between implants and between implant and nerve
can be adjusted in Default settings dialog, see "Implant settings" on page
261.
NOTE
The implant diameter and the assumed surface are equal to intra-
osseous diameter defined by manufacturer. If the defined diameter is
less than the real diameter the distance between implants or implant and
nerve is less.

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On the left no collision is detected whereas on the right the detected

collision is indicated by the dashed red line surrounding the safety area.
Implant extension length and diameter
The implant extension is an implant-centred and orientated rod indicating

the orientation and position of implant. The default length is 25 mm and
the diameter 2 mm.
For adjusting the visibility, diameter and length of implant extension, see
"Implant settings" on page 261.
7.4.3 Adjusting slices in implant centric view
About this task

The view can be activated to implant centric as follows.

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Steps
1. Click the Implant centric view button.
Implant centric view automatically creates two perpendicular slices of the

implant (or segmented tooth) instead of the normal cross sections view.
The slice on the left side is perpendicular to the panoramic curve (if
defined) and the right side is parallel to the panoramic curve (if defined).

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To view the areas around the implant, rotate the views with the slider.
When moving an implant in any of the slices the implant centric view
adjusts automatically to the new position.
To use implant centric view for another implant or segmented tooth

added to the image click on the implant or tooth in 2D views or in the
Object Browser.
To rotate the slices, use the slider on top of them.
7.4.4 Aligning implants
About this task

Follow these instructions to align implants.
Steps
1. Select the master implant from the views or from Object Browser.
The selected implant shows in bold in the Object Browser.

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2. Select the implant(s) to be aligned using the check boxes.
3. Click the alignment button.
When using custom abutments you need to confirm whether to align

implants by implant body of by abutment extension.
On the left the master implant has been selected and on the right the
alignment result is shown.
7.4.5 Implant tools
Fit model
For detailed usage instructions, see section "Fitting digital dental model in stl
file format onto image" on page 206.
Add implant
Click Add implant tool to place a default implant into the plan. The default
implant can be defined in the Implant library.

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Draw implant
Click Draw implant to sketch an implant matching with patient anatomy.
Click Implant Library and select the nearest matching implant from library.
Implant library
Click Implant Library to select an implant from the library and add it to the
plan.
Click Add.
Align the implant to the anatomy by dragging from the control points. To add
new and to edit current implants, see section "Implant library" on page 272
Implant verification
Opens the implant verification tool, see section "Implant verification" on page
280.
Crown library
Opens the crown library where you can select and edit crowns for specific
implant, see section "Crown library, adding crowns to implants" on page 277
and subsequent sections.
Abutment editor
Select implant and click Abutment editor to add an abutment for the implant.
To modify abutment dimensions, click the up and down arrows, scroll the
mouse wheel or enter the suitable value in the dimension field.
Set rotation angle by dragging the Rotation angle knob.
Click Update existing to update the views in the Implants module.

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Place the mouse over the measurement field, to show a preview of the
measurement, e.g. collar height/diameter or extension length as in the
images below.
Implant guide
For detailed description, see section "Guide design" on page 282.
Implant report
For detailed description, see section "Implant report" on page 292.
7.4.6 Adding implants
About this task

Implants are added as follows.
Steps
1. Add an implant by clicking:
• Add Implant
• Draw Implant
or
• Implant library
2. Click where you want to place the implant.

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3. Orientate the implant by dragging from the control points.

The implant can be added to 2D panoramic, axial and cross-sections
views.
For reorienting in rendered view, hold down the Ctrl+Shift or Alt+Shift
keys while dragging from control points.
To copy or flip the implant, right-click on it.
To change the size or model of the implant open the Properties window
or the Implant library.
4. Verify margins and orientation with Implant Verification tool (see section
"Implant verification" on page 280) and place the next implant.
7.4.7 Implant library

Implant library can be used to search and create new implants and to modify
and replace added implants.
Implants are grouped by manufacturer and implant type. If available, a
preview is shown when clicking on an implant.
NOTE
The implants in the current plan are not affected by changes made in the
library.
New - Create new implant

Copy - Copy the properties of the implant to another implant.
Properties - Edit the properties of the implant. These changes do not affect
implants in the current plan.
Delete - Delete from the library. These changes do not affect implants in the
current plan.
Set default - Set implant as the default implant.
Add to Plan - Add the implant into the current plan. To adjust the size of the
implant, change the size in the Properties dialog.
Replace - Replace the selected implant with an implant from the library. To
change the size of the replaced implant, select size in the library and click
Replace again.
7.4.7.1 Implants with sleeves
About this task

It is possible to create an implant guide for specific sleeves and implants.

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NOTE
Requires implant guide license.
Steps
1. Select sleeves.
7.4.7.2 Set favourites
About this task

You can set manufacturer, product line or implant model as favourite.
Steps
1. Right-click on the implant and select Set favorite.

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To show only the favourites, check the option on the lower left corner.
7.4.7.3 Tooth number for implant
About this task

A tooth number for the implant is added as follows.
Steps
1. Click a tooth on the chart.
Results
The tooth numbers show in Object Browser and in implant report.
7.4.7.4 Create new implant
About this task

Create a new implant as follows.
Steps
1. Click the New button.
2. Enter or select the manufacturer and product line from the drop-down
menus.
3. Enter model, length and diameter.
4. Select colour by clicking the Choose color icon.

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5. Click OK.
7.4.7.5 Fixation pin library

Fixation pins are grouped by manufacturer and product line. If available a
preview of the selected pin is displayed. The fixation pins in the current plan
are not affected by the changes made in the library.
To adjust single pins in the plan, use the Properties dialog or select Replace,
see section "Implant library" on page 272.
On how to create new fixation pins, see section "Implant library" on page
272.
7.4.7.6 Abutment library
About this task

In the abutment library a matching abutment can be added to the implant.
Steps
1. Select the implant in the plan.
The implant is selected when the control points appear on the implant.

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2. Click Implant Library.
3. Select the abutment from the library and click Attach.

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Results
The implant and the abutment can now be moved as single object.
To adjust their properties separately, double-click the implant/abutment.
7.4.7.7 Replacing abutment
About this task

Abutment is replaced as follows.
Steps
1. Select the abutment to replace in the plan.
2. Select Implant library.
3. Select a new abutment.
4. Click Replace.
7.4.7.8 Crown library, adding crowns to implants
About this task

Crowns are added to implants as follows.
Steps
1. Click the Crown library button.

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2. Select the right crown and click Add to plan.
3. Place the crown on any 2D view by clicking.
TIP
The tooth identification system (FDI/ISO or ADA) can be changed in
Planmeca Romexis Configuration application in Regional folder. For
more information, see Planmeca Romexis technical manual.
TIP
To import a specific crown into plan, see section "Fitting digital dental
model in stl file format onto image" on page 206.
7.4.7.9 Replacing crowns in plan
About this task

Replace crowns in the plan as follows.
Steps
1. Select the crown in the plan.
2. Click Crown library.
3. Select a suitable crown and click Replace.

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7.4.7.10 Rotating crowns in plan
About this task

Crowns are rotated in plan as follows.
Steps
1. Select the crown in the plan.
2. Drag the crown with the right mouse button.
7.4.7.11 Adjusting width and height
About this task

Width and height can be adjusted as follows.
Steps
1. Hold down the Shift + Ctrl or Alt + Shift keys while dragging the crown
with the mouse.
Adjust height by dragging up and down and the width by dragging left
and right.
7.4.7.12 Adjusting rotation angle
About this task

Rotation angle can be adjusted as follows.
Steps
1. Select Properties.

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2. Drag the Rotation Angle slider.
7.4.7.13 Library search
About this task

Make library searches as follows.
Steps
1. Select manufacturer, product line, length or diameter from search
options.
2. Click Search.
What to do next
To start a new search, click Clear, select search options and click Search.
7.4.8 Implant verification

Implant verification is intended for verifying the placement of implants and
segmented teeth. To estimate the fit between the implant/tooth and anatomy

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at the site the slice views and average HU-values in the proximity of an
implant/tooth can be used.
In implant verification the views are centred around the current implant/tooth
so that the implant/tooth can be evaluated in relation to the surrounding
anatomy.
When the Verification dialog is opened the currently selected implant/tooth is
automatically shown.
The implant/tooth can be selected and reoriented in Implants module while
working on the Verification tool. Also slices can be re-oriented and the
measurement margins adjusted as illustrated below.
1 Around implant 2 Green cross 3 Red cross section

slice section
4 HU mean values 5 Axial slice 6 HU mean values
outside and inside around implant
implant
7 Select previous or 8 Total mean value 9 Adjust thickness
next implant and standard of measured layer
deviation inside both inside and
and outside outside implant
implant
10 Density colours 11 Density colour 12 Implant colour or
adjustment dialog HU measurement
layer adjusment
7.4.8.1 Visual implant site evaluation
Axial, cross section and envelope slice views

To rotate the cross section views around the implant’s vertical axis, click and
drag with mouse in the axial slice. This allows you to inspect the anatomy
by viewing the green and red cross sections (lines 1 and 2 respectively in
the axial view) and compare them with the overview on the implant Envelope
view.

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The implant envelope ring and the anatomical orientation of the data
(anterior, posterior, left, right) are also shown on the Axial slice.
To move the axial slice plane (blue line) up and down on the vertical axis of
the implant use the mouse wheel. This allows you to view the axial slice at
any level on the implant’s height.
Cross section views

The green and red cross sections (number 1. and 2. on the axial slice) are
slices perpendicular to each other and parallel to the axis of the implant.
They can be used to verify the anatomy around the implant when rotated
using the axial view. The cross sections also show the silhouette of the
implant, axial slice position and orientation (A, P, L, R).
To zoom in and out use mouse wheel on the cross section and envelope
slice views.
Implant envelope view

The Implant Envelope view is a flattened cylinder view of the anatomy on the
implant’s outer perimeter. It allows you to see if any of the implant’s outer
wall would fall on a weaker bone for example instead of having to do with
360 degree rotation of the cross section views. Also the implant apex and
insertion depths (cyan lines) and intersections with the green and red cross
section slices are shown.
Density colours
To enable pseudo-colouring of the data to differentiate different anatomy
densities use this option. With pseudo-colours each gray scale value is
mapped to different colour making the subtle differences between different
values easier to perceive. The colours and their distribution over the gray
scale histogram can be adjusted in the histogram.
7.4.8.2 Statistical implant site evaluation

The HU mean values display the mean value of voxels inside or outside
of the implant in the margin. The margin is specified using the Options
- Measure range outside / inside sliders. The values are shown in a line
graph from top of the implant towards the apex with implant silhouette and
margin thickness references on the right and HU value scale reference at the
bottom.
Under Measurements are shown the mean value totals corresponding to
the vertical lines as well as the corresponding standard deviation values.
By default the outside values are marked in violet and the inside values in
orange. To adjust the colours use the colour chart icon at the bottom of the
Options section.
The bulls-eye chart at the bottom right indicates the distribution of mean HU
values in the outside margin around the implant in the posterior/anterior and
left/right directions.
7.4.9 Guide design
Before you begin
NOTE
Guide design is available on license.

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NOTE
In the US, surgical guides for dental implants is considered medical device.
For information on regulatory status and manufacturing requirements,
contact your local regulatory agency.
CAUTION
Only qualified dentists and dental technicians should design and
manufacture guides. The user is fully responsible for suitability and
application of the designed guide. The user must also be familiar with the
drilling protocols specified by the manufacturer.
CAUTION
The dental model must be of high quality and represent the exact current
situation in the mouth. The minimum recommended resolution for model is
100µm. Check the fitting of the model to ensure the correct positioning of the
guide.
CAUTION
Guide design is to be used with Planmeca Romexis software revision 6.0 or
later with teeth and mucosa supported guides. For recommended workflow,
see section "Designing mucosa-supported guides" on page 290.
NOTE
Before starting, check that the dental model used in design is visible in the
Object browser. Hide the rest of the models by clicking the eye icons.
About this task

Guides are designed as follows.
Steps
1. Click Guide design tool.
Guide design work mode opens.

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2. Set the insertion position by rotating the model considering the undercuts
and click Set Manually.
To use the Planmeca Romexis default position, click Set Automatically.
With fully edentulous cases select Use denture model to create a guide
on top of the mucosa surface to remove the teeth from the model.
NOTE
The inner side of the denture model must correspond to the current
gingival anatomy for the guide to fit in fully edentulous cases.
The guide will not follow the anatomy of the red, undercut areas.
3. Set active area.
The active area is the area on which the implant guide is created. By
default, the active guide area is the whole model. The active area can
be modified by removing sections of it or an entirely new area can be
drawn. The active area is shown on the model with bright colours.
• To draw a new active guide area, click the Draw Guide Area button
and hold down the left mouse button while drawing.
• To remove an area, check the box Remove and draw by dragging
with left mouse button.
• To rotate model, hold down the Ctrl key while dragging with the right
mouse button.
• If the implant is to replace an existing tooth, after setting the active
guide area check the Tooth extraction option.
• To extract a tooth, draw the area to extract on the occlusal
surface by dragging with mouse. Make sure to not draw on the
area above the teeth that you do not want to extract. The location
of sleeve holder and the missing tooth at the time of implant
placement is indicated by the gridded area.
• To remove a part of the active area, mark the area to be
removed by selecting Remove and dragging with the left mouse
button.

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• Start defining the guide area from the beginning, by clicking Reset
Area.
4. Select 3D printer options.

Select the printer from the drop-down menu
or
Select guide thickness and the gap to teeth and sleeve by clicking arrow
buttons or typing value into field.

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By clicking Show 3D printer defaults you can adjust the default printer
settings as well as add new or delete current ones.
NOTE
The preset printer parameter defaults are only suggestions, and they
are affected by printer calibration and on the fit preferences of the user.
Check that you are using suitable parameters.
To add a new printer, click this button.
To delete a printer, click this button.
5. Set sleeve holder parameters (optional).

In case sleeve information is NOT selected during implant planning,
you can define sleeve parameters here. These parameters define the
sleeve holder position and size. The parameters should be defined by
the implant system currently in use.
Wall thickness can be defined by the user as it doesn't affect the fit of the
sleeve. A minimum thickness of 2 mm is recommended.

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• Distance to implant (1)

• Height (2)
• Wall thickness (3)
• Inner diameter (4)
• Drill length (5)
• Handle height (6)
6. Preview the guide.

Select the desired resolution setting from Normal, High and Very high.
The higher the quality, the sharper the details on the guide.
NOTE
The processing time increases with higher quality.
To smooth out the surface, select the Smoothing check box.

Select the Allow Unconnected Parts check box to allow creating a guide
with unconnected parts. The parts can be connected with the Add Bar
function in the next step.
The image below shows a guide with unconnected parts.
Click on the Preview Guide button to open a preview of the guide.

To view the guide alone click on the Show only Guide button. To hide the
guide, click on the Hide guide button. To adjust the visibility of the guide,
use the slider.

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The following image shows the preview guide on the left, and the show
only guide setting on the right.
7. Modify the guide.
To remove material from guide, click Remove Material button and paint
with mouse. You may select between a round and a square shaped
brush tool. When the Limit check box is selected, material is removed
to the depth specified. This way the tool can also be used to create a
window on one side of the guide.
• To resize the paint brush, hold down the Alt key while scrolling the
mouse wheel.
• To rotate the guide, hold down the right mouse button while dragging
with mouse.
• To rotate the model axially, hold down the Ctrl key while dragging
with the right mouse button.

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To add support e.g. for larger guides or unconnected parts, click Add
bar. Click on areas between of which you want to add a bar.
Select the bar diameter from the Diameter menu.
You can add text e.g. patient name to the guide by typing the text to the
Add text dialog and overlaying the dialog onto model. The font size can
be adjusted by zooming +/- the model. You can also determine how high
the text appears on the surface by adjusting the value in the text height
box.
8. Finalize the guide.

To create the final stl model of the guide click the Create guide button.
You can also export the guide as an STL file and create an implant
report PDF simultaneously.
Select Optimize Model for smaller STL sizes and quicker post-
processing.

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The following information appears. Read through the text and if you
agree with the text click the button I have read the above and agree.
Results
The guide will then be saved to Romexis and it will be visible on the volume
and in the Object Browser’s Implant guides category.
What to do next
Click the X-icon to exit the guide design window or click Cancel.
NOTE
If you click the Cancel button, the guide design is not saved.
7.4.9.1 Designing mucosa-supported guides
Before you begin

Before starting the design, prepare the following:
• a metal-free denture or wax-up
NOTE
Check that the denture fits accurately with the current patient anatomy.
If it does not, reline the denture using acrylic resine before taking a 3D
exposure. The guide can only fit as well as the denture, not better.
• 6 - 8 radiographic markers
About this task

Design mucosa-supported guides as follows.
Steps
1. Place the markers to the denture or wax-up.
Make sure the markers are not aligned or on the occlusal plane.
2. Place the denture or the wax-up into the patient's mouth.
3. Take a 3D patient exposure.
For detailed instructions, see your X-ray unit's user's manual.

7 3D module
4. Obtain an STL model for mapping.

Either:
• Take a 3D exposure of the denture or the wax-up and convert it into
STL format (for detailed instructions, see section "Exporting CBCT
volumes in STL format" on page 443).
OR

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• Scan the denture or the wax-up with a lab scanner.
NOTE
A digital prosthetic plan is required even when using a physical
impression or an intraoral scan.
5. Map the obtained STL model with the 3D image of the patient using the
Fit model tool.
See section "Fitting digital dental model in stl file format onto image" on
page 206 for instructions.
6. Plan implants and fixation pins as instructed in the Implants module.
7. Go to Guide design and, if using a denture or wax-up, select Use
denture model to hide the teeth.
8. Follow the guide design steps as instructed above.
7.4.10 Implant report
About this task

Create an implant report as follows.
Steps
1. Click the Implant Report icon.
2. Enter necessary comments or other information if needed.

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3. Browse to the location where you want to save the report and click Save.
Results
The report contains implant and guided surgery kit information for added
implants.

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NOTE
If you are using implant guide module you can create reports while creating
the guide by checking the Export PDF option when finalizing the guide.
7.5 TMJ module
About this task

The TMJ sub-module is intended for viewing and diagnosis of temporo-
mandibular joint regions.
Follow these instructions to use the TMJ module.
Steps
1. Open the 3D image you want to view and click TMJ tab on top of the
screen.
2. Find the condyles from the axial view and rotate the volume if needed.
3.

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Draw the left and right PA line to axial view.
Enter the centre point and drag downwards.
4. Click Define data range in Adjust tools.
5. Adjust the range by dragging the sliders and click OK.
6. Click the Viewport settings icon and adjust the slices.
7.5.1 Synchronise sides
About this task

Enable / disable synchronisation of left PA line with right PA line as follows.

7 3D module
Steps
1. Click Synchronise.
When enabled the length of the line is automatically restricted to the

length of the existing lines. To adjust both PA lines simultaneously, go to
View settings.
When disabled each PA line can be defined separately.
7.6 Superimposition module

Superimpositioning can be used to visualize and measure the anatomical
differences in images before and after treatment by comparing two CBCT
images.
The comparison is done in overlay or in synchronized side-by-side view by
defining three common points or by manually moving the after volume.
7.6.1 Fitting CBCT images for superimposition
About this task

Fit CBCT images for superimposition as follows.
Steps
1. Open CBCT image to compare from File module.
2. Click Superimposition tab.
3. Select Fit Manually or Use Fitting Tool.

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What to do next
If you select Cancel you can continue superimpositioning at a later time by
clicking the Add Volume button.
7.6.1.1 Fit manually

Volumes can be manually fitted by adjusting the position and rotation of the
after volume by using the Move/Rotate Volume tool.
7.6.1.2 Using Fitting tool
About this task

Use the fitting as follows.
Steps
1. Click the Select... button to add the after image.
The before CBCT is shown on the right.
2. Add 3 common points (marked in red, green and blue on the image
below) on the surfaces in both CBCTs by clicking with the left mouse
button.
Images can be rotated with the right-click drag.
If needed, adjust the Threshold 1 and Threshold 2 sliders so that the
bone surface is displayed equally in both volumes.
3. When finished click Done.
Results
The after volume will appear in the Object Browser.

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To remove the superimposition from the after volume, see section "Object
Browser" on page 300. The image is not removed from the patient’s
volumes.
NOTE
All measurements and saved views are specific to the fitted volume pair and
Superimposition module. If superimposition is removed, all measurements
and saved views will be lost.
7.6.2 Superimpose tools
Overlay view
In the Overlay view the differences of two superimposed volumes can be
visualised by overlaying the after volume with the before volume. This view
is similar to the 3D Explorer view except that the after volume is painted
transparently using pseudo colours on top of the before volume (marked in
grey). If both the before and after volume are visible the HU value is not
shown. In the 3D rendering view, the volumes are painted in corresponding
pseudo colours except for the Surface rendering mode.
Side by side view

Side by side view allows viewing axial, sagittal and coronal slices in both
CBCT images at the same time. The CBCT views are synchronised, so
using sliders in one image also moves the other one to the same position in
the anatomy. The show/hide axial, sagittal and coronal views, use show/hide
buttons.
Show Sagittal Show Coronal Show Axial

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Add Volume
Add Volume button allows to add new CBCT image for fitting.
7.6.3 Adjust tools
Only the Superimposition module specific tools are explained here.

These tools only work in the Overlay view.
• Overlay threshold slider
Adjusts the after CBCT’s threshold value.

• Overlay transparency slider
Adjusts the after CBCT’s transparency.

• Move and rotate second CBCT
Move by dragging with the left and rotate by dragging with the right
mouse button.
7.6.4 Annotation tools
For description of the tools, see section "Annotation" on page 214.

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7.6.5 3D rendering
For description of the tools, see section "3D Rendering" on page 223.

Object browser lists the after CBCT and it can be hidden, deleted and its
colour can be changed.
• To delete the after volume from Superimpose module, select the volume
and click the trash can icon.
• To hide the after CBCT, click the eye-icon.
• To change the colour, select the colour scheme from the drop-down list.
7.7 Surface module

The Surface module is designed for viewing surface models such as 3D
photos and 3D models in .PLY, .PRO, .OBJ and .STL formats.

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1 CBCT 3D rendering view (only visible when CBCT image is open)

2 Surface view
3 Tools
7.7.1 Surface view

The Surface view is the area to manipulate surface images.
• Rotate the image with left-click drag.
• Zoom the image with mouse wheel.
• To set the rotation centre, right-click on the desired centre point.
7.7.1.1 Surface view tools

Snapshot
Takes a snapshot of the Surface view. The snapshot will be saved in 2D
imaging module under photo category.
Wireframe
Wireframe rendering can be used to analyse the triangulation in scanned
images. To set wireframe rendering style for all images click this button.
Surface
Surface rendering can be used to analyse the topography of a measured
surface. To set surface (i.e. no texture) rendering style for all images click
this button.
Parallel projection
Use this mode to turn on and off linear perspective that provides a more
natural view of the face.
Show grid
To show a symmetric grid on top of ProFace image click this button. By
selecting parallel projection also measurement values are shown in the grid.
7.7.2 CBCT 3D rendering view

The CBCT 3D rendering view is identical with the 3D module’s Explorer
view. In case the CBCT image is opened it will be displayed in the CBCT
rendering view.
The 3D rendering view can be shown/hidden with the show/hide rend button.

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7.7.3 Tools
7.7.3.1 Surface tools
Set move mode

By clicking this button the image can be moved, rotated and zoomed in and
out.
To drag the image on the screen to the left or right, click the blue arrow
with the left mouse button and hold it down while dragging the image to the
desired direction.
To drag the image on the screen up or down, click the red arrow with the
left mouse button and hold it down while dragging the image to the desired
direction.
To rotate the image horizontally (around its Y-axis) click the green arc using
the left mouse button and hold it down while rotating the image to the
desired direction.
When the move mode is switched on, the other modes are switched off. For
example, if the Measurement Mode was active before switching on the move
mode the measurements are no longer displayed once the move mode is
activated.
To rotate and pan the rendered view press and hold down the Alt key on
your keyboard while moving the image.
Reset Offset
To reset all images to the state in which they were after import click this
button. This tool can be used to detect variations in patient positioning.
Centre All
To centre models click this button.
Add Surface Model

To select and open another image from the same patient click this button.
The added image will be saved and opened the next time the original image
is opened from the Volumes sub-module. The position and orientation of
added images will also be saved.
The added images can be used for measurements and image comparisons.
Define orientation
Define orientation using orientation widget and a grid. Verify by examining
the position from different directions.

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When a new surface model is imported the orientation tool opens

automatically.
The orientation can also be defined later by clicking the tool.
Show / hide renderer

Shows or hides the CBCT rendering view.
7.7.3.2 Adjust tools
NOTE
These adjustments affect only the ProFace images selected in the object
browser.
Adjust contrast, brightness and softness of ProFace images (before, after,

CBCT rendering view) by dragging the sliders.
The adjustments are saved when closing images.

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7.7.3.3 Trim tools
Paint ROI to trim

Paint the areas to remove from the selected surface. The surface behind the
painted area(s) will be automatically removed.
NOTE
Only the coloured triangles are cut from the surface. For more precise
trimming, use the precision cut tool, see below.
TIP
With this tool it is recommended to use Wireframe rendering mode.
To increase/decrease the size of the paint tool press and hold down the Alt
key while scrolling the mouse wheel.
To rotate the image while the tool is selected press and hold down the Alt
key while pressing the left mouse button.
Precision cut
NOTE
Before using this tool adjust and orientate the image as necessary as you
cannot zoom or pan the image while this tool is activated.
The precision cut tool can be used to remove an area from an image by
drawing a precise cutting line on it.

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Define area to be cut by clicking on the image.
Cut out the defined area by right- or double-clicking.
Reset trim
This tool restores all trimmed areas of the original surface. The effect of
reset will be stored within image data.
7.7.3.4 Fitting tools

The Fitting tools can be used to analyse differences between scanned
surfaces.
The BEFORE group marks the scan taken earlier of the two scans and
AFTER group the latest scan image.
NOTE
For the fitting to work, the registered images need to have common surface
(anatomy).

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Launch fitting wizard

The fitting wizard allows easy fitting of 3D models that have common
anatomy. It can mainly be used to
• Fit together ProFace 3D photos of before and after treatment
• Fit ProFace 3D after treatment photos to CBCT data using an earlier
ProFace 3D photo, which is already correctly positioned (offset) over
CBCT data.
• Fitting two upper/lower jaw dental models together
• Fit dental models to correct bite using a bite piece model.
See the following sections for information on different fitting methods.
For detailed comparison instructions, see section "Before and after treatment
comparison" on page 313.
Fit after to before

Using the Fit After To Before tool the anatomical regions can be fitted
together using the Before and After groups.
Fitting is successful when the fit result is 1 or less. If the fit result is not
acceptable try to readjust the point sets or to re-align the images.
In the fitting the latest scan (After or green group) will be fitted to the blue
Before group.
Before starting the fitting the models must be manually fitted to their initial
position.
Fitting settings dialog

Use the overlap parameter to improve point selection and noise in
measurements. Ideally the point sets fully overlap and contain very little
noise.
Show deviation
Shows distance between After and Before surfaces.
Warm colours indicate the After group surface is over the Before surface and
the cool colours indicate the After group surface is below Before surface.
The deviation legend indicates the distance each colour represents.
To adjust the deviation range use the deviation legend slider. The default
range is from -5mm to +5mm.
Moving mouse over the deviation map indicates the distance between
surfaces in the current position.

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Right-clicking on the deviation map will leave a distance indicator in the

current position. Note that by moving the ProFace image or by making a new
fitting the measurements will be erased.
7.7.3.5 ROI selection tools
Add model to ROI

Adds the whole surface model to the ROI.
Paint ROI
Use this tool to paint the areas you want to add to ROI by dragging holding
down the left mouse button.
To increase/decrease the size of the tool press and hold down the Alt key
while scrolling the mouse wheel.
To rotate the image while the tool is selected press and hold down the Alt
key while clicking the left mouse button.

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Draw ROI
Use this tool to draw a new ROI (Region of Interest) in the image. The ROI
can also be used for trimming parts of scans and marking regions. The ROI
is essentially a closed polyline shape.
To add vertex points to a ROI using the left mouse button, click the Draw
ROI button.
To finish and close a polyline double-click in the area in the image where
you want to end the polyline. Alternatively you may single-click the right
mouse button.
NOTE
The rendering view can be rotated and panned by holding down ALT-key
while drawing the ROI.
Erase ROI
Click this button to paint the areas to be removed from the selected ROI.
Clear ROI
To clear any existing ROI object, click this button.
To clear the previous ROI before drawing a new one, click the Clear ROI
button.
7.7.3.6 ROI tools
NOTE
For the ROI tools to work the image must be selected in the screen.
Calculate area
Use this tool to calculate the area of a ROI.
Remove ROI area

This tool can be used to remove areas from a surface given that a region is
selected using the ROI tool. Information about trimmed regions is stored with
image data. The trimmings are stored to all images.
The trim tools can also be used with STL files.
NOTE
Trim the main image before any processing or measuring.

7 3D module
Add ROI to BEFORE group

Click this button to add the ROI area of selected image to the Before group.
All previous assignments to the Before group will be reset. The selected area
shows in blue.
Add ROI to AFTER group

Click this button to add the ROI area of selected image to the After group.
All previous assignments to the After group will be reset. The selected area
shows in green.
Remove all groupings

Click this button to remove the Before or After group from all images in the
active session.
7.7.3.7 Tissue simulation tools
Tissue simulation tools can be used to manipulate ProFace image surface in

the following ways:
• Stretch / shrink the surface along a direction perpendicular to the surface
• Slide the surface along the current viewing plane
The shaping tool has a spherical radius (for example, 3 cm). This means
the modification is strongest at the centre of the sphere and falls off to zero
towards the edges of the sphere.
7.7.3.8 Using shaping tool
About this task

Follow these instructions to use the shaping tool.
Steps
1. Open the ProFace image to work on.
2. Click on the Shaping tool button.

3. Specify the area you want to modify by clicking anywhere on the
ProFace surface.
An indicator displays the range, centre point and the surface normal at
the centre point.
You can adjust the effective area of the shaping tool by holding down the
Alt key while scrolling the mouse wheel.
• To specify a radius for the tool, scroll the mouse wheel to increase or
decrease it. The range is drawn with a thin white line.
• To stretch/shrink the surface at a given position, drag the arrow.

7 3D module
• To slide the surface along the viewing plane, drag any point inside
the selected area. When sliding the surface, it moves perpendicular
to the viewing direction.
• To specify a new centre point inside the selected area, hold down
the Ctrl key while clicking on the new point with the mouse. If
you don’t hold down Ctrl key and click inside the tool’s area, it is
interpreted as a slide operation.
• To remove the tool indicator, hold down the Ctrl while clicking with
the mouse anywhere outside the surface.
• To zoom the surface in/out while the tool is active, hold down the Ctrl
while scrolling the mouse wheel.
• To rotate the model while the tool is active, drag outside the model
surface. Otherwise you will end up selecting a new centre point for
the tool.
• To zoom in/out the model scroll the mouse wheel.
7.7.3.9 Before/after tool
About this task

Compare the modified ProFace surface image to the original with the Before/
After tool as follows.
Steps
1. Click the Before/After button.
The tool can be used whether or not the Shaping tool is activated.

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7.7.3.10 Undo/Redo
All surface modifications are stored so that the original surface is left
untouched. The modifications of the current editing session are stored into
undo history.
To undo/redo modifications use the Undo/ Redo buttons. The modifications
are stored into the database when the patient is closed.
NOTE
When opening a modified patient file you can only undo modifications of the
latest editing session.
7.7.3.11 Revert to original

To discard and remove all modifications and to go back to the original
surface click the Revert to original tool.
As long as no new modifications are made and patient is not closed. The
reverted modifications can still be restored by clicking the Redo button.
7.7.3.12 Annotation tools
Point of interest
You can add a point of interest on the surface and use it as a facial soft
tissue landmark for analysing the symmetry of the face.
The names of the points added can be changed in the Object Browser.
Angle measurement
Use this tool to measure angles on a surface model or between two surface
models.
Polyline measurement
The measurements are poly lines that display the distance of every line
segment and the overall length of the measurement.
To make a new measurement select this tool.
Using the left mouse button click on the image where you want to start the
measurement. Next click on the image where you want the measurement to
finish.
To save the measurement double-left-click in the area where you want the
measurement to end or single click with the right mouse button.
NOTE
The rendering view can be rotated and panned by holding down ALT-key
while adding measurements.

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Two surface measurement

When the two-surface measurement mode is activated new measurements
can be added to measure distances between two surfaces. These
measurements contain only two points, both on separate surfaces.
By left-clicking the first measurement point on a surface, the image
containing this point is toggled invisible until the second measurement point
is left-clicked on another surface.
After the second measurement point is added, the first surface is toggled
visible once the measurement is finished.
7.7.3.13 CBCT rendering tools

For detailed description of the other rendering tools see section "3D
Rendering" on page 223.
In this section only the ProFace specific tools, the rendering snapshot and
the save overlay offset, is described.
NOTE
The CBCT rendering tools are hidden if no CBCT images are open.
NOTE
The rendering snapshot and save overlay offset tools are active only if
ProFace image has been added.
Rendering snapshot
To create a snapshot position the CBCT rendering object so that the
features of interest are visible in the image. Features that are not visible
in the CBCT rendering will not be available in the snapshot surface.
If CBCT image is not open during the session no snapshot can be created
and an error message will appear.
When a Planmeca ProFace image is set as an overlay for CBCT data, all
rendering snapshots created from the CBCT data inherit the (inverse) offset
from the overlay. This means that when Planmeca ProFace images are

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captured together with CBCT data, the user can create rendering snapshots
from CBCT data and start doing measurements immediately between soft-
tissue and bone surfaces.
Save overlay offset

The tool can be used to save the fitted position between the CBCT image
and Planmeca ProFace image in the rendering in case Planmeca ProFace
and CBCT image have been taken in different occasions and therefore not
automatically fitted. The Planmeca ProFace image will be fitted correctly in
the rendering in relation to the CBCT image.
To use this tool the images need to be designated to Before and After
groups. To save the definition click the Save overlay offset tool. The face
image will be shown in the saved position in the Rendering view with CBCT
volume data.
7.7.3.14 Object browser
For detailed description see section "Object Browser" on page 233.
7.7.4 Setting ProFace image as overlay for CBCT data
Before you begin
NOTE
Before starting make sure that both the CBCT data and ProFace image are
added to patient files in the File module.
About this task

Set a ProFace image as overlay for CBCT data as follows.
Steps
1. Open the CBCT volume.
2. Click Add Surface Image.
Results
The CBCT volume and ProFace rendering views now show in ProFace
module and a ProFace overlay is added on the CBCT data and shows in
other 3D modules.
7.7.5 Before and after treatment comparison
About this task

Planmeca ProFace can be used for comparing the anatomy of the
patient before and after treatment. The images are superimposed and the
anatomical differences between images acquired before and after treatment
are displayed.

7 3D module
Steps
1. Click this button to launch the Fitting wizard.
2. Open the before and after ProFace images using the Select Before and
Select After buttons.
3. Position models so that you can select common anatomy in them.
• Turn the model by dragging with the left mouse button.
• Move the model on screen by dragging with both mouse buttons.
• Zoom in/out by scrolling the mouse wheel.
4. Select common anatomy on both models by using the tools next to the
models.
NOTE
To maximize the accuracy of the fitting process, select anatomy that has
NOT been affected by treatment.
• To adjust the tool size press and hold down the Alt key while
• To turn the models while the paint tools are active press and hold
down the Alt key.
• To move the model press and hold down the Alt key and both mouse
buttons.
NOTE
If the before status is already mapped to a CBCT image and you want
to use the same offset mapping for the after image enable the Save
Overlay Offset option. This will make the after image appear in the
correct position over the CBCT image.
If necessary, you can use the ROI removal tool to remove unnecessary
areas from the selection.
5. When finished click the Fit button.
Results
The images are automatically fitted together and appear in correct position.

7 3D module
What to do next
To study the differences in coloured topology based on the amount of
change in anatomy click the Deviation Map button in Fitting tools.
The blue colour indicates retraction of anatomy and red indicated protrusion.
7.7.5.1 Automatic fitting using previous ProFace image
About this task

If the patient has an earlier ProFace image mapped to a CBCT image, its
offset can be used to map new ProFace images to the same CBCT as
follows.
Steps
1. Open the CBCT image to which the earlier ProFace image is mapped to.
2. Go to Surface module.
3. Launch the fitting wizard by clicking this button.
4. Click the Select Before button to open the image taken before treatment.
Click the Select After button to open the image taken after treatment.

7 3D module
5. Position the models so that you can select common anatomy in them.
You can:
• Turn the model by dragging.
• Zoom in and by scrolling mouse wheel.
6. Paint common anatomy on both models by using the Paint and Draw
ROI tools.
NOTE
For maximum accuracy select anatomy not affected by treatment.
• To adjust the tool size, use Alt + mouse wheel.

• To turn the models while the paint tools are active, press and hold
down the Alt key.
• To move the model, press and hold down the Alt key and both
mouse buttons.
7. Enable the Save overlay offset option.
This will make the After ProFace image appear in the correct position
over the CBCT exposure.

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8. If necessary, remove areas from the selection by using the ROI removal
tool.
9. Click Fit.
Results
Planmeca Romexis fits the images together and they appear in correct
position over the CBCT image.
7.7.5.2 Alternative before and after image comparison
About this task

Alternative before and after image comparison is done as follows.
Steps
1. Open the ProFace image.
The image opens in the Surface sub-module.
2. Click the Add Surface Model button in Surface tools.
3. Select the image acquired before treatment and click the Add to Before
button.
The image is added to the Before group and shows in blue.

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4. Select the image acquired after treatment.

5. Click the Draw ROI button.
6. Select an area that is identical in both images (not affected by the

treatment).
7. Click the Add ROI to After Group button.
The marked area turns green.

8. Drag one image on top of another for approximate fitting.
9. Click the Fit After to Before button.
Planmeca Romexis now fits the surfaces precisely.

10. To evaluate the changes in anatomy, click the Show Deviation Map
button and uncheck the before ProFace image from the in the Object
Browser list.
Blue colour indicates receded anatomy, green colour shows unchanged
areas and red areas indicate the areas that have protruded after
treatment.

7 3D module
7.7.6 Fitting Planmeca ProFace image to CBCT volume
About this task

Planmeca ProFace image is normally automatically fitted to the CBCT data
during the exposure. However, manual fitting is necessary for example in
case the images were acquired at different times.
Manual fitting is easiest on 3D volumes that include skin surface as the
surface can be used as a fitting reference.
On how to fit a new ProFace image to a CBCT volume using an earlier
ProFace image see section "Automatic fitting using previous ProFace image"
on page 315 .
Follow these instructions to manually fit Planmeca ProFace image to CBCT
volume.
Steps
1. Check that the CBCT volume and its related Planmeca ProFace image
are listed in the Volumes sub-module.
2. Open the CBCT volume and click the Surface sub-module.
3. Add ProFace image to the study by clicking the Add Surface Model
button.
4. Adjust 3D rendering so that skin surface is visible using Soft Tissue 3D

rendering preset.

7 3D module
5. Click Rendering snapshot button to make a surface model of the 3D

rendering.
The snapshot is added to the Object browser where the two items can
be activated and modified.
6. Select the 3D rendering snapshot and click the Draw ROI button to mark
an area that is unmodified in both images.
NOTE
The cheeks and forehead are suited for selecting common anatomy. The
chin can be used if chin support was not used for exposure and nose
when included in the volume.
7. Click the Add to before group button.
The selected area turns blue.

8. Select the Planmeca ProFace image.
9. Click the Draw ROI button to define a common area with the 3D
rendering snapshot.
10. Click the Add ROI to after group button.
The marked ROI turns green.

7 3D module
11. Move the surfaces on top of each other so that the anatomy roughly fits.
12. Click the Fit after to before button to have Planmeca Romexis fit the
surfaces precisely.
13. To evaluate the fitting result, click the Show deviation map button and
deactivate the 3D rendering snapshot in the Object browser.
The fitting is successful when most of the face shows in bright green,
see step 7.
14. To save the Planmeca ProFace offset select the Planmeca ProFace
image and click on the Save overlay offset button.
The Save overlay offset tool ensures that the Planmeca ProFace surface
is correctly positioned in relation to the CBCT volume when shown in the
3D rendering as an overlay.
7.7.7 Fitting two 3D models using bite piece
About this task

The Fitting Wizard can be used to fit two dental models into correct bite
using a bite piece model. In order to fit STL models they need to be listed
in the Volumes sub-module. To fit the models into correct bite, follow these
steps.
The general workflow is always as follows:
• Run the fitting wizard and set the bite piece as the Before model and the
upper model as After model.
• Run the fitting wizard again and select the bite piece again as the Before
model and the lower model as the After model.
Steps
1. Click Launch Fitting Wizard.
The models open in the fitting window.

7 3D module
2. Position the models so that occlusal surfaces are clearly visible.
• To turn the model, hold down the left mouse button while dragging.
• To move the model around, hold down both mouse buttons while
dragging.
• To zoom in/out, use the mouse wheel.
3. Paint occlusal surfaces on both models by using the ROI paint tools.
4. Adjust the models as necessary.

• To adjust the tool size, use the Alt key and the mouse wheel. In
general, all the occlusal surfaces can be painted with one stroke
using a wide brush.
• To turn the models while the paint tools are active, press and hold
down the Alt key.
• To move the model, hold down the Alt key and both mouse buttons.
For improved fitting result use the ROI removal tool to in the After model
(lower / upper bite) to clean any extra selections from the non-occlusal
surfaces (MDBL).
A few wide swipes across the sides of the dental arch is usually sufficient
for good results.

7 3D module
5. Click Fit.
The models are automatically fitted.
6. Repeat the steps from 1 to 5 for the remaining opposite bite.
7.7.8 Fitting two 3D models without bite piece
About this task

The Fitting Wizard can be used to fit two dental models without using bite
piece. For example, models of the upper arch taken at different times of the
treatment can be fitted together. It is recommended to select the first model
(the model taken of the initial situation) as the before model for the fitting.
The STL models to be fitted need to be listed in File module.
Steps
1. Click Launch Fitting Wizard.
2. Click Select Before model.

3. Click Select After model.

7 3D module
4. Position the models so that the occlusal surfaces are clearly visible.
• To turn the model, hold down the left mouse button while dragging.
• To move the model around, hold down both mouse buttons while
dragging.
• To zoom in/out, use the mouse wheel.
5. Paint the areas that have not been changed during treatment, e.g. the
molar occlusal surfaces by using the ROI paint tools.
• To adjust the tool size, use the Alt key and the mouse wheel. In
general, molar occlusal surfaces can be painted with one stroke
using a wide brush.
• To turn the models while the paint tools are active, hold down the Alt
key while dragging.
• To move the model, hold down the Alt key and both mouse buttons.
6. Click the Fit button.
Results
The models are automatically fitted.

7 3D module
7.7.9 Creating set of ProFace snapshots
About this task

Follow these instructions to create a set of ProFace snapshots.
Steps
1. Click Save View.
2. In the following window click on the images you would like to appear in
the snapshot set.
3. Select the suitable snapshot options.
4. Click OK.
Results
The snapshots are stored in the 2D module's Image browser.
7.7.10 Importing surface images
About this task

Follow these instructions to import surface images.

7 3D module
Steps
1. Click Import on the Surface module.
2. Select the image to import.
Results
The imported image opens in Surface module.
7.7.11 Exporting surface images
About this task

Follow these instructions to export surface images.
Steps
1. Click Export.
2. Select export options.

ProFace image can be exported with overlay offset and with Viewer.
If exporting Viewer select the optimized platform (32-bit / 64-bit Windows
or MacOS) for your system.
The extension for Planmeca ProFace image is *.PRO for wavefront
objects .OBJ and .STL for stl files.

7 3D module
3. Click OK.
7.7.11.1 Exporting CBCT image with ProFace images
About this task

The combination of CBCT volume, ProFace image and STL file can be
exported with matching coordinates. This means that when the receiver
opens the exported images they will open as aligned by the sender. The files
can also be imported to 3rd party software.
For external software use the .OBJ format for ProFace images.
Steps
1. Open CBCT volume with ProFace overlay and go to Explorer sub-
module.
2. From the top tool bar select Export volume.

7 3D module
3. Check the option Include ProFace.
NOTE
CBCT volume and Planmeca ProFace image are exported as separate
files. The extension for the exported Planmeca ProFace-image is *.pro
and *.dcm for the CBCT volume.
NOTE
If you select the option Include ProFace make sure that the setting in 3D
Rend / Overlay Properties / Type is set to 3D Photo.
7.8 3D Cephalometry module

In the 3D Cephalometry module, it is possible to perform cephalometric
analysis in 3D format based on patient's CBCT image.
NOTE
General knowledge of cephalometry and the used cephalometric analysis
type is necessary for using the 3D Cephalometry module.

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1 Sagittal slice view

2 Coronal slice view
3 Axial slice view
4 3D rendering view
5 Adjust tools
6 Cephalometric Tools
7 3D Rendering tools
8 Object Browser
7.8.1 3D cephalometric analysis workflow
7.8.1.1 Cephalometric tools

The following tools are used in performing cephalometric analysis.
Add Anatomical Landmark
Enables the add anatomical landmarks mode and opens a list of landmarks
defined by the selected analysis type.
Show Analysis
Show/hide cephalometric analysis dialog. The analysis presented in the
dialog depends on selected analysis type.
Set Head Orientation
Change and adjust head orientation either by using specific cephalometric
points or manually in the Define Head Orientation dialog. Used head
orientation determines the direction and position of the reference coordinate
frame used in cephalometric analysis. Imaging orientation is used by default.
7.8.1.2 Selecting analysis type
About this task

The 3D Cephalometry module offers two analysis types, the TFA Perrotti
Analysis and the Orthognathic Surgery Analysis.
To select analysis type:

7 3D module
Steps
1. Select the desired option from the drop-down menu under Cephalometric
Tools.
7.8.1.3 TFA Perrotti Analysis

TFA Perrotti Analysis is the default analysis type used in Romexis 3D
Cephalometry module. If the TFA Perrotti Analysis is selected, the following
landmark list opens.

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In order to implement the analysis, a few points calculated from the other
points are needed. The calculated points are hidden from the list shown.
Points calculated from the other points:
Landmark Short name Definition

Condylion Median CoM Mid point between of (CoL)
and (CoR)
Jugale Median JM Mid point between of (JL)
and (JR)
Gonion Median GoM Mid point between of (GoL)
and (GoR)
Upper Incisor Edge Median UIEM Mid point between of (UIEL)
and (UIER)

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Upper Incisor Apex Median UIAM Mid point between of (UIAL)

and (UIAR)
Lower Incisor Edge Median LIEM Mid point between of (LIEL)
and (LIER)
Lower Incisor Apex Median LIAM Mid point between of (LIAL)
and (LIAR)
The points define the following planes:
Plane Short name Definition

Anterior facial plane AFP Parallel to Coronal plane,
passing through (ANS)
Anterior Nasal Spine
Superior facial plane SFP Parallel to Axial plane,
passing through (N) Nasion
Spinal plane ANSP Parallel to Axial plane,
passing through (ANS)
Mental plane MeP Parallel to Axial plane,
passing through (Me)
Menton
Maxillary plane MxP Perpendicular to Sagittal
plane, passing through (JM)
Jugale Median and (ANS)
Mandibular plane MbP Perpendicular to Sagittal
plane, passing through
(GoM) Gonion Median and
(Gn) Gnathion
Using the above mentioned points and planes the TFA Perrotti analysis can
be defined:
Measurement Short Definition Unit

name
Superior vertical S Distance of point (ANS) mm
dimension to (SFP) plane
Inferior vertical I Distance of point (Me) mm
dimension to (ANSP) plane
Total vertical dimension T Distance of point (N) to mm
(MeP) plane
Maxillary position MX Distance of point (A) mm
to (AFP) plane, signed
value. Value is negative
if (A) is in front of the
plane. Otherwise it is
positive.
Mandibular position MB Distance of point (Pog) mm
to (AFP) plane, signed
value. Value is negative
if (Pog) is in front of
the plane. Otherwise it
is positive.

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Intermaxillary ratio IR (MX) - (MB) mm

Verticality, left VertL Distance of point (GoL) mm
to (SFP) plane
Verticality, right VertR Distance of point (GoR) mm
to (SFP) plane
Verticality Vert (VertL) - (VertR) mm
Mandibular height, left MbHL Distance between mm
points (CoL) and (GoL)
Mandibular height, right MbHR Distance between mm
points (CoR) and (GoR)
Mandibular height MbH (MbHL) - (MbHR) mm
Maxillary height, left MxHL Distance of point mm
(PcmUL) to (MxP)
plane
Maxillary height, right MxHR Distance of point mm
(PcmUR) to (MxP)
plane
Maxillary height MxH (MxHL) - (MxHR) mm
Incisal upper axis IUA Angle between (MxP) deg
and axis created from
the points (UIEM) and
(UIAM) projected on the
sagittal plane of (UIEM)
Incisal lower axis ILA Angle between (MbP) deg
and axis created from
the points (LIEM) and
(LIAM) projected on the
sagittal plane of (LIEM)
Mandibular growth MGD Angle between planes deg
direction (MbP) and (MeP)
TFA Perrotti Analysis type is propriety of Dr. Giovanna Perrotti.
For further information consult:
Lake Como Institute ®
Advanced Implantology Training Center
Via Rubini, 22
22100 Como, Italy
Tel. +39 031 2759092
Fax +39 031 243027
info@lakecomoinstitute.com
7.8.1.4 Orthognathic Surgery Analysis

Orthognathic Surgery Analysis allows you to analyse the patient's facial
symmetry vertically and horizontally for the purposes of orthognathic surgery
planning. It helps to visualize the amount of movement of each landmark
from the pre-operative position to the simulated post-operative position.
If the analysis is selected, the following landmark list opens.

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When using Orthognathic Surgery Analysis, you may also add your own
anatomical landmarks. See sections "Adding user defined landmarks" on
page 357 and "Creating distance measurements" on page 359 for more
information on user defined landmarks.
The landmarks define the occlusion plane:
Plane Short name Definition

Occlusion plane OccP Passing through (OcR)
Occ.plane point right,
(OcF) Occ.plane point front
and(OcL) Occ.plane point
left.
The angles and distances presented in the table below are calculated using
the given landmarks. Head orientation planes mentioned in the table are
described in "Setting head orientation" on page 339.
Measurement Short Definition Unit

name
Ceph analysis: SNA SNA Angle between vectors deg
(N)-(S) and (N)-(A)

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Ceph analysis: SNB SNB Angle between vectors deg

(N)-(S) and (N)-(B)
Ceph analysis: ANB ANB Angle between vectors deg
(N)-(A) and (N)-(B)
Vertical symmetry: VGoL Distance of point (GoL) mm
(VGo) Gonion, left to vertical orientation
plane
Vertical symmetry: VGoR Distance of point (GoR) mm
(VGo) Gonion, right to vertical orientation
plane
Vertical symmetry: VGo (VGoL) - (VGoR) mm
(VGo) Gonion, diff
Vertical symmetry: VOcL Distance of point (OcL) mm
(VOc) Occlusion, left to vertical orientation
plane
Vertical symmetry: VOcR Distance of point mm
(VOc) Occlusion, right (UOcR) to vertical
orientation plane
Vertical symmetry: VOc (VOcL) - (VOcR) mm
(VOc) Occlusion, diff
Horizontal symmetry: HGoL Distance of point (GoL) mm
(HGo) Gonion, left to horizontal orientation
plane
Horizontal symmetry: HGoR Distance of point (GoR) mm
(HGo) Gonion, right to horizontal orientation
plane
Horizontal symmetry: HGo (HGoL) - (HGoR) mm
(HGo) Gonion, diff
Horizontal symmetry: HOcL Distance of point mm
(HOc) Occlusion, left (UOcL) to horizontal
orientation plane
Horizontal symmetry: HOcR Distance of point mm
(HOc) Occlusion, right (UOcR) to horizontal
orientation plane
Horizontal symmetry: HOc (HOcL) - (HOcR) mm
(HOc) Occlusion, diff
7.8.1.5 Placing anatomical landmarks
Before you begin

Select analysis type before proceeding with placing anatomical landmarks,
see section "Selecting analysis type" on page 329.
About this task

Follow these instructions to place anatomical landmarks.

7 3D module
Steps
1. Select the Add Anatomical Landmark tool.
A list of landmarks defined by the selected analysis type opens. The list
of unset landmarks is shown in red.
2. Click on a landmark on the list.
The landmark's background turns blue. The illustration on top of the
landmark list shows the landmark's location.
3. Left-click on any of the four views to place the landmark.

After the selected landmark is marked, the text turns white and the slice
views focus on the landmark.
You can fine-tune the location using any view while the same landmark
is selected by marking a new position by left-clicking again.
4. When ready, press the ENTER key to select the next undefined
landmark.
You can turn on the automatic selection by selecting the arrow button on
the top of the landmark list.
When activated, the next undefined landmark is selected immediately

after the current landmark is set.
Selected landmark is deleted by clicking on the trash can icon next to it.
A group of landmarks can be deleted by selecting the check boxes next
to them and clicking on the trash can icon on top of the landmarks list.
7.8.1.6 Show analysis
About this task

As you proceed with placing landmarks, the measurements of the selected
analysis type are updated. You can view the analysis as follows:

7 3D module
Steps
1. Click Show Analysis in Cephalometric Tools.
Results
The chosen analysis is shown.
TFA Perrotti Analysis

In TFA Perrotti Analysis, the patient's values are compared to reference
values of the respective patient's gender.
The measurement's background colour and the following text classifies
the measurement according to the norms. If the gender is not set, the
background colour of the measurement remains black, and the text is
missing.

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The norm values for a female patient:
The first three norm values for the male patient. The other norms are same
as for the female patient.
For further information on the norm values, please contact Dr. Perrotti. See
section "TFA Perrotti Analysis" on page 330 for contact information.
Orthognathic Analysis
An example of results of the Orthognathic Analysis are shown in the table
below.

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The bottom part of the analysis view is the Point movement sub panel. It
shows the movement of each point after surgery simulation done in "Surgical
planning, Step 5: Moving segments and saving plans" on page 383. In 3D
Cephalometry module the values are always 0.0.
7.8.2 Setting head orientation
About this task

Imaging orientation is used by default in the 3D Cephalometry module. The
orientation can be changed either by using specific cephalometric points or
manually, in the Define Head Orientation dialog.
If the cephalometric landmarks Left Orbitale (Or), Left Porion (PoL), Right
Porion (PoR), Anterior Nasal Spine (ANS) and Sella Turcica (S) exist, it is
possible to use the head orientation defined by the landmarks.
The projected landmarks are drawn over the 3d rendering views. Horizontal
plane is determined by (Or), (PoL) and (PoR). Vertical plane is set
perpendicularly to the horizontal plane and crosses the points (ANS) and
(S). The cephalometric point defined orientation is set from the upper most
reset buttons between the rendering panels. If one or more above mentioned
points is missing the button is inactivated. In order to use the point defined
orientation you must define the points using the Add Anatomical Landmark
tool.
Follow these instructions to manually set the head orientation.

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Steps
1. Click Set Head Orientation.
The Define Head Orientation dialog opens.
2. Use the buttons in this dialogue to adjust the view.

The view on the right
View skull from the front.
View skull from the top-down.
View skull from the bottom-up.
The view on the left

View skull from the patient left.
View skull from the patient right.
Reset to imaging orientation
Reset to landmark based orientation

(Available only if cephalometric landmarks Or, PoL, PoR, ANS and S are
set.)

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Adjust the cutting threshold for the rendering HU value.
Adjust brightness.
3. Hover the mouse over the red handle or arrow to activate it.
When the handle or arrow turns bright red, it is activated.
Rotate the orientation plane by rotating the handle. You can adjust the
centre point by dragging the arrows.
Upon mouse-button release, the orientation adjusts.
4. When satisfied with the new orientation, click Done.
If necessary, the changes can be rejected by clicking Cancel.
Results
The new orientation is updated to all views and stored to database.
7.8.3 Adjust tools

You can select between 2x2 layout and maximized 3D rendering layout with
the following buttons:
Maximize 3D Rendering
Set 2X2 View
Visible slice views can be adjusted by selecting the following buttons:
Show Sagittal

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Show Coronal
Show Axial
7.8.4 Object visibility

The following tools under Cephalometric tools control the visibility of objects
related to cephalometric analysis.
Show Analysis Planes
Show/hide cephalometric planes. Shows all planes related to selected
analysis type.
Show Landmarks
Show/hide cephalometric points in 3D rendering and slice views.
Show Analysis Measurements

Show/hide cephalometric measurements in 3D rendering view.
Show Orientation Planes

Show/hide vertical and horizontal orientation planes in 3D rendering view.
7.8.5 Object browser

The cephalometric analysis planes are added to the object browser. The
planes are grouped in Sagittal, Coronal, Axial and Other planes groups. The
visibility of each group can be controlled from the group's visibility button, I.e.
the eye icon. The visibility of an individual plane can be controlled from the
plane's own visibility button. All planes can be set visible/invisible from the
Cephalometric Tools menu. The colours of the planes are user-selectable
and image specific.

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7.9 Surgery module

The surgery module is intended for virtual planning of orthognathic surgery.
In the module, virtual cuts to the CBCT data can be made and the jaw
segments repositioned to the desired occlusion and position.
To translate the plan to the operating room, both intermediate and final
splints can be designed (*).
The CMF Surgical Workflow consists of the following steps:
Preparing case
see section "Preparing case" on page 344 for detailed instructions
Surgical planning
"Surgical planning, Step 1: Cephalometric analysis and landmark based
measurements" on page 356
"Surgical planning, Step 2: Defining head orientation" on page 361
"Surgical planning, Step 3: Creating osteotomies" on page 361
"Surgical planning, Step 4: Fitting target model" on page 376
"Surgical planning, Step 5: Moving segments and saving plans" on page
383
"Surgical planning, Step 6: Designing splints" on page 389 (*)
Steps 1 and 4 are optional I.e. completing them is not a requirement for
moving on to the following phases.
NOTE
(*) The splint design functionality is not available in the United States and
consequently the splint design button is not shown under Post-processing
tool bar.
7.9.1 Disclaimer
The surgical intermediate and final splints created with Planmeca Romexis
CMF Surgical module shall be designed and manufactured only by
professionally qualified persons. Thus the user bears full responsibility for
the design, use, suitability, function, shape and the application of the splints
and acknowledges having reviewed the intermediate and final treatment
steps and respective splints in the software before exporting.

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7.9.2 Preparing case

Before starting the planning in CMF Surgery module prepare the case by:
• Creating a patient in Planmeca Romexis in section "Adding patients" on
page 23
• Importing or opening 3D image and digital dental models in sections

"Importing images for current patient" on page 53 and "Opening images"
on page 50.
• Aligning upper and lower digital dental models with 3D image in section
"Fitting digital dental model in stl file format onto image" on page 206.
• Segmenting the mandible from 3D image in section "Jaw segmentation"

on page 187.
7.9.3 Surgery module views

The Surgery module is divided into two main views:
1 Slice views
2 3D rendered view

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7.9.4 Slice views

The slice views visualize the progress of virtual surgical planning by
superimposing the simulated virtual plan to the pre-operative image. The
currently selected or moved bone segments of the virtual plan are visualised
yellow on the image.
Also, cross-sections of the following items are shown in the slice views:
• Dental models, including target occlusion model
• Anatomical landmarks
• Splints
• Cephalometric analysis planes
• Nerves, in Initial Position only
To browse through the image stack, scroll the slider.
7.9.4.1 Adjusting slice views

The settings for the slice views are found in Adjust tools.

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1 Adjust brightness
2 Adjust contrast
3 Adjust sharpen
To adjust contrast, brightness and sharpness of images, see
section "Contrast, brightness and sharpness" on page 179
4 Adjust overlay transparency
Use this slider to adjust the visibility of superimposed moved
segments.
5 Toggle Zoom mode for Mouse Scrollwheel

See section "Toggle zoom/layer browsing" on page 179.
6 Show/hide Annotation Overlay
See section "Show / hide annotation overlay" on page 180.
7 Adjust Levels
See section "Adjust levels" on page 180.
8 Show Sagittal/Coronal/Axial
These buttons allow to control individually the visibility of each of
the slice views on the left side of window. By default, sagittal and
axial slices are shown.
9 Show Bone Surface in Slice Views
This button can be used to show/hide the projections of the bone
surfaces in the slice views. Please note that computing of the
projections is slow and therefore should be only temporarily used.

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7.9.5 3D rendered view

In the 3D rendered view, there are three different modes:
1 Surface rendering with the current surgical plan
2 Surface rendering with dental models only I.e. the dental model
view
3 Volume rendering
The 3D rendered view is controlled by using the 3D rendering tools.
7.9.5.1 Surface rendering with current surgical plan

This view visualizes the progress of the virtual surgical planning by showing
the bone segments and related objects in their current position. When
entering the module, this is the default view.
It can also be used to adjust the osteotomy templates during osteotomy

planning. After osteotomy planning, the new segments are shown in different
colors depending on the performed osteotomy.

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Use these buttons to select the viewing direction:
View skull from the front
View skull from the left
View skull from the right
View skull from the bottom
7.9.5.2 Dental model view

In the dental model view, the current and pre-operative position of the dental
models can be compared.
Use the Show Dental Model View button located under the 3D Rendering
tools to switch to the dental model view.
Use view buttons on the top-right corner of the view to select the position in
which the dental models are shown:

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Show both upper and lower models in open position

In this view the progress of virtual surgical planning is visualized by
superimposing the simulated virtual plan to the pre-operative position of the
dental models. The anatomical landmarks added to the dental models are
dynamically updated and the distance between the original and simulated
position is shown.
Show both upper and lower models in closed position

The closed position is particularly useful when adjusting autorotation, see
section "Autorotation" on page 389. The designed splints and are also
shown in this view.
The following colours for the dental models are used:

• Blue: planned (i.e. current) position of the upper dental model
• Pink: planned (i.e. current) position of the lower dental model
• Grey: pre-operative position of the dental models

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To adjust the visibility of the dental models, use the Segment Tree. For more
information, see "Adjusting hierarchy and visibility of items using Segment
Tree" on page 351.
7.9.5.3 Volume rendering

Volume rendering mode is available as an option during osteotomy planning.
It enables better visibility to the dental roots when defining the osteotomy
lines.
Use this icon on top right side of the 3D rendering view to switch to volume
rendering.
To change the COI (the centre of interest around which the virtual camera
rotates), hold down the Ctrl key and right-click on the image.
To reset the COI, hold down the Ctrl key and click outside the image.
To change the 3D rendering style, see section "Selecting 3D rendering
preset" on page 225.
For more information on how to adjust the 3D rendered view, see sections
starting from "3D Rendering" on page 223.
7.9.5.4 3D rendering view tools
1 Adjust brightness
2 Adjust threshold
3 Adjust volume transparency
4 Show Segment Tree
5 Show Mandible Rotation Axis

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6 Show Measurement Grid

7 Show/Hide All Planes
8 Show Dental Model View
7.9.5.5 Adjusting brightness

Brightness adjustment can be used only when the volume rendering
is enabled. For more information about brightness adjustment, see
section "Setting 3D rendering contrast, brightness, cut-off threshold and
transparency" on page 224.
7.9.5.6 Adjusting threshold

If surface rendering mode is selected the segment surfaces are updated
after the slider is released. The minimum value of the slider is set
according to the segmentation threshold that was set by the user during
jaw segmentation. If using volume rendering mode, see section "Setting 3D
rendering contrast, brightness, cut-off threshold and transparency" on page
224.
7.9.5.7 Adjusting volume transparency

When using surface rendering with current surgical plan, the transparency
of bone segments can be adjusted. Maximum value 100 equals 100%
transparency.
7.9.5.8 Adjusting hierarchy and visibility of items using Segment Tree

The Segment Tree visualizes the hierarchy of the bone segments and the
related objects. It can also be used to control the selection of active bone
segments and related objects and to change the hierarchy of objects added
to the surgical plan.
After you have completed the jaw segmentation and enter the Surgery
module, the skull is divided into Mandible and Cranium & Maxilla segments.
After osteotomies have been performed, the mandible and maxilla segments
are divided into further bone segments depending on the performed
osteotomy types. Each bone segment appears in the tree as its own branch.

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User added objects such as anatomical landmarks and dental models are
also added to the segment tree. These objects are hierarchically related to
their parent objects. The items included in the plan are marked with the
following icons:
Cranium&Maxilla segment
Mandible segment
Predefined landmark
User added landmark
Root segment landmark
Dental model
Nerve
Nerves are added to the root segment and they do not have an eye icon.
They are visible only in the initial position.
User added landmarks are by default added to the root segment and marked
with the red border. These landmarks must be moved by the user to the right
segment, after which the red border will disappear.

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To change the hierarchy of an object, left-click on the object in question and

drag it under the right section in the tree.
The grey-coloured landmarks at the end of the Segment Tree belong to
the root segment, as these landmarks are not expected to move with any
segment.
The tree is used for controlling the selection of active segments. Left-click to
select an object and all items located under that object. Hold down Ctrl-key
and left-click to select more than one segment and related objects.
The selection of segments is also hierarchical e.g. it also controls which child
segments and other objects are moved when a certain segment is moved.
Use the eye icon to show/hide an item in the slice and 3D rendered views.
NOTE
It is the responsibility of the user to ensure that the objects included in the
plan reside on the correct segments. Failure to do so may result in incorrect
cephalometric analysis and distance measurement values to be displayed
after the segments are moved.
7.9.5.9 Showing mandible rotation axis
About this task

The mandible rotation axis is defined by the (CoL) Left Condylion and
(CoR) Right Condylion landmarks. For more information on how to set the
landmarks, see section "Placing anatomical landmarks" on page 335.
Steps
1. To show/hide the rotation axis of the mandibular segments, click Show
Mandible Rotation Axis.

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Results
7.9.5.10 Showing reference grid
About this task

To show/hide the reference grid to help in symmetry evaluation:
Steps
1. Click Show Measurement Grid.

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Results
7.9.5.11 Showing/hiding all planes
About this task

To show the locations of the slices that are currently shown/hidden in the
slice views in surface rendering with current surgical plan:
Steps
1. Click Show/Hide All Planes.
Only the planes that correspond to the currently shown slice views are
shown/hidden by this button.

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7.9.5.12 Showing dental model view
About this task

To show/hide the dental model view:
Steps
1. Click Show Dental Model View.
For more information, see section "Dental model view" on page 348.
7.9.6 Surgical planning, Step 1: Cephalometric analysis and landmark based

measurements
Cephalometric analysis and landmark based measurements can be
combined with the surgical planning. A cephalometric analysis can be
defined by using the Cephalometric Tools.
For more information on how to define a cephalometric analysis see section

"3D cephalometric analysis workflow" on page 329.
7.9.6.1 Orthognathic Surgery analysis type

The cephalometric analysis types include a dedicated Orthognathic Surgery
analysis.
The Orthognathic Surgery analysis can be used to analyse the patient’s
facial symmetry vertically and horizontally. It also shows the movement
of each landmark from the pre-operative position to the simulated post-
operative position. For more information about this analysis type, see section
"Orthognathic Surgery Analysis" on page 333.
7.9.6.2 Viewing cephalometric analysis
About this task

To view the current values of the selected cephalometric analysis type:
Steps
1. Click Show Analysis.

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Results
7.9.6.3 Adding user defined landmarks
About this task

When using Orthognathic Surgery analysis type, user defined anatomical
landmarks can also be added.
Steps
1. Select the Add Anatomical Landmark tool.
A list of landmarks opens.

2. Make sure that none of the landmarks on the list is selected, i.e.
highlighted with blue background colour as shown in the image.
To deselect a landmark, click on the highlighted row in the Landmarks

list.
3. To add the landmark, click on the desired position in the 3D rendered
view or the slice views.

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4. Give a name to the new landmark in the dialog window that pops open.
The landmark is added to the end of the Landmark list and is shown with
the green colour in the slice and 3D rendered view.
The landmark is shown also in the Segment Tree with a red border. The
landmark is placed by default to the root segment.
5. Drag the landmark to the correct segment.
Results
The landmark is shown in the Analysis window, under Module D: Point
movements.

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If the landmark is placed on a moving segment, the movement values are

updated during planning.
7.9.6.4 Creating distance measurements
About this task

Two anatomical landmarks can be connected manually to create a distance
measurement as follows.
NOTE
When osteotomies are performed, all previously created measurements will
be deleted.
Steps
1. Select the Orthognathic Surgery cephalometric analysis type.
2. Select the Add Anatomical Landmark tool to open the Landmarks list.
3. Tick the checkboxes of the two landmarks between which the landmark
is created, for example ANS and N as shown below.
4. Click on the link icon on the top row of the Landmarks list.

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5. Give a name to the measurement in the dialog window that opens.
6. Click Show Analysis to view the measurement value.
Results
User defined measurement will be added as a new row under Module A:
Ceph Analysis
The measurement is also shown in the 3D rendered view with blue colour if
Show Analysis Measurements is selected in Cephalometric tools.
NOTE
If a point used in a measurement in deleted, the measurement will be
deleted as well.

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7.9.7 Surgical planning, Step 2: Defining head orientation
About this task

The head orientation determines the directions and position of the reference
coordinate frame used in cephalometric and dental analyses.
By default, the imaging orientation is used.
The head orientation can also be set manually by:
• placing cephalometric landmarks, or
• rotating and translating the coordinate planes.
To define the head orientation:
Steps
1. Click Set Head Orientation.
For more information, see section "Setting head orientation" on page

339.
NOTE
It is the user's responsibility to ensure that the correct head orientation is
used.
7.9.8 Surgical planning, Step 3: Creating osteotomies
About this task

Create Osteotomies is a wizard-like tool in which the osteotomies can be
planned step-by-step. The maxilla and mandible osteotomies are performed
separately.
To start the osteotomy planning:
Steps
1. Click Create Osteotomies.
7.9.8.1 Selecting osteotomy type
About this task

As a first step, the osteotomy type(s) to be performed must be selected as
follows.
Steps
1. Choose the jaw and then osteotomy type(s).
When opening the tool for the first time, Maxilla osteotomies and LeFort
I, One-piece is selected by default. By selecting Mandible the mandible
osteotomies can be shown.

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For the maxilla the following osteotomy types are provided:

• LeFort I One-piece
• LeFort I Two-piece
• LeFort I Three-piece
For the mandible, the following osteotomy types are provided:
• Ramus cuts:
• BSSO Hunsuck
• BSSO Obwegeser
• Inverted L
• Vertical Ramus
• Genioplasty
NOTE
Maxilla and mandible osteotomies must be planned in separate steps I.e.
one jaw at a time.
2. Click Next.
NOTE
Some of the osteotomies must be performed in several steps. For
example when performing LeFort I two-piece or three-piece, LeFort
I one-piece is first performed. Detailed descriptions of the workflows
are shown in sections "Maxilla osteotomy workflows" on page 370 and
"Mandible osteotomy workflows" on page 371.
7.9.8.2 Defining shape of osteotomy template
About this task

To be able to define the shape of the osteotomy template, landmarks
suggested by the software must be placed.

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Depending on the selected osteotomy type, the software will show a list of
landmarks to be placed, below an example of BSSO Hunsuck.
The software will select the first undefined landmark, I.e. a landmark marked
with red colour, on the list. To help identify the landmark, an illustration of
the selected landmark is displayed on top of the list. In the osteotomies that
require placing several points on different sides of the jaw, the 3D model
of the jaw is also automatically rotated to the angle corresponding to the
illustration.
Steps
1. To place the landmark, click on the desired position in the 3D rendered
view or the slice views.
The landmark appears in the 3D and slice views.
The name of the landmark will turn grey on the list and the software will
automatically select the next undefined landmark. The illustration of the
following landmark is also shown.

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2. Continue to place all the landmarks on the list as instructed by the

illustrations.
When all the landmarks have been placed, the illustration is changed to
show the complete osteotomy.
What to do next
To change the location of a landmark, reselect the landmark from the list and
click on the desired position in the 3D rendered view or the slice views.
7.9.8.3 Adjusting the osteotomy template
About this task

After all the landmarks on the list have been placed, the selected osteotomy
template, here BSSO Hunsuck, is shown in all views.

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The osteotomy lines can now be adjusted manually in the 3D rendered view.
To change the shape of the template:
Steps
1. Hover over a red control point until it turns green.
2. Drag the control point to adjust the template.
In the case of BSSO Hunsuck, to rotate the plane between points 1 and
2 hold down the Alt-key while selecting the control point.

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The cross-sections of the osteotomy lines can also be seen in red colour
in the slice views. The changes are updated dynamically.
7.9.8.4 Marking tooth roots
About this task

During osteotomy planning, tooth roots can be marked and their distance to
the nearest cutting plane shown.
Mark tooth roots as follows.
Steps
1. Click Measure distance to nearest osteotomy plane to activate the tool.
2. Click on the desired position in the 3D rendered view or the slice view to
mark the root.

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3. In the opening window, enter a name for the root point and click OK.
Results
The root name and its distance in mm to the nearest cutting plane are shown
in pink in the slice and 3D Rendered View.
The root is also added to the Root Tips list.
The closest cutting plane is green coloured if the root tip is selected from the
Root Tips list. The distance is updated when the cutting plane is moved.
If perpendicular distance of the root tip to any of the osteotomy planes
cannot be calculated the value NaN is displayed.
TIP
Switch to volume rendering view to improve visibility of roots in 3D rendered
view.

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7.9.8.5 Verifying osteotomies
About this task

Once the osteotomy lines have been defined, the virtual osteotomy can be
performed.
Steps
1. Select Cut.
After the software has finished processing, the new bone segments are
selected and shown as superimposed to the Initial position in the slice
and dental model views.
2. Use the views to verify the plan visually.

3. Verify the plan also using the Segment Tree.
The Segment Tree is updated with the new segments and the dental
models are moved to the new segments.
NOTE
In Le Fort I two- and three-piece the upper dental model is divided into
three parts.
Anatomical landmarks are moved to new segments, with the exception

of user defined landmarks. They should be moved, I.e. dragged to the
correct segment in the Segment Tree.
What to do next
To adjust the osteotomy lines, move the control points and select Recut.
To also reset the landmarks, select Back and repeat the steps.

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7.9.8.6 Finalizing osteotomies
About this task

When the osteotomy is as desired, proceed as follows.
Steps
1. Select the appropriate option to continue.
• If the selected osteotomy requires planning in more than one step,
Next button is shown. Select it to continue to the next step.
• If the first osteotomy is now complete but the osteotomy for the other
jaw has not been planned, the planning steps must be repeated for
the uncut jaw. Use the Maxilla/Mandible buttons on the top row to
view the osteotomy options.
2. If all osteotomies have been completed, click Create Osteotomies to end

the osteotomy planning.
Results
Upon closing the tool, the software will create a new Initial position to the
Saved Positions list.
NOTE
It is the responsibility of the user to verify that the osteotomies were correctly
performed. The osteotomy lines are shown as long as the tool remains open.
NOTE
It is the responsibility of the user to ensure that the objects included in the
plan reside on the correct segments after cutting. Failure to do so may result
in incorrect cephalometric analysis and distance measurement values to be
displayed after the segments are moved.
What to do next
Continue to section "Surgical planning, Step 4: Fitting target model" on page
376.

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7.9.8.7 Maxilla osteotomy workflows
LeFort I one-piece
LeFort I two-piece
NOTE
This osteotomy is performed in two steps. In the first step, LeFort I one-piece
is first performed. In the second step, additional osteotomy lines are defined.
LeFort I three-piece
NOTE
This osteotomy is performed in two steps. In the first step, LeFort I one-piece
is first performed. In the second step, additional osteotomy lines are defined.

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7.9.8.8 Mandible osteotomy workflows
BSSO Hunsuck

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BSSO Obwegeser

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Inverted L

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Vertical ramus
Genioplasty
NOTE
If genioplasty is combined with another mandible osteotomy, genioplasty is
performed as the second step.

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7.9.8.9 Undoing osteotomies
Before you begin
NOTE
Recutting will permanently delete all previously created surgical plans and
related items such as performed movements, Saved Positions, splints, target
model fittings, user added measurements between landmarks, etc.
This operation is irreversible.
About this task

Follow these steps to recombine either the maxilla or mandible.
Steps
1. Click Create Osteotomies.
2. Unselect:
• LeFort I tick-box for Maxilla

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• Ramus cuts and/or Genioplasty tick-boxes for Mandible
3. Select Uncut.
Wait until the software has finished the calculation.
Results
The uncut maxilla or mandible is shown in all of the views and the Segment
Tree is updated.
7.9.9 Surgical planning, Step 4: Fitting target model
About this task

The aim of this step is to move the cut bone segments to the designed target
occlusion. It also allows the simulation of condyle rotations if performed prior
to osteotomies for the uncut maxilla and mandible.
NOTE
Fitting target model is optional. If you are not using a target occlusion model,
proceed to section "Surgical planning, Step 5: Moving segments and saving
plans" on page 383. In this case, the movement planning starts from the
Initial position.

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The workflow depends on the performed osteotomies and whether the user
is using a virtually planned digital occlusion model.
Steps
1. Click Import Target Occlusion.
2. Select the appropriate option from the opening dialog.
• Import and fit the target occlusion model manually:

This option allows to manually fit the target model with the pre-
operative models.
Depending on the osteotomy types that have been used, the
following model is shown on the left side on the window:
• Le Fort 1 – one-piece + Any mandible osteotomy type (+
genioplasty or not): Upper dental model
• Le Fort 1 – two-piece + Any mandible osteotomy type (+
genioplasty or not): Right piece of the upper dental model
• Le Fort 1 – three-piece + Any mandible osteotomy type (+
genioplasty or not): Middle piece of the upper dental model
• Maxilla osteotomies only: Lower dental model
• Mandible osteotomies only: Upper dental model
• Genioplasty only: Target occlusion fitting not applicable
In this example the workflow is described for a bi-maxillary case with
Le Fort I, One-piece and BSSO Hunsuck osteotomies.
Continue to step 3 and follow the instructions.

• Move segments to the occlusion defined by the virtual occlusion of
the current preoperative models:

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This option can be used if:

• The target occlusion has been designed virtually and the
occlusion model is available as separate upper and lower models
containing the occlusion information.
• These upper and lower models of the virtual occlusion have been
used as the preoperative models and fitted with the CBCT data
during preparation phase of the surgical planning.
• LeFort I 2-piece or 3-piece has not been used.
If these requirements are met, the software can read the occlusion
information and hence move the bone segments to the target
occlusion position without manual fitting.
Click OK and continue to step 9.
NOTE
It is the user’s responsibility to ensure that the virtual occlusion
models used contain the needed information. Verify occlusion and
the segment positions before continuing planning.
3. Proceed with the appropriate option:
• If target occlusion model has not been imported to the patient click
Browse to import the model from the file system.
Select the model and click Open.

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• If the target occlusion model has been imported click Select and
select the target occlusion model from patient's dental models.
4. Define the up/down, left/right, posterior/anterior directions for the target

occlusion model.
4.a. Rotate the red handle to orientate the model as illustrated.
4.b. Use the Direction buttons to change viewing direction.
4.c. Click OK to finish.
The target occlusion model appears on the right.

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5. Fit the target occlusion model to the upper dental model by painting
similar areas on both models.
The paint brush tool is activated in both views. Use the left mouse button
to mark the same areas in both models.
To adjust the size of the paint brush, hold down the Alt key while
To rotate both models simultaneously use the right mouse button or hold
down the Alt key.
For a good fit, areas on all sides of the model should be marked.
To clear all markings, use these buttons on the right side of both
windows.
6. Click Fit models.

The target occlusion model appears on the left and the fitting is
performed.

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7. Check and verify the fitting.

7.a. Click Modify areas to go back to marking the areas and adjust the
selection of the areas.
7.b. Click Next to continue to fitting the lower models.
8. Repeat the same steps for the lower models.
Pre-operative model shown on the right.
9. Click OK to Finish.
Results
The bone segments are moved to the target occlusion. The moved
segments are superimposed in yellow in the slice views.

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Use the slice views to verify that the upper and lower models are correctly
fitted to the target occlusion so that the outlines of both models are
superpositioned.
The Target Occlusion position is saved also to the Saved Positions list
Click on this row to re-open the position.
NOTE
It is the responsibility of the user to verify the target occlusion position.
Failure to do so may result in incorrect surgical plan.
What to do next
Continue to section "Surgical planning, Step 5: Moving segments and saving
plans" on page 383.

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7.9.10 Surgical planning, Step 5: Moving segments and saving plans
About this task

To begin moving segments and saving plans:
Steps
1. Click Plan Movements.
7.9.10.1 Default selections

When Plan Movements is selected, the different options for moving the bone
segments are shown.
1 Move bimaxillary complex: This option automatically selects the
bimaxillary complex segments and sets the rotation centre to
Anterior Nasal Spine (ANS).
2 Rotate left ramus: This option selects the left ramus segment and
sets the rotation centre (CoL) Condylion Left.
3 Rotate right ramus: This option selects the right ramus segment
and sets the rotation centre Condylion Right (CoR).
4 Move chin: This option selects the chin segment and sets the
rotation centre to Anterior Nasal Spine (ANS).
5 Move selected segments: This option allows the user to freely
select the segments to be moved from the Segment Tree and sets
the default rotation centre to Anterior Nasal Spine (ANS).
6 Rotate around condyles: This option selects the both rami
segments and allows to rotate them around an axis defined by
(CoL) Condylion Left or Condylion Right (CoR) landmarks.
Options 1, 4 and 5 allow to rotate and translate the specific segments in all
three directions. Options 2 and 3 allow only rotation in all directions.
One or all of these options are displayed depending on the osteotomies that
have been performed:
Bimax Mandible only Maxilla only Genioplasty

Move bimaxillary x
complex
Rotate left ramus x x
Rotate right ramus x x
Move chin x
Move selected x x x
segments
Rotate around x
condyles
An example with the options given for bimaxillary operation with genioplasty
is shown below:

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7.9.10.2 Defining movement value

After the user has selected one of the movement options described in
section "Default selections" on page 383, the segments are positioned to
the Target Occlusion position. In case the Target Occlusion position does
not exist, the Initial Position is used.
To define the rotation and translation values, use the sliders or enter the
desired value in the value field. The movement applies to the selected bone/
dental model segments. The selected segments can be checked from the
Segment Tree, for more information see section "Adjusting hierarchy and
visibility of items using Segment Tree" on page 351.
Rotations are in degrees and translations in millimetres. The step size is 0.1
in millimetres or in degrees.

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If the bone selection or the rotation centre is changed, the numerical fields
and sliders are reset to zero.
The coordinate system is defined by the head orientation as set by the user,
see section "Surgical planning, Step 2: Defining head orientation" on page
361.
In the 3D view, the axis direction is visualized with Red = X = Pitch, Green =
Y = Roll and Blue = Z = Yaw.
The sign is determined by the right-hand rule.

The rotation values are expressed in relation to a selected rotation centre.
The most commonly used rotation centres are listed on the Rotation centres
list.
The currently used rotation centre is indicated with the blue background in
the Rotation Centers list and with a coordinate system in 3D rendered view.
Below an example with Anterior Nasal Spine (ANS) selected.
TIP
The user may always return the segments to any of the saved positions and
start moving segments from that position by selecting the desired position
from the Saved positions list.
7.9.10.3 Changing rotation centres

Each movement option 1-6 has a predefined default rotation centre, listed
in section "Default selections" on page 383. This predefined rotation centre
is selected by the software automatically, unless the landmark used as the
rotation centre has not been set by the user. In this case, the undefined

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rotation centre must be set as instructed in section "Setting undefined

rotation centre" on page 386.
The rotation centre can be changed by selecting the desired rotation centre
in the Rotation Center list.
7.9.10.4 Setting undefined rotation centre
About this task

If the selected rotation centre is undefined, I.e. the user has not set the
landmark during the previous phases of the planning, the following warning
message appears:
Follow these instructions to set the selected rotation centre.
Steps
1. Select the undefined landmark from the Rotation Centers list, here for
example (CUI) Center of upper incisors.
2. Click Add new rotation center.
3. Click on the desired area in slice or 3D rendered view.
Results
The rotation centre name turns grey in the Rotation Centers list to indicate
that the landmark has been set.

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7.9.10.5 Adding new rotation centre
About this task

Follow these instructions to add a new rotation centre.
Steps
1. Click Add new rotation center.
2. Click on the desired area in slice or 3D rendered view.

3. In the opening window, enter name for rotation centre.
4. Click Add new rotation center to close the tool.
5. Select the new rotation centre from the Rotation Centers list.
Results
Movement values have been set to 0. Movements can now be specified
using the new rotation center.
7.9.10.6 Tools for symmetry evaluation

The current segment positions can be analysed in the Analysis dialog. This
requires that the corresponding landmarks have been placed. See section
"Placing anatomical landmarks" on page 335 for more information.
To evaluate patient symmetry visually, position the patient perpendicularly to
the head orientation axes by:
• Using the three orientation buttons on the upper right corner of the 3D
rendered view.
• Turning on the grid overlay.

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7.9.10.7 Saving movements as Saved Position
About this task

Once the movement planning is completed, save the position of the
segments and generate the intermediate position (bimaxillary case only) as
follows.
Steps
1. Click this button to save the current position.
The options shown in the opening dialog depend on the osteotomy types
that have been planned.
• In bimaxillary case:
• Save the final position and create an intermediate position for
Maxilla first or Mandible first operation order, or
• Save a single position by checking the Save position check-box.
• In single jaw case, save a single position by checking the Save

position check-box.
2. Define the name and select OK.
Results
Depending on the selection, the new positions appear in the Object Browser
in the Saved Positions list.
• Final: this is the user-defined post-operation position of the bone
segments.
• Final intermediate: in this position, when Maxilla first is selected, maxilla
is in its post-operative position, while the mandible maintains its pre-
operation position. When Mandible first is selected, the intermediate
position is inverted.
In this example, a final position with automatically created intermediate
position with maxilla first operation order is shown:

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Open the positions by selecting the desired row from the Saved Positions list
and verify the plan.
What to do next
Continue to section "Surgical planning, Step 6: Designing splints" on page
389.
7.9.11 Surgical planning, Step 6: Designing splints
7.9.11.1 Autorotation
About this task

In bimaxillary case, after the first jaw is operated, the moved bone segments
may push the mandible to rotate around the condyle points. This is called
autorotation. To create a realistic intermediate splint, the mandible has to be
manually rotated until a good position is achieved.
To simulate the autorotation:

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Steps
1. Use the slider under intermediate position to adjust the position.
The amount of rotation may be visually checked from the slice views and
the dental model view.
7.9.11.2 Splint design
Before you begin
NOTE
The splint design functionality is not available in the United States and
consequently the splint design button is not shown under Post-processing
tool bar.
About this task

Follow these steps to design splints.
Steps
1. Select the saved position, for example Final or Final intermediate
position, to which the splint is designed in the Object Browser.

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2. Click Splint Design to open the Splint Design tool.
In the launched dialog, the splint upper and lower limits can be set.
The list on the right of the dialog shows the six landmarks that need to
be placed. The first landmark on the list is automatically selected and an
illustration of the landmark is shown.
3. Left-click on the dental model to indicate the upper limit on the left side of
the model.
The next landmark is automatically selected and the preview image
updated. Left-click to place the lower left limit.
The software will then automatically turn the model to face the front for
placing the next two landmarks. The same is repeated in the right side of
the models.
To change the location of a landmark, reselect the landmark from the list
and left-click to place it again.
NOTE
The splint limits can still be fine-adjusted in the next step.
4. Click Next to continue.
Results
The following dialog is launched:

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What to do next
In this dialog you can:
• Adjust splint thickness.
• Adjust the upper and lower perimeters of the splint.
• Add fixation holes.
• Visualize a 3D preview of the current design.
• Generate the splint and verify the splint design.
7.9.11.3 Adjusting splint thickness
About this task

The views in the top row are used to adjust the thickness of the splint by
using the red, blue and green control points.
Steps
1. Use Adjust upper or Adjust lower to select either upper or lower control
points on both sides of the model.
2. Activate the control point by hovering the mouse over it.

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3. When the control point turns solid green/red/blue, drag with the left
mouse button to adjust the thickness.
NOTE
The control points on both sides of the model define a single plane.
Therefore, adjusting the location of the plane on one side of the model
affects the location of the plane in the other side as well. For example, if
thickness on the left side is increased, the thickness is slightly decreased
on the right side.
7.9.11.4 Adjusting splint perimeters
About this task

The views on the right and left side of the bottom row allow adjusting the
splint perimeter.

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The splint perimeters are adjusted by using the white control points as
follows.
Steps
1. Activate the control point by hovering a mouse over it.

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2. When the control point turns solid pink/blue, drag with the left mouse
button to move the control point.
NOTE
Check and take into account the printing requirements, such as leaving
enough space to the outer side of the splint.
7.9.11.5 Visualizing 3D preview
About this task

The view in the middle of the bottom row can be used to check the 3D
preview of the current splint design. In this view the models can be rotated
with left mouse button.

7 3D module
Steps
1. Click these buttons to view:
upper model only with splint
both models with splint
lower model only with splint
splint only
7.9.11.6 Adding fixation holes
About this task

Follow these instructions to add holes that allow fixing the splint to the
braces.
Steps
1. Click this button.
2. To add a fixation hole, left-click on the upper perimeter.

A white control point will appear on the image.
3. To move the control point, activate the control point by hovering a mouse
over it.
When the control point turns solid blue, drag with the left mouse button.

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The fixation holes are shown also in the 3D preview image with blue
cylinders.
To remove a fixation hole, right-click on the control point. The control

point will turn yellow in upper perimeter and 3D preview windows. Click
on the trash can icon to remove the control point.
7.9.11.7 Generating splint
About this task

Follow these instructions to generate the splint based on the plan.
Steps
1. Define the tolerance setting.
This sets the space between the teeth pattern on the splint and the
dental model used for splint generation. By default, the value is set to
0.13 mm.
2. To generate the splint, click the Generate Splint button.

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3. Read carefully and accept the disclaimer to continue.
Depending on the computer hardware, the generation can take several

minutes.
The splint appears on the 3D preview window.
4. Check and verify the splint.

If the splint is not as desired, use the tools again to adjust the shape and
then regenerate the splint. Adjusting the splint is possible as long as the
splint design window remains open.
5. Finally, click OK to close the tool and to import the designed splint into
the surgical plan.
Results
The splint appears in the surgical plan.

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The splint is also added to the Object browser under the Saved Position to
which it was designed to.
What to do next
Use the views to verify the fit of the splint.

7 3D module
7.9.11.8 Exporting splint
About this task

Follow these steps to export a splint.

7 3D module
Steps
1. Open the position that includes the splint by selecting it from the Saved
Positions list.
2. Click this icon on the top toolbar.
The following dialog opens.
3. Select the items to be exported, the export location and file name.
4. Click OK.
7.10 Jaw motion module
7.10.1 Visualising jaw movements in real time

When the system is in ready-state, the jaw movements can be viewed live
in Planmeca Romexis and can be recorded for later analysis, see section
"Recording jaw movements" on page 402.

7 3D module
Ask the patient to perform the needed movements.
Moving and rotating surface models

To rotate the surface models, drag the left mouse button.
To move the surface models, drag the left mouse button while holding down
the Alt key.
Snap shot
Use the Snap shot tool at the top-right corner of the 3D View window to take
a 2D image of the view as it appears on the screen. The snap shot can be
viewed in the 2D Imaging Module.
Showing /hiding 3D objects

To show/hide 3D object, click the eye icon in the object browser. Note that
also the hidden 3D objects are saved with the image.
7.10.2 Recording jaw movements
About this task
NOTE
The jaw movements can be recorded with Planmeca ProMax 3D Mid
(K103689), 3D Max (K093590) and Viso G5/G7 (K181576) x-ray units.
Steps
1. To enable recording, click START CONNECTION.

7 3D module
2. Click the Record button.
The ongoing recording is shown on the top right corner of the window
and in the Recordings menu.
3. When done re-click the Record button.
4. Enter a name for the recording and click OK.
Results
The recording now shows in the recordings list.
7.10.3 Recording workflow templates

Recording workflow templates can be used to create standard protocols for
recordings. A recording workflow template contains a certain sequence of
blank recordings on top of which recordings can be made.

7 3D module
A new recording workflow template can be saved either from an existing list
of recordings or from a list of blank recordings.
7.10.3.1 Saving current list of recordings as template
Steps
1. Record movements normally and name the recordings as you would like
them to appear in the template.
2. Click the Save current recording as a recording workflow button.
3. Enter a name for the workflow template and click OK.
Results
The saved workflow appears in the Recording workflow drop-down menu.
7.10.3.2 Saving list of blank recordings as template
Steps
1. To add a blank recording to the Recordings list click the Add button.

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2. In the opening window enter a name for the recording and click OK.
The recording appears in the Recordings list.
3. Repeat the steps 1-2 until all blank recording rows have been added.
4. To save the list as template, click on Save current recording as a
recording workflow button.
5. In the opening window, enter a name for the Recording workflow

template and click OK.
Results
The template appears in the Recording workflow drop-down menu.

7 3D module
7.10.3.3 Making recordings using workflow template
Steps
1. Select a template from the Recording workflow drop-down menu.
The blank recordings appear in the Recordings list in red.
2. Select the blank on which you want to record from the Recordings list.
3. Start the recording by clicking this button.
The ongoing recording is shown in the Recordings menu.
4. When ready stop the recording by re-clicking the Record button.

7 3D module
Results
The name of the recording on the Recordings list turns grey.
7.10.3.4 Deleting recording workflow template
Steps
1. Select the recording workflow template to delete in the Recording
workflow drop-down menu.
2. Click Delete selected workflow.
3. In the opening window, click Yes.
Results
The recording workflow is removed from the drop-down menu.
7.10.4 Viewing jaw movement recordings
About this task

Follow these instructions to view jaw movement recordings.

7 3D module
Steps
1. Select the recording you want to view and click the Play button.
When the recording is playing the green playback symbol appears on the
top left corner of the window.
To pause the recording, click Pause.
To stop the recording and return to the start, click Stop . The chart views
and measurements are reset.
The recording progress displays on the time line.
7.10.4.1 Moving manually in recording

• Use the slider to move forward or backward second by second.
• Use the arrow buttons to move forwards or backwards frame by frame.
7.10.4.2 Adjusting speed of recording

• Slow the speed to one quarter or half of the normal speed by selecting
1/4x or 1/2x.
• Double the normal speed by selecting 2x.

7 3D module
7.10.4.3 Adding points of interest to time line
About this task

The TimePOI tool allows you to create quick links to specific time points in
each recording.
Steps
1. Play the recording or move the time line slider to the intended time point.
2. Click the Add new TimePOI button.
Results
The TimePOI is marked on the time line with a dashed vertical red line and is
added to the Recordings list.
What to do next
To change the name of the TimePOI use the wrench tool.
To view the time point, click it on the Recordings list.
7.10.4.4 Use calibration

Select/deselect to view recordings with or without calibration.
• This is a global setting i.e. it cannot be set individually for each
recording.
• After calibration, this setting is selected by default.

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• The setting is disabled if a recording is played, paused or a TimePOI is

selected.
• If none of the cases mentioned above apply and the setting is still
disabled, there is no existing calibration for the system.
• The setting is taken into account when exporting jaw motion files. For
more information, see section "Exporting jaw motion files" on page 414.
7.10.5 Analysing recorded jaw movements
7.10.5.1 3D View
Use the annotation tools to add annotations, length and angular
measurements.
Adding point measurements

To add a point measurement, click this button and then click on the
mandible/maxilla surface.
The point shows as a coloured ball on the image (Point 1 on the image
below).
When the patient moves the lower jaw the point location can be seen as a
2D plot of two axes (YZ, XZ or XY). Alternatively, the location of the point
can be visualised as a function of time (see section "Chart views" on page
412)

7 3D module
Adding line measurements

Click at two points.
Two small balls and a connecting line is created (Length 1 in the image).
• When both points are placed on the mandible or on the maxilla a simple
distance measurement is created. This measurement does not change
during tracking.
• If one point is placed on the maxilla and the other on the mandible, the
length of the measurement changes when patients move their jaw. This
can be visualised as a function of time (see section "Chart views" on
page 412).
Adding angular measurements

Click on the model to insert the middle point, then click to add two-line
segments. An angle between the two-line segments is created.
• If all the points are added on the maxilla or on the mandible a simple
angle measurement is created and it will not change as the patient
moves their jaw.
• If one of the points is located on the mandible and the other two on the
maxilla (or vice versa) the angle will change as the patients move their
jaw. This can be visualized also as a function of time in the chart views
(see section "Chart views" on page 412.

7 3D module
Annotation properties
All added measurements are shown in the Object browser under
Annotations. The default colour for all annotations is red.
The current length and angle measurement values are displayed after the
annotation name during movement. For a point measurement, the current
coordinate values are displayed.
To change the colour of multiple measurements, check the measurements

and use the Choose Color tool.
The colour selected for the measurement is used also in the 3D view and in
the charts.
The default text for a new annotation is POI N', Length N X or Angle
N X where N is a consecutive measurement number and the X is the
value. The value changes as the patient moves during tracking. For a POI
measurement, the coordinates are shown during tracking in format POI N
(x,y,z).
The text field can be modified by using the wrench tool. The same text is
shown in the 3D view and in the charts.
The visibility of the measurements in the 3D view is controlled using this
button.
To remove measurements, check the ones you want to remove and click the
Delete selected button. Note that removing a measurement removes it from
the Object browser, from the 3D view and from the charts.
7.10.5.2 Chart views

The values of the measurements can also be visualised in the chart views.
The measurements selected in the Annotations list are shown in the charts.
The selected measurement (default value), shows with white font and blue
border and the unselected measurement in grey font with no border.
NOTE
The reference coordinate system in which the added point measurements
are shown should be verified. For more information, see section "Viewing
reference coordinates" below.
The scale of the charts is adjusted automatically.

The following chart options are available:

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POI Projection
Shows a 2D plot of two axes in all three directions (Sagittal, Coronal, Axial)
for a point measurement.
Each measurement’s change from its starting position is shown.
POI versus Time

Shows X, Y and Z-coordinates as a function of time for a point
measurement.
Distance/Angle versus Time

Values of the distance and angle measurements as a function of time.
Resetting charts
To reset all charts and timer click the Reset charts button.
Viewing reference coordinates

To view the coordinate system in which the added point measurements are
shown in the POI charts click on this button.

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To adjust the 2D graph projection planes, move the control gimbal by

dragging it with the left mouse button.
Chart view angle measurement

To make angle measurements in the chart views, click this button. To
measure the angle in relation to:
• The vertical plane: click with the left mouse to indicate the starting and
end points of the measurement.
• The horizontal plane: hold down the Alt key when indicating the starting
point, then click the end point of the measurement.
A line is drawn between these points and the measured angle is shown.
To zoom in the chart view, click and draw the area to be zoomed by
dragging with left mouse button.
To zoom to fit, click and drag with the left mouse button from the lower right
corner to the left upper corner. The chart view is automatically fitted with the
plot.
7.10.6 Exporting jaw motion files
About this task

Follow these instructions to export jaw motion files.

7 3D module
Steps
1. Click Export.
2. Select the export type and options (see descriptions below) and click
OK.
Export type
• 4D Case Export
Export the entire case (CBCT image, jaw models, recordings and
measurement data).
• STL models in current position
Export the stl models as currently displayed on screen.
Export options
Include POI measurement coordinates in .csv format
Export the POI coordinate values per frame separately for each
recording. For each POI a separate folder is created, where the related
excel files are placed. The files are named as the recording in question.
The POI folders can be found in measurements folder at the root of the
export folder.
NOTE
If exporting POI coordinates with Viewer, the measurements folder is
located under data\images\FileName.
Viewer options

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For more information, see section "Viewer options" on page 443.
7.10.7 Creating and saving reports
About this task

Follow these instructions to create and save reports.
Steps
1. Click the PDF button.
2. Enter clinic and patient information.

3. Select the recording(s) and annotation(s) to be included in the report.
4. Click Browse to select the folder where to save the report.
5. Click Save.
6. Click Close and preview or Close.

7 3D module
7.11 3D top toolbar

The 3D module’s top toolbar contains tools common to all main views of
the 3D module. In the following their functions are explained in brief and
references to sections providing more information are listed.
NOTE
To activate all tools in the toolbar a volume must be opened.
7.11.1 Importing 3D images
About this task

3D images can be imported in DICOM Multiframe, DICOM Single frame,
STL, OBJ, PLY and PRO (ProFace image) file formats.
Steps
1. Click Import.
2. Select file to import.
For DICOM Single frame images all single files must be selected.
Files can be filtered by image format.
3. Click Open.

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7.11.2 3D capture
Before you begin
TIP
See also Planmeca ProMax 3D/Dimax3/Viso user’s manual.
NOTE
Do not use the software for other tasks during exposure.
About this task

Follow these instructions to take a 3D capture.
Steps
1. Start exposure by clicking this button.
TIP
To take 2 scout images before the 3D exposure, see Planmeca ProMax
3D user’s manual.
2. Select capture options (see detailed descriptions below).
Artefact removal level

Select artefact removal level (None / Low / Med / High).
Use higher settings if there are high density materials (such as amalgam
fillings) in the exposed area.
Automatic artefact removal can be applied to all new exposures. This
eliminates the need to remove artefacts separately from each volume.
The following preset artefact removal options are available:
• None – no artefact removal is applied
• Low – low threshold level for minimum effect on anatomic
information.

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• Mid – medium threshold level to compromise between artefact

reduction and effect on anatomic information.
• High – high threshold level for maximum artefact reduction with the
risk of effect on anatomic information of hard tissue.
TIP
To change the default artefact removal level, see section "Default
artefact removal" in Planmeca Romexis technical manual. The default
level setting can be overridden per exposure using the buttons as
described above.
See section "Artefact removal" on page 422 for more information.

HU Correction
HU correction provides more uniform HU-values on volume edges.
NOTE
When using Reco PC software revision 3.6.0.R or later HU correction
must be enabled for patient imaging. Only for calibration phantom
exposure or when exposing some other non-living object it must be
disabled.
AINO filter
NOTE
AINO filter increases image reconstruction time.
AINO (Adaptive Intelligent Noise Optimiser) is a 3D noise filter that

reduces noise in CBCT images with minimal loss of detail. The filter
analyses exposure data during reconstruction and differentiates noise
and fine details. It is most useful for images with very small voxel size or
very low radiation dose.
The AINO Filter is available only on supported hardware combinations,
contact your local sales representative for more information.

7 3D module
The original image is stored in the reconstruction PC (100 exposure

buffer).
To recall the original image, select File > Capture >Redo 3D
reconstruction.
Results
The study is a saved in patient files and displayed on the screen.
If ProMax 3D stitching mode is used, the stitching window opens in
Planmeca Romexis, see section "Stitching volumes" on page 423 for more
information.
7.11.3 3D model capture
CAUTION
Use 3D model capture only to scan dental models or plaster casts, never on
patients.
The 3D Model Capture is intended to be used with Planmeca ProMax 3D
unit’s model scan program. The program automatically generates 3D surface
dental models. The models show in the Files module once the exposure is
completed.
NOTE
Only the surface model is stored into Planmeca Romexis image archive, the
CBCT volume is discarded.

7 3D module
The surface models can be viewed and processed in the Surface module
and exported to other software using the Export Volume tool, for more
information see section "Exporting CBCT image with ProFace images" on
page 327.
For step-by-step instructions on how to take exposures on dental models,
see your Planmeca X-ray unit user’s manual.
The digital casts can be used for electronic archiving of the impressions or
they can be turned into STL surface models for further use in Planmeca
Romexis or other treatment planning software. See also sections "Importing
3D images" on page 417 and "3D Noise filter (noise removal)" on page 182.
Select material
Select calibrated material that was used for dental impression to be
scanned.
NOTE
All material must be calibrated in order to produce accurate scans.
Add material
After crafting a calibration target for Planmeca ProMax, use this button to
start a calibration scan and to name the calibrated material for later use.
Calibration exposure values are automatically predefined to the material
name.
The Model Capture should always be done using exposure values identical
to those of the calibration scan.
Remove material
Select the material to remove from the list of calibrated materials.

7 3D module
7.11.4 Artefact removal
About this task

Objects of high density, such as amalgam or other metallic bodies,
can cause artefacts on X-ray images as the radiation cannot penetrate
them. Artefact removal is not automatically applied when the volume is
reconstructed, but if disturbing artefacts are present after a successful
capture, recalculate the volume using the artefact removal algorithm (ARA).
Steps
1. Align the axial view so that the whole teeth arch can be seen, and the
maximum amount of amalgam shows in axial view.
Use the sagittal (or coronal) view for the alignment
2. Click Artefact removal on the top tool bar.
3. Set the artefact threshold between 0 (pure black) and 4096 (pure white)
using the slider.
For amalgam the approximate value is 4000).
Decreasing the threshold allows you to remove potential artefacts
(darker shades of gray), and increasing the value brightens the
colours and removes less potential artefacts. A decrease in threshold
value makes suspect areas more likely to be considered for removal.
Therefore, a decrease in value may also increase the processing time as
more areas need to be processed.
4. When adjusting the slider from right to left, pay attention to the axial view
aligned in step 1.
The areas of amalgam, which are normally bright white, turn red.

7 3D module
NOTE
Adjust the threshold only until amalgam or other metallic bodies appear
red, not more. Too aggressive settings may affect dentin.
5. Move the slider to the left until all presumed areas of amalgam have
barely turned red and the dentin remains white or light grey.
NOTE
Too many red areas can extend the recalculation time and produce
unwanted results. Adjust threshold separately for each volume.
6. Start artefact removal by clicking Apply.
The reconstruction PC will start a recalculation of the 3D volume,
ignoring all areas (voxels) above a certain grey level, which have been
flagged as undesired in step 3 by colouring them red. Leaving the
problematic areas out of the calculation will remove artefacts caused
by amalgam or other metallic bodies from the recalculated volume. The
bodies that caused artefacts will, however, still be visible.
7. Click Done to finish.
NOTE
If the volume was taken with Planmeca Romexis version 1.4 or older
you the right frameset ID must be manually selected. Planmeca Romexis
requests the original frame sets from the reconstruction PC. If the correct
frame sets are not on the PC anymore the artefacts cannot be removed.
7.11.5 Stitching volumes
About this task

By joining together two or more volumes of neighbouring anatomy larger
volumes than the maximum size of 8 x 8 cm of Planmeca ProMax 3D can be
created.
NOTE
For vertical stitching the volumes must be manually pre-aligned in Planmeca
Romexis using the Auto with tilt stitching mode.

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Volumes can also be re-stitched and the volumes captured in some other
imaging mode can be manually aligned.
NOTE
With stitching all volumes are converted into the size of 300 µm resolution
corresponding to the resolution achieved using ProMax 3D low dose mode.
NOTE
Before starting make sure the patient has at least two volumes suitable for
stitching.
Steps
1. Click Stitch volume on the top toolbar.
2. Select the volume to stitch from the drop-down menu.

3. Click Add.

7 3D module
4. Add other volumes for stitching.

In this image three volumes are correctly aligned.
In this image the volumes are incorrectly aligned.
If necessary the volumes can be further adjusted as follows:

4.a. Align the volumes as accurately as possible.
To align volumes side by side select Horizontal or select Vertical
to align them on top of one another.

7 3D module
4.b. Select Black or White background colour.

In some cases, it is more convenient to use the white background,
but the colour of the background does not affect the alignment
result.
5. Select alignment mode.

• Auto – creates best horizontal alignment after the volumes have
been roughly aligned. This mode is most suited for horizontal
stitching and is the default setting for horizontal stitching in Planmeca
X-ray units.
• Auto with Tilt – as Auto mode but considers also different rotations
for the volumes in case the patient’s head has tilted between
exposures. Most suited for vertical stitching and as a default setting
in vertical stitching imaging mode in Planmeca X-ray units.
• Manual – can be used if neither of the automatic modes does not
produce an adequate result.
If the volumes do not share anatomy in the same slice, the sliders can be
used to adjust the slices to view a common anatomy in all volumes. This
is necessary in vertical stitching, as the anatomy shown by the default
centre slice (125) of the top and bottom volume will be 2-4 cm apart.
Check/uncheck the boxes next to the sliders on the left to show/hide
volumes.
6. Click Stitch.
Results
The volumes are automatically stitched and fine-tuned. The stitched image is
saved.
7.11.6 Save view
About this task

Follow these instructions to save a view.
Steps
1. Save the current view on the screen by clicking Save View.

7 3D module
2. Enter a name for the view and click OK.
The views can be selected or deleted in the Object browser.
7.11.7 Restore view
About this task

To restore the original view:
Steps
1. Click Restore view.
7.11.8 Save 2D snapshots
About this task

This tool can be used to generate 2D snapshots of 3D volumes.
The snapshots will appear in the 2D module in CBCT group where they
can be processed, exported and printed using the tools described in the 2D
module.
Steps
1. Click the Snapshot button on the top toolbar.

7 3D module
2. In the appearing dialog, specify the image(s) or ranges of images to be

included in the snapshots, snapshot options and panel division.
• Create Snapshots as shown on screen

By default, this option is selected. To exclude a view click it in the
preview image.
• Snapshot Options
• Color image
If selected an 8-bit colour image will be created. If unselected a
12-bit grey scale image is created.
• Create single image
If selected, a single image is created. If unselected, single
images from different views will be created.
• Generated images as shown
If selected a snapshot with the same zoom level that is applied in
the underlying module is generated.
• High Resolution
Doubles the resolution of the image.
• Larger fonts
Generates larger font size for annotations.
• Set As Default preset
Sets the current values as defaults for the 2D snapshot dialog.
• Specify panel division
This option can be used to create slice snapshots in freely
configurable numbers and layouts from all available projections in
the underlaying 3D module. For example, it can be used to generate
multiple images that include cross-sectional slices from the full dental
arch with 1 mm spacing. The slice distance, thickness and width
are defined in the slice settings in underlying module. See more in
section "Slice and rendered views" on page 177.

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• Select Coronal, Sagittal and/or Axial panels.

• Specify the range of slices. The maximum number depends on
the slice settings in underlaying module.
• Choose the desired number of images and define the columns
and rows.
3. Click OK.
Results
The 2D snapshot are saved to 2D module under CBCT 2D category.
7.11.9 Virtual Ceph
About this task

This tool can be used to generate virtual 2D cephalograms from 3D volumes.
Steps
1. Click the Virtual Ceph button.
2. Select the desired projection direction and other settings.

• To rotate and align the volume use left mouse button. Note that the
projection is perspective free so the close and far anatomy can be
aligned perfectly.
• To rotate the volume sagittally (nodding) use the Ctrl + right mouse
button.
• To adjust contrast and brightness use Ctrl + left mouse button.
Use the direction buttons to set the direction of which the
cephalometric image should be generated. These can be used
together with crop options so that the far side of anatomy is removed
from the cephalometric image creating an image where duplicate
anatomy does not need to be considered.

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The following options can be selected from the drop-down menu:

• Default: Produces the most film like quality in the image.
• Flat: Flattens the image by reducing differences in contrast
between areas.
• Log: Adds contrast.
• To show/hide ruler check/uncheck the Rulers check box.
• To turn on/off the ProFace profile overlay, check/uncheck the
ProFace profile check box.
• To adjust the left/right positioning of the ProFace profile line, use
the scroll bar.

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Virtual cephalogram files are saved to 2D module's patient files.
3. Click Save.
The virtual cephalometric image is stored to 2D module under Ceph
category. Several cephalometric images with different settings can be
created during same session.
4. To finish click Close.
7.11.10 Image properties
About this task

To view the properties of the image.
Steps
1. Click the Properties icon on the top toolbar.

7 3D module
Results
File information, X-ray parameters and added comments are displayed.
• To save a diagnosis, click Diagnosis, type the diagnosis and click OK.

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• To view all image and DICOM parameters, click All Parameters button.
Click OK to close.

7 3D module
• To choose which parameters to display, select parameter and click Add

or Edit and select parameters from the menu.
7.11.11 Inactivating 3D image

See section "Inactivating images" on page 53 for detailed description.
7.11.12 Exporting objects
Before you begin

Make sure all the objects to be exported are set to show in the plan, (the eye
icon next to the object in the Object Browser is active).
Active
Inactive
About this task

The following objects can be exported from the treatment plan as STL
surface models:
• Dental models fitted with the volume.
• Segmented teeth, jaws, airways and any anatomies segmented with the
region grow or free region grow tools.

7 3D module
• Implants, fixation pins and their extensions as well as abutments

designed with the abutment editor. All implants and fixation pins,
including those added from the library, are exported as generic cylinders.
The optional implant extension in the export is not automatically the
same as the extension in the implant plan, but its dimensions can be
defined at export. Thus, the extension can be defined as e.g. an implant
abutment.
• Nerves and root canal nerves
• Implant guides designed in the Planmeca Romexis.
Follow these instructions to export objects.
Steps
1. Click the Export Objects button.

7 3D module
2. Fill in the STL export options.
• Select either:
Export to one STL file to merge and align the models as appearing
on screen.
or
Export to separate STL files to export models as separate files with
common coordinates.
With both options the objects retain their coordinates and appear
in the same positions in relation to each other as in the original
plan. For implant extensions dimensions need to be defined.
The dimensions for the extensions in the implant plan are not
automatically included in the export.
• Select the objects and object groups to be exported by checking the
respective boxes.
• Select the export folder and enter a file name.
3. Click OK.
7.11.13 Print images and edit layouts

See section "Printing images" on page 125.
7.11.14 DICOM print

For instructions on how to configure DICOM printer, see Planmeca Romexis
technical manual.

7 3D module
7.11.15 DICOM storage
Before you begin
NOTE
The service must be configured in the Admin module before use, for more
information, see Planmeca Romexis technical manual.
TIP
With DICOM full license, images can be sent to a remote DICOM
application, i.e. DICOM image archive (PACS).
About this task

Follow these instructions to use DICOM storage.
Steps
1. Open the image you want to store.
2. Click the DICOM storage button.
3. Select storage settings.

See section "DICOM storage settings" on page 438.
4. Click OK.
TIP
For automatic storage to DICOM archive, see instructions in Planmeca

7 3D module
7.11.15.1 DICOM storage settings
• AE title
Specifies the AE title of the PACS server where the image is to be
stored.
• Calling AE title
Shows the AE title of the current Planmeca Romexis workstation.
• Crop empty space from volume
Empty space from around the volume (from the top, bottom, left, right,
anterior or posterior) is removed before sending. a volume smaller in
size is sent compared to original volume.
• Advanced options
• Send axial, coronal, sagittal slices
By default only axial slices are sent. Additionally or instead coronal
or sagittal slices can be sent.
• Send Full Resolution / Specify Range
By default full range of thinnest possible slices (smaller range if
Crop Empty Space is selected) are sent. The range can be specified
with the starting and end points, distance between slices and slice
thickness all in millimetres. If start and end points are outside of the

7 3D module
volume after applying Crop Empty Space settings they are adjusted
to new volume limits.
7.11.16 Launch in external applications
About this task

Launch 3rd party applications from Romexis as follows.
Steps
1. Click the Launch button.
2. Select which applications to show in the Launch dialog in the Admin

module (see Planmeca Romexis technical manual for more information).
7.11.17 Cloud export
About this task

Follow these instructions to export to Planmeca Romexis Cloud.
Steps
case).

7 3D module
For more information on the Planmeca Romexis Cloud management,

see section "Cloud Management" on page 35.
7.11.18 Exporting volumes
About this task

Follow these instructions to export volumes.
Steps
1. Click this button.
2. Select the appropriate export options.

For detailed descriptions of the export options see the following sections.
7.11.18.1 File & format options

Planmeca Romexis can export 3D volumes in different formats:

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Single multi frame DICOM file

A single DICOM standard file that contains the 3D image data in a set of
frames.
Set of single frame DICOM files

A set of multiple DICOM standard files each of which contains a single
Frame of the 3D Image data.
If images are to be exported as they were originally captured, tick the Export
Original (not rotated) selection. All rotations and translations done to the
image afterwards will not be exported with this function.
Insert a blank writeable CD and click OK to start the CD creation.
Resolution
Select the desired resolution for exporting DICOM files from the Resolution
drop-down menu.
Bit depth
Select the volume bit depth, 12 or 15 bits.
Original orientation
Check this option to export images as shown right after exposure.
Export cropped
Check this option to export cropped volume when cropping has been
applied.
Lossless compression
Compresses volume approximately to the size of 1/3 of the original.
Anonymize
Remove personal identification information from the export DICOM file.
7.11.18.2 Overlay options
Burn nerves and implants

Select this option to export voxel representation of nerves and implants
present in the study.
Nerves and implants are burned to the image and thus cannot be edited
after export. Implants and nerves are burned to the image as they are seen
in 3D module.

7 3D module
Include nerves and implants

Select this option to export nerves and implants as editable Planmeca
Romexis objects. For the implants to appear as realistic implant models the
Romexis Implant Library must be locally installed. Otherwise the implants will
appear as cylinders.
Include annotations
Includes annotations (such as measurements, labels and arrows) as editable
Planmeca Romexis objects.
Include ProFace (.PRO)

Includes Planmeca ProFace images in the export.
Include ProFace (.OBJ)

Includes Planmeca ProFace images in the export.
Include fitted model

Includes intraoral scan in the export.
Include segmented teeth

Includes segmented teeth in the export.
NOTE
All surface models (ProFace & STL) currently visible in the 3D module
will be included in the export. To add or remove surface models from the
export use the 3D Overlays menu. This allows exporting, for example, a full
combination of CBCT, ProFace and intraoral scans in correct coordinates.
The images can then be imported into another Planmeca Romexis or viewed
in Planmeca Romexis Viewer.
Remove segmented teeth from data

Removes segmented teeth from the volume to be exported.
Include segmented jaws

Select this option to include the segmented jaws in the volume in STL file
format.
7.11.18.3 Export 3D volume to
Folder
Data is exported to a folder.
Disc image (.ISO)

Data is exported to a CD/DVD disc image that can be written to a media
using 3rd party CD/DVD writer software.
CD or DVD
Data is written directly to a CD/DVD if a CD/DVD writer is installed.
You can also select the burning speed from the drop-down menu.

7 3D module
As new image to database

By selecting this option a new volume is created to the Volumes sub-
module. The cropping, rotations, annotations etc. will be included in the new
volume if selected as export options from the 3D Export window.
This option can be used for example for cropping one volume of only upper
jaw and another volume of lower jaw.
To distinguish the volume from the original volume a comment for the new
volume can be entered in the File name field. In the Volumes sub-module
the comment will show in front of the original volume comment.
7.11.18.4 Viewer options
Include Viewer
Select to include the Planmeca Romexis Viewer software in the export.
Skip Viewer launcher

When exporting single image select this option for the Planmeca Romexis
Viewer to open without displaying the patient selection dialog in the
launcher.
Viewer platform
If you know on which platform the Viewer will be used, select the specific
platform from the drop-down menu to optimise Viewer size.
Viewer language
Set the default language for the exported Planmeca Romexis Viewer
software.
7.11.18.5 Exporting surface models in Surface module

See section "Exporting surface images" on page 326.
7.11.18.6 Exporting CBCT volumes in STL format
About this task

The CBCT volumes can be converted to surface model format (.STL) and
exported to desired location.
The models can then be re-used in any 3rd party software supporting the
STL standard format.
Follow these instructions to export volumes in STL format.
Steps
1. Open the CBCT volume to export.

7 3D module
2. From the File menu select Export > Export Volume as STL.

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3. In the opening window select the appropriate export options.
• Normal / Low Resolution

The selected resolution affects the amount of detail in the exported
STL file. Using Normal resolution also results in a larger file size.
• Apply Smoothing
The exported STL is smoothed but with possible loss of detail.
• Export Cropped
Select this option to export the STL of the selected crop region only.
You can adjust the crop region by drawing a box around the area
that you want to export.

7 3D module
You can preview the crop result in real-time in the 3D Rendering view
where it can also be rotated while the STL Export dialog is open.
The following image shows the crop result preview in 3D rendering.
4. Adjust the 3D Rendering threshold value so that the surface to export

shows cleanly.
5. Select the folder where to export, enter the file name and click OK.

8 Model analyser module

Planmeca Romexis Model Analyser module is intended for working with
digital impressions. Digital impressions can be acquired with Planmeca
Emerald, Planmeca Emerald S or Planmeca Planscan intraoral scanner
or they can be imported into the software. Digital impressions can be
visualized, and measurements and analysis can be performed. Digital
impressions taken at different times can be compared side by side and
superimposed. Also bases for models for 3D printing can be created.
Digital impressions can be exported in STL and PLY format or sent to a
laboratory using Planmeca Romexis Cloud service (for more information,
8.1 Importing 3D models
About this task

Follow these instructions to import 3D models.
Steps
1. Click Import.
2. Click the Browse buttons to select the upper and lower models in stl or
ply or obj format.

The imported models appear under Patient's Case Files in the File
module.
8.2 Starting scan
8.2.1 New scan
About this task

To begin scanning:
Steps
1. Click the Scan button.
For scanning instructions, refer to Planmeca FIT user's manual.
8.2.2 Continue scanning
About this task

You can continue an existing scan as follows.
Steps
1. Open the scan you want to continue.
2. Click the Continue Scanning button.
The previous scanning data is loaded to scanning software.

NOTE
When continuing scanning the current Model Analyser models are
replaced by upper and/or lower models that are rescanned. If bite
alignment is modified both the upper and lower models are replaced.
Measurements performed on the current models are deleted.
3. Proceed with the scanning, generate the model and click Finish.
For detailed description on how to proceed with scanning, see Planmeca
FIT CAD/CAM system user's manual.
8.3 Analysis view

When the scan is opened from the case list it appears in the Analysis view.
8.4 Preparation tools
8.4.1 Defining occlusion plane

To orientate model the occlusal plane and midline must be defined.

After scanning or importing files into Model Analyser module, a dialog for
defining occlusion plane opens up automatically with the 3-point alignment
dialog where the lower model is hidden.
8.4.1.1 3-point alignment
About this task

Follow these instructions to define 3-point alignment.
Steps
1. Indicate 3 points (right molar, midline and left molar) from the surface of
the model by clicking on the model.
If you want to use the lower model in the definition, select it from the
viewing buttons in the upper right corner of the dialog.
The models are automatically aligned.

2. If necessary fine-tune the alignment manually, see section "Manual

alignment" on page 452.
3. Finish the alignment and exit the dialog by clicking Done.

8.4.1.2 Manual alignment

If necessary, you can use manual alignment to fine-tune alignment after
3-point alignment.
You can freely translate the models by dragging.

To rotate the models, drag from the arcs around the models.
To change viewing direction, use the buttons on the manual alignment

toolbar.
8.4.2 Trimming model

Paint ROI to trim

Select Paint ROI to trim and drag the tool on the model to remove any
unwanted areas.
To change the brush size, hold down the Ctrl and Shift keys while scrolling
the mouse wheel.
To increase the size of the trimming tool, zoom out.
To rotate models while trimming, hold down the Alt key while dragging.
The surfaces behind the painted area(s) are automatically removed.
To undo/redo modifications, click the Undo and Redo buttons.

8.5 View tools
To view models from different directions, click the front, right, left, back and
open mouth view buttons.
Reset view
Click this button to reset orientation to the state right after model orientation.
Multi-view
To visualize models from different directions and occlusal view at the same
time click multiple views.
8.5.1 Calculate contact map

Calculate and show contact map
Click this tool to visualize distances between upper and lower models.

The color map scale can be adjusted from both ends.

To indicate contact and the distance under which all is visualized in red, drag
the red dot.
To set the maximum distance visualized, drag the blue dot.
Model overlap is visualized in grey.
8.5.2 Calculate undercuts
About this task

Follow these instructions to calculate undercuts.
Steps
1. Select the surface model in the object browser.
2. Rotate the model to the desired insertion direction.

3. Click the Calculate and show undercuts button.
The undercut areas in the selected insertion direction are coloured in

blue.
To change the insertion direction, deactivate the tool, re-orient the model
and click the button again.
The colour of the surface model returns to normal when the tool is
deactivated.
8.5.3 Colours
Use this tool to show/hide model colour.

8.5.4 Taking 2D quickshot
About this task

Follow these instructions to take a 2D quickshot.
Steps
1. Click the Quickshot button.
Results
The quickshot is saved to 2D imaging module under Photos.
8.6 Measurement tools
8.6.1 Point-to-point measurement
About this task

Use this tool to measure a distance from one point to another.
Steps
1. Activate the Point-to-point measurement tool.
2. Click on the model where you want the measurement to start.

3. Click on the model where you want the measurement to end.

The 3D measurements are shown in the object browser under
Measurements.
8.6.2 Tooth width measurement
About this task

Follow these instructions to take a tooth width measurement.
Steps
1. Click the Tooth width measurement tool.
2. Click on a numbered tooth on the chart.

In the upper jaw start from the posterior right side, in the lower jaw start
from the posterior left side.
3. Click on the distal and mesial side of the tooth.
The next tooth is automatically selected from the chart.
• To skip a tooth, click on another tooth on the chart.
• To re-measure a tooth, click on it on the chart.

The measurements are shown in the object browser under Tooth width
measurements
The width measurements are calculated as a projection of the 3D points

on the occlusal plane. The measurements are used in some of the
analyses.
8.6.3 Arch length measurement
About this task

Arch length measurement is calculated as a projection of the 3D points on
the occlusal plane. This measurement is used in some of the analyses.
NOTE
The first arch length measurement per jaw is used in the calculation of
Space analysis. Measure arch lengths from distal of 5 to distal of 5 for the
Space analysis to be calculated correctly.
To measure arch length:

Steps
1. Activate the Arch length measurement tool.
The open bite view opens by default.

2. Add measurement points by clicking on the occlusal surface of the upper

or lower arch.
To adjust the view, hold down the Alt key while dragging the model.
3. When enough measurement points have been added, complete the arch
by deselecting the measurement tool or right-click on the model.
Results
The measurement appears in the object browser.

What to do next
If necessary, you can fine-tune the measurement points by activating the
Drag measurement points tool and dragging the points to correct locations.
8.6.4 Curve measurement
About this task

Follow these instructions to measure curve.
Steps
1. Click the Curve measurement tool.
2. Click on the model to draw curve.

3. Add measurement points by clicking on the surface of the upper or lower
arch.
4. Finish the curve by right-clicking on the model or deselecting the
measurement tool.
Results
The measurement is shown in the image and in the Object browser.
What to do next
To fine-tune the measurement points, select Drag measurement points tool
and drag the points to correct locations.
8.6.5 LM-Activator arch length measurement
About this task

The LM-Activator arch length measurement tool aids in the selection of
the appropriate appliance model and size. The tool measures the distance
across the incisors (from the mesial surface of the right canine to the mesial
surface of the left canine) and indicates the estimated size of the appliance.
NOTE
Complete tooth width measurements are needed for the LM-Activator
analysis. In case of missing frontal or lateral incisors mark the estimates
of the widths of unerupted teeth. If necessary, see estimations for the widths
of unerupted teeth.
WARNING
Disclaimer: In case of crowding or diastemas (e.g. in case of deciduous
incisors) the size estimation may be inaccurate. Evaluate individually the
extra space needed for the eruption of the permanent maxillary and
mandibular lateral incisors and re-evaluate the size of the appliance. Also, in
case of mixed dentition consider the expansion of the dental arches.

WARNING
Disclaimer: In case of tooth-size-discrepancy, the estimated size of the
upper and lower jaw may be different. Evaluate individually to select or
design the appropriate appliance.
TIP
You can use the Romexis Space analysis to evaluate crowding or diastemas
in the anterior region and Bolton analysis to evaluate if patient has tooth-
size-discrepancy.
WARNING
Disclaimer: Double-check that the impressions of all teeth are complete
and e.g. the distal surface of the molars or second molars is not missing.
Incomplete impressions may reduce the accuracy of estimations.
WARNING
Disclaimer: Fit the appliance on the patient and double-check that the teeth
fit correctly in the appliance. If the patient’s teeth are not guided towards
the bottom of the slots but constrained by the ridges between the slots,
treatment may not be successful. It is particularly important to check that the
LM-Activator applies desired force on the canines.
NOTE
The LM-Activator appliance is intended to be used on one patient and
then discarded. It may exceptionally be reprocessed (inspected, cleaned
and high-level disinfected or sterilized) for use on another patient in case
the appliance has been used on a same-day procedure (e.g. fitting the
appliance) under the monitoring of health care professionals. If the appliance
has been used by a patient at home, it shall not be reprocessed for use on
another patient. See the Cleaning and reprocessing instructions for details.
NOTE
Please refer to LM-Activator documentation for more information.
Steps
1. Click the LM-Activator tool.

2. Read and confirm you have read the following statement.
The front view of the model is automatically displayed.

To zoom in the model, hold down the Alt key while scrolling the mouse
wheel.
3. Measure the arch length from the mesial surface of 13 to mesial surface
of 23 by clicking on the vestibular surface of the crowns in between.
4. End the measurement by disabling the tool.

5. Verify the arch shape by rotating the model as illustrated.

If necessary, fine-tune the position of the points and the shape of the
arch using the Drag measurement points tool.
6. Complete the measurement by deselecting the tool.

7. Repeat the process for lower teeth.
Results
The measurements appear in the object browser.
8.6.6 Drawing tooth margin
About this task

Margin line can be used for drawing an outline for prepared teeth before
sending the scan to a laboratory. The outline can be used to improve the fit
off the prepared tooth.
Steps
1. Click Margin Line tool.

2. On the tooth chart click on the tooth for which you want to draw a
margin.
3. Click around the tooth to add points for a margin line.

At minimum three points are required.
A margin line is automatically drawn between the added margin points.

Results
When points have been added around the entire tooth and you click next to
the first added point, the margin is completed, and it appears in the object
browser.
To adjust the location of margin points, deselect the Margin Line tool, hold
down the Shift key while dragging a point to a desired area.
To delete a margin, check the box of the margin in the object browser and
click the trash can icon.
The default colour of the margin is red. To change the colour, click the red
square next to the margin in the object browser and select the desired colour
from the colour map.
To change the camera viewing angle, hold down the Alt key while dragging
on the model.
8.6.7 Fine-tuning measurements
About this task

If necessary, the measurement points of all types of measurement (Point-
to-point, Tooth width, Arch length, LM activator and Margin Lines) can be
fine-tuned using the Drag measurement points tool.
Follow these instructions to fine-tune measurements.
Steps
1. Select the Drag measurement points tool.

2. Drag the point(s) to correct locations.
Results
The measurement is updated to the object browser and on the measurement
label.
8.6.8 Editing models in object browser

In the object browser you can:
• Show/hide models by clicking this button.
• Adjust transparency using the sliders.
• Change model colour by clicking the square next to the model and
choose colour.
• Name the model by clicking the wrench icon and entering a suitable
name.

8.7 Analyses
The analyses are shown when all the necessary measurements are
available. Otherwise they are shown in red.
Bolton
Tooth width measurements are used to obtain the Bolton analysis using the
following formulae:
• Bolton overall = (sum of mesiodistal widths of 12 mandibular teeth) /
(sum of mesiodistal widths of 12 maxillary teeth) * 100%
• Bolton anterior = (sum of mesiodistal widths of 6 mandibular teeth) /
(sum of mesiodistal widths of 6 maxillary teeth) * 100%
Space analysis
To obtain tooth width and arch length measurements for space analysis use
the following formulae:
• Measure arch circumference from mesial of first molar to mesial of first
molar = space available
• Measure the mesiodistal width of teeth from 5 to 5 and add together =
space required:
• Reduce the space required from the space available = arch length
discrepancy
NOTE
The first arch length measurement for upper and lower jaw is used in the
calculation of Space analysis.
8.8 Comparison tools

The comparison tools can be used to compare the models from different
time-points.
8.8.1 Side-by-side comparison
About this task

To compare scans of different time points (e.g. at the beginning and end of
treatment):
Steps
1. Click the Side-by-side comparison tool.

Results
The previous scans are loaded from database for comparison. All scans are
shown as a notches on the timeline. To select a scan for comparison, click
on the desired notch.
What to do next
You can adjust the colour and opacity of a model by selecting it in the object
browser and dragging the slider.
To hide models from view, click the Show/Hide button.
8.8.2 Superimposition
About this task

To switch the 3D view to superimposed view:

Steps
1. Click the Superimpose button.
8.8.3 Sync camera

The Sync camera tool can be used in side-by-side view.
When the sync camera is switched on, the cameras on the left and right side
of the 3D view are synced, i.e. when the right side view is rotated, the left
side rotates accordingly and vice versa.
When the sync button is not selected, both views can be adjusted
independently.
8.8.4 Fit surface models
About this task

Follow these instructions to fit surface models.
Steps
1. Select Side-by-side.
or
Superimposition comparison view

(see sections "Side-by-side comparison" on page 470 and
"Superimposition" on page 471 for more information).

2. Start the fitting by clicking the Fit surface models button.
The fitting takes from a few seconds to a few minutes depending on the
size of the data and how well the models fit together, etc.
3. Fine-tune the alignment by re-clicking the Fit surface models button.
The existing registration is used as a starting point.
The registrations are not stored into the database.
8.9 3D printing
8.9.1 Creating 3D printable models
Before you begin
NOTE
Check the trimming to make sure no extra data is left outside the model.
About this task

Follow these instructions to create 3D printable models.
Steps
1. Click the Generate a solid or hollowed-out model button.
NOTE
The orientation of the model defines the orientation of the base so that
the bottom of the base is orientated parallel to the occlusal surface of the
model. The height of the model also defines the height of the base.
2. Proceed as applicable:
• To create a solid model, simply click OK in the following dialogue.

• To create a hollowed-out base, select the suitable wall thickness

from the drop-down menu and click OK.
Results
The models appear in the object browser as separate surface models.
8.9.2 Exporting 3D models with bases
About this task

The folder where the models are exported must be defined in the Admin
module, for more information see Planmeca Romexis technical manual.
Steps
1. Click the Export the selected base(s) button.
Results
The models are exported as .stl files into the configured folder from where
they can be sent to the 3D printer.

8.10 Exporting models
About this task

The 3D models can be exported to local disk in .stl or .ply format,
depending on the original data. The margin lines are exported in .xyz
format.
Steps
1. Start the export by clicking Export.
2. Select the folder where to export the models.
When the export is complete the message indicating that the export was
successful appears.
3. Click OK.
8.10.1 Opening cases in Planmeca Romexis OrthoStudio
About this task
NOTE
Planmeca Romexis 3D Ortho Studio is available on license.
The Planmeca Romexis 3D Ortho Studio application is intended for

preparation of digital dental models, dental model analysis, treatment
planning in 3D and model series creation.
To launch a case in Planmeca Romexis OrthoStudio:
Steps
1. Click OrthoStudio.

For detailed usage instructions, see Planmeca Romexis 3D OrthoStudio

user’s manual.
8.10.2 Fill in lab order form

For detailed instructions, see section "Fill in lab order form" on page 485.
8.10.3 Sim to Care export
About this task

Sim to Care (S2C) uses tooth surface models as an input allowing the user
to virtually operate on them using virtual drills, explorers, etc.
On how to configure the Sim to care export see Planmeca Romexis technical
manual.
Follow these instructions to send models.
Steps
1. Click the S2C button on the top toolbar.
2. Select the models, upper and/or lower, to send.

3. Enter a valid email address, a message and if desired, a due date.
TIP
By default, the due date is set to a month from the current date but can
be changed by clicking the icon next to the date.
4. Click OK.
The file transfer is shown by a progress bar.

Results
When the transfer is completed you receive a QR code from the Sim to Care
server. You can take a picture of the code if needed.
NOTE
The code is not saved anywhere. Once the QR code dialog is closed you
cannot retrieve the code from Romexis
In addition to the QR code a password is requested.

If necessary, you can re-send the models.
If the sending fails an error dialog appears.
8.10.4 Cloud export
About this task

Follow these instructions to export models to Planmeca Romexis Cloud.
Steps



9 CAD/CAM module
9 CAD/CAM module
Planmeca Romexis CAD/CAM module is intended for working with digital
impressions and restorations. Digital impressions can be acquired with
Planmeca PlanScan, Emerald or Emerald S intraoral scanner.
The digital impressions can also be used for designing restorations in the
software. The impressions and restorations can then be paired with CBCT
volume in Implants sub-module for implant simulation.
All data are automatically stored into Planmeca Romexis database and
organized into cases to be exported to another system or sent to a certified
laboratory for design and milling using Planmeca Romexis Cloud service
(see section "Cloud Management" on page 35 for more information).
NOTE
When returning to Romexis after scanning, the software prompts about
saving changed data to the database. Make sure all changes have been
saved to the database before closing Planmeca Romexis client.
9.1 Starting new scan
New scan only

Select this option for scanning only. For detailed description on how to
proceed with scanning see Planmeca FIT user’s manual.

9 CAD/CAM module
New scan and design

To start a new scan and create a new case for design select this option.
For detailed description on how to proceed with scanning and design see
Planmeca FIT user’s manual.
Settings
To adjust the CAD/CAM settings click this button. The Settings window
opens. For detailed description, see Planmeca FIT user’s manual.
9.2 Importing 3D models

There are four options for importing CAD/CAM data:
• Import CAD/CAM cases
See section "Importing CAD/CAM cases" on page 480.
• Import CAD/CAM STLs for design
See section "Importing CAD/CAM STLs for design" on page 481.
• Import CAD/CAM STL for milling
See section "Importing CAD/CAM STL for milling" on page 482.
• Import CAD/CAM patients
See section "Importing CAD/CAM patients" on page 483.
9.2.1 Importing CAD/CAM cases
About this task

Follow the steps below to import CAD/CAM cases with scans and design
data.
Steps
1. Click the Import button and select the CAD/CAM Cases.

9 CAD/CAM module
2. Select the Import single CAD/CAM Case option.
3. Click Next.
4. Click the Browse button and select the folder from where to import the
case by and the case's .zip file and click Select.
5. Click the Import button.
Results
The CAD/CAM case will be stored under the current open patient.
9.2.2 Importing CAD/CAM STLs for design
About this task

Follow the steps below to import CAD/CAM STLs for design.
Steps
1. Click the Import button and select the CAD/CAM STLs for Design.

9 CAD/CAM module
2. Select the STLs to be imported.
• To import STL models from external source, click the Browse...

button.
• To import STL models from the 3D module, click the Select... button.
NOTE
Both the Prep STL and Opposing STL must be imported.
3. Select the file(s) to import and click OK.
4. Click the Done button.
The imported files appear in the Setup view of the Planmeca Chairside
CAD/CAM window (see more in Planmeca FIT CAD/CAM user's
manual).
9.2.3 Importing CAD/CAM STL for milling
About this task

Follow the steps below to import CAD/CAM STLs for design.
Steps
1. Click the Import button and select the CAD/CAM STL for Milling.
2. Select the STL to be imported.
• To import STL model from external source, click the Browse...

button.
• To import STL model from the 3D module, click the Select... button.
3. Select the file(s) to import and click OK.
4. Click Done.

9 CAD/CAM module
Results
CAD/CAM window (see more in Planmeca FIT CAD/CAM user's manual).
9.2.4 Importing CAD/CAM patients
About this task

Follow the steps below to import one or several CAD/CAM cases with patient
information.
Steps
1. Select File > Import > Import CAD/CAM cases.
2. Select the Import one or more CAD/CAM Patients option.
NOTE
This option is possible only when no patient is open.
3. Click the Browse button.
4. Select the patient data folder and click Open.

9 CAD/CAM module
5. Select patient import option.
6. Select from the following options:

• Prompt for each patient: the patient information for each folder
must be confirmed. The suggested information can be accepted and
modified, and a new patient created based on that information or
alternatively an existing patient from the patient list can be selected.
• Auto generate each patient info: a new patient for each imported
folder is automatically created.
7. Click the Next button.
If 'Prompt for each patient' option was selected, select next either Create
new patient or Select an existing patient. If a new patient is created
the first name, last name and external ID can be modified in the dialog
before clicking Add patient.
8. Click the Import button.
9. Click the Done button.
Results
CAD/CAM window (see more in Planmeca FIT CAD/CAM user's manual).
9.3 3D model export
About this task

Follow these instructions to export 3D models.

9 CAD/CAM module
Steps
1. Select the CADCAM case from the list and click 3D Model Export.
2. Click 3D Model Export.
3. Select the file type from the drop-down menu:

Select the file type from the drop-down menu:
• All available files (.pdf, .xml, .3oxz, .stl, .pts, .ply)
• STL files (only .stl files)
• PlanCAD Premium Export (.xml, .pts, .ply)
• 3Shape export (3.oxz)
• Order Form(s) export (.pdf)
NOTE
CAD/CAM export to 3Shape Dental System 2015 in .3oxz format is
compatible with 3Shape Dental System 2015 software revision 15.5.0.
The models must be ditched in Planmeca PlanCAD Easy before export.
4. Define the export location and click Export.
9.3.1 Fill in lab order form
About this task

Follow these instructions to create an order form in PDF format.

9 CAD/CAM module
Steps
1. Click Create Lab Order.
2. Fill in information on the receiving lab, of the patient, and of the referring
clinic.
To add a restoration, click Add Restoration.
3. Select tooth, indication, material, shades and character.

9 CAD/CAM module
4. Click on the tooth, click Characteristics and type the characterisation.
5. Click Done.
The added restoration appears at the bottom of the window.
6. Click Save.
Results
Once a lab order has been created it can be inactivated, viewed as PDF or
edited by right-clicking.
The form is stored in the File module under Attachments from where it can
be opened by double-clicking.
To export the form, click the Export button.
To inactivate the form, select Inactivate from the right-click menu.
9.3.1.1 Adding implants
About this task

To define an underlying implant:

9 CAD/CAM module
Steps
1. Select Abutment in the indication field.
9.3.1.2 Adding bridges
About this task

Follow these instructions to add bridges.
Steps
1. Add the necessary restorations before proceeding.
2. Select one tooth to be included in the bridge in the Tooth selection field.
3. Select Bridge as indication.
4. Create the bridge structure by clicking on the grey dots.

The clicked dots turn green marking the location of the bridge.

9 CAD/CAM module
9.3.1.3 Sending lab order form

The order with the STL files included can be sent to the lab either over
Planmeca Romexis Cloud data transfer or exported in pdf format from File
module.
9.3.2 Opening cases in PlanCAD Premium
About this task

The Planmeca PlanCAD Premium is a dental design platform intended
for dental technicians and dentists to design dental restorative prosthetic
devices from digital optical impressions.
To launch a case in PlanCAD Premium dental design platform:
Steps
1. Click PlanCAD Premium button.
For detailed description on how to use the PlanCAD Premium software

see the Planmeca PlanCAD Premium user’s manual.
9.3.3 Cloud export
About this task

Follow these instructions to export images to the Planmeca Romexis Cloud.
Steps

9 CAD/CAM module
case).

9.3.4 DDX export
About this task

Use Digital Dental Exchange to send cases digitally.
Steps
1. Select the cases to export.
2. Click DDX export.
For more information see "DDX Cloud" on page 545.
9.4 Opening CAD/CAM cases

CAD/CAM cases can be opened for scanning and design or for design only.
The options available depend on the Romexis license.
9.4.1 Open for scan and design
About this task

To continue scanning and design with an existing case:
Steps
1. Select the case folder from the case list.

9 CAD/CAM module
2. Click Open for Scan and Design from the right-click menu.
Results
The case opens in Planmeca PlanCAD Easy Scan view.
NOTE
Both Scan and Design license for Planmeca PlanCAD Easy is required.
9.4.2 Open for design only
About this task

To continue design with an existing case:
Steps
1. Select the case folder from the case list.
2. Click Open for Design only from the right-click menu.
Results
The case opens in Planmeca PlanCAD Easy Design view.
NOTE
Design license for Planmeca PlanCAD Easy is required.
9.5 Viewing CAD/CAM case in 3D module
About this task

Follow these instructions to open CAD/CAM scan or restoration STL file in
3D module.
Steps
1. Select the file.

9 CAD/CAM module
2. Click View STL in 3D Module from the right-click menu.
Results
The file is automatically opened to Romexis 3D module Surface view.
9.6 Inactivating CAD/CAM cases

To inactive an entire CAD/CAM case, select the case folder and click
Inactive case from the right-click menu.
To inactivate a single STL file, select the file and click Inactivate STL from
the right-click menu.

10 Clinic module
10 Clinic module
Planmeca Romexis Clinic module allows time stamped recording and real-
time monitoring of the following Planmeca units:
Dental units
• All Planmeca dental units
X-ray units and sensors

• Planmeca ProMax ProTouch X-ray units
• Planmeca ProOne X-ray units
• Planmeca ProSensor HD intraoral sensor
Milling units
• Planmeca PlanMill 40 and 40 S
3D printers
• Planmeca Creo C5
The gathered data can be used for remote assistance, service, quality
assurance and maintenance, as well as preventive maintenance planning.
NOTE
Depending on the device configuration, the views presented in this manual
may appear different from the views on your computer screen.

10 Clinic module
Overview
The Overview field shows the devices currently connected to Planmeca
Romexis.
Reports
Clicking the event types to view reports. For detailed description on how to
use the reports see section "Logs" on page 514.

10 Clinic module
Guides
Click the units for which you want to open the Quick and maintenance
guides for in pdf format.
TIP
Only the guides of the connected devices are shown by default. To view the
guides for all devices, check the option Show all Planmeca devices.
Clinic
In the Clinic section the number of connected devices, error and warning
messages are displayed for each floor. Open a detailed view of the clinic
by clicking the plan image, see section "Floorplan" on page 497 for detailed
description.

10 Clinic module
10.1 Search
Before you begin
NOTE
For the Search section to appear, click the floorplan (Plan 1) in the Clinic
section on the front page.
About this task

To search for a specific user, device, operatory or unit:
Steps
1. Enter the search criteria in the search field.
Results
The software automatically returns results corresponding to the entered
search term.
You can select the type of units to search for (Dental units, X-rays, Mills,
Other) by checking the boxes.
The results can also be sorted by name, status or device type.

10 Clinic module
10.2 Floorplan
TIP
To access Monitoring, Logs and Summary tabs, click their names at the top
of the screen. For detailed descriptions, see section "Monitoring" on page
506, "Logs" on page 514 and "Summary" on page 516.
TIP
You can return to home screen by clicking the arrow at the top right corner of
the window.

10 Clinic module
In the floorplan the location and current status of the installed devices is
displayed.
The clinic layout can be configured for up to 10 floors. On how to configure
the layout see Planmeca Romexis technical manual.
To view the location of devices on different floors, select the desired floor
from the drop-down (Plan 1) menu.
By placing the mouse cursor on a unit listed on the left side of the window
the selected unit is highlighted on the floorplan.

10 Clinic module
By placing the mouse cursor on a unit on the floorplan the unit user is
displayed.
Icons explanation
The floorplan icons are colour-coded according to the current status and
connectivity of the unit as follows.
Device icons
Planmeca Romexis Client PC
X-ray unit
Intraoral sensor
Dental unit
DTS (Dental tracking system) reader
Milling unit
Creo C5 3D printer
Solanna Vision

10 Clinic module
Connection status icons

Connected to Romexis
No connection to Romexis
Connected to Romexis, attention required
Connected to Romexis, immediate attention

required
Operating status icons

Washing ongoing
Imaging ongoing
Upgrade ongoing
Operation ongoing
Operation complete
Error, attention required
Warning, immediate attention required
Device is being serviced
Dental unit icons
Backrest angle
Chair height
Chair usage

10 Clinic module
Dental unit icons
Chip blow
Distance from floor
Dry mode
Endo auto-reverse
Fibre-optic light
Operating light
Headrest length
Flushing
Instrument flushing
Legrest angle
Micromotor
Nurse call
Open door
Patient time
Polymerisation light
Polymerisation light (composite mode, yellow

light)

10 Clinic module
Dental unit icons
Quick start
Reverse rotation
Scaler
Speed/Power limit
Spray
Sterile water
Suction
Suction cleaning
Syringe
Torque limit
Unit
Waterline cleaning - insert container
Waterline cleaning - feeding
Waterline cleaning - flushing
Waterline cleaning - in progress
Waterline cleaning - start

10 Clinic module
Dental unit icons
Waterline cleaning - ready
Restoration type icons
Crown
Inlay
Onlay
Pontic restoration
Veneer
Milling unit icons
Air pressure
Collet
Left drill
Right drill
Milling
Tool (left, blue)
Tool (right, blue)
Tool (left, yellow)
Tool (right, yellow)

10 Clinic module
Milling unit icons
Tool (left, white)
Tool (right, white)
Notice
Water level
Water quality
Send settings / Update software / Configure layout / Configure groups
NOTE
Only for service user's. For details, see Planmeca Romexis technical
manual.
10.2.1 Maintenance scheduling and demands
NOTE
This feature is available for Planmeca Sovereign Classic dental units using
software revision 1.7.0 or later.
NOTE
For instructions on how to set and edit the schedules see Planmeca
Schedules
The scheduled operations are performed automatically at set times for a
specific group of dental units.
Demands
The Maintenance Demands feature enables you to set selected groups
of Planmeca Sovereign Classic units with a designated number of suction
cleaning and instrument flushing procedures per day.
If the set demands are not met, Planmeca Romexis displays a notification
and/or prohibits the further use of water and suction.
The selected notifications are visible in the Planmeca Romexis Clinic
Management floorplan view, as well as the Planmeca Sovereign Classic
user interface.

10 Clinic module
To check the current schedules for timed flushing and cleaning programs
select Maintenance Scheduling on top of the screen on the right.
The programmed flushing and cleaning program schedules appear in weekly

table.
To view the devices belonging to the selected group, click the group on the
left.

10 Clinic module
10.3 Monitoring
10.3.1 Dental units

The usage of all units at the clinic can be monitored in real time to spot
users requiring assistance as well as to review, store and restore the unit’s
settings.
Eventual error messages are also displayed in this view.
10.3.1.1 Control panel

The dental unit control panel corresponds to the control panel of the unit that
is currently in use.
• For Planmeca Compact i dental units the control panel is fully functional.
• For Planmeca Sovereign Classic no control panel is displayed.

10 Clinic module
See your dental unit’s user’s manual for detailed description of the
control panel functions.
10.3.1.2 Saving and restoring settings
TIP
If you are currently logged in with PlanID, the dental unit automatically asks
whether to save the changed user settings at logout. For detailed description
on how to manage the personal settings, see your Planmeca dental unit
user's manual and Planmeca PlanID quick guide.
Planmeca Compact i dental units

The unit settings can be adjusted according to user’s preferences. On how
to adjust the settings, see your unit’s user’s manual.
To save your settings in Planmeca Romexis click this button.
Enter the name for the settings.
The settings are recorded for Planmeca Romexis user and are automatically
activated at login or can be selected from the settings list.
To delete saved settings click this button.

10 Clinic module
To take the saved unit settings into use click on this button and select the
appropriate settings from the list.
Planmeca Sovereign Classic units

The personal settings for Planmeca Sovereign Classic units can be stored to
Planmeca Romexis using the Planmeca Sovereign Classic control panel. For
more information see Planmeca Sovereign Classic User’s manual section
“Managing users and personal settings”.
10.3.1.3 Shortcuts for Planmeca Compact i dental units

The short cuts can be used for quick access to routine unit activities.
By placing the cursor on top of the button a tool tip explanation appears.
The following short cuts are available:

Service mode
NOTE
Before entering the service mode on a unit remotely, make sure that the unit
is not currently in use.
Micromotor drive mode
Set micromotor torque limit on/off
Start instrument flushing

10 Clinic module
Start Waterline Cleaning System cycle
Start Suction Tube Cleaning System cycle
10.3.1.4 Instrument console

The instrument that is currently in use is indicated by the arrow on the
console and it is coloured in blue on the panel. The current instrument
settings are presented below. On how to adjust the settings see your unit’s
User’s manual for more information.

10 Clinic module
10.3.1.5 Chair position

In this field you can monitor the time the patient has been in treatment
(if the upholstery is equipped with patient detection sensor), the backrest
and legrest angle, seat height, swivel angle (for Planmeca Sovereign and
Sovereign Classic) as well as motorised headrest length, height, and angle.
10.3.1.6 Foot control

In this tab you can view the configuration settings for foot control side knobs
and for pedal. The settings for the selected instrument are also shown. If no
instrument is selected, foot control idle state settings are displayed.

10 Clinic module
10.3.1.7 Usage graph

The following unit activities can be monitored in the usage graph:
• Active instrument and power level
• Water usage
• Air usage
• Seat height
• Backrest angle
• Operating light level
• Syringe on/off
• Suction on/off
The graphics are automatically displayed. To hide the graphics click this
button on the top right corner of the graphics window.

10 Clinic module
10.3.2 Milling units

For Planmeca PlanMill 40 / 40 S milling units the following information is
shown:
• Mill ID
• Tools status
• Components status
• Previous milling jobs
• Remaining time of the current milling job
• Progress of the current milling job
10.3.3 X-ray units

For Planmeca X-ray units the following information is shown:
Planmeca ProMax ProTouch X-ray units

• Currently selected imaging program
• Current exposure values
• Exposure times, number and type of recently acquired images

10 Clinic module
Planmeca ProOne X-ray unit

• Currently selected imaging program
• Exposure times, number and type of recently acquired images
Planmeca ProX X-ray unit

• Currently selected imaging program(in this example endodontic imaging)
• Current exposure values
• Exposure times and type of recently acquired images

10 Clinic module
10.3.4 Sensors
Planmeca ProSensor HD
For Planmeca ProSensor HD system the following information is shown:
• Size of the selected sensor
• Exposure times, sensor size and sensor ID of recent images
• Sensor usage (distribution of images acquired with different sensors)
10.4 Logs
The logs display the unit events with detailed description.

10 Clinic module
The events can be viewed by unit, type of events, or according to a certain

time period.
Click on the appropriate drop-down menu and select the desired criterion.
To display all unit events in real-time select <All> with current date.
To copy and send a report forward click the Copy to clipboard button to send
the event log by email for example.
To view an error in its context of use, select an event and click the Show
event in graph button.
In front of the selected event a history graph is shown.
The graph shows the context of use at the time of error and can be used for
troubleshooting.
Also, client user and device user is shown in the User Name field if saved to
the database.
To send automatic warning messages via email see section E-mail
notification in the Planmeca Romexis technical manual.

10 Clinic module
10.4.1 Viewing imaging parameters

By double-clicking on an imaging event you can view detailed information on
imaging parameters and possible reasons for imaging failures.
10.5 Summary
About this task

The Summary view provides information on the unit’s usage and
maintenance.
To select the unit(s) for summary:

10 Clinic module
Steps
1. Click the Device drop-down menu.

10 Clinic module
10.5.1 Dental units
Dental unit
• The Total column indicates the total usage time.
• The Current column indicates the number of usage hours after the last
reset (usually annual maintenance or lamp change).
Usage time is shown for:
• Power on
• Unit usage
• Operating light
• Suction
• Seat height
• Headrest (motorised)
• Backrest
• Legrest
• The Limit column shows the time until the preset alert limit. The limit can
be set in the Admin module, see Planmeca Romexis technical manual
for more information.
Instruments
The instruments section shows the total usage hours for different dental unit
instruments.

10 Clinic module
Patient in chair
NOTE
This feature is only available for dental units with an upholstery equipped
with patient recognition sensors.
Chair usage shows the total time the patient stays on chair.
Patient time shows the percentage of chair usage of the entire usage.
Latest cleaning operations

Based on real-time data collected on unit usage, a full history of the unit’s
cleaning procedures is recorded and can be reviewed. Entries of the latest
cleaning procedures are shown for:
• Short instrument flushing
• Long instrument flushing
• Suction cleaning
• Waterline cleaning
To display the full history of the cleaning procedures listed in the Logs
click View All.
Yearly maintenance
The date of the yearly maintenance confirmed on the dental unit as well as
the number of days left to the next yearly maintenance is shown in this field.

10 Clinic module
Treatments
In the Treatments tab all treatments and their date, start and end time,
as well as duration of treatment are recorded. The user is shown if user
information is recorded.
For this data patient recognition feature is used (provided that the unit
upholstery is equipped with patient detection sensors).
Device settings
NOTE
For service user's only.
In the Device settings tab the status of the unit sub-devices is displayed.
Service history
Shows the confirmed yearly maintenance operations and other recorded
service visits.
For more information see Planmeca Romexis technical manual.
User settings
The name of the user is displayed if the user is signed in to the dental unit.

10 Clinic module
10.5.2 Planmeca Promax, ProOne and ProX X-ray units

Select the unit from the drop-down menu to view the following information.
Information
Configuration
Imagings done
Shows the totals of different types of imagings.
Calibration dates
Shows the latest calibration dates.
Device settings
Licenses

10 Clinic module
Shows the active and inactive licenses.
Program features
Shows the currently selected program features.
Network settings
Shows the currently selected network settings.
Functions after exposure

Shows which activities occurring after exposure are on/off.
Program presets
Shows the currently selected program features.

10 Clinic module
Service history
User settings
The name of the user is displayed if the user is signed in to the X-ray unit.
10.5.3 Planmeca ProSensor HD intraoral sensors

The configuration of the current sensor, the number of imagings and
calibration dates are shown.
Service history
For detailed description see Service history in section "Dental units" on page
518.
10.5.4 Milling units

PlanMill finished jobs
The number of finished milling jobs grouped according to job type.

10 Clinic module
Service history
See Service history in section "Dental units" on page 518 for detailed
description.
10.6 Virtual Clinic simulation tool

Planmeca Romexis Virtual Clinic simulation tool is intended for
demonstrating how to monitor and register unit actions when the units
cannot be connected to Planmeca Romexis.
10.6.1 Before first use
About this task

When using the tool for the first time you need to add unit(s) to the floorplan
as follows.
Steps
1. Select Configure layout from the top toolbar.
2. From the File menu select Virtual clinic.

10 Clinic module
3. Click on the desired virtual device in the Virtual Clinic window.
4. Wait until the selected unit appears at the bottom of the screen.

10 Clinic module
5. Drag and drop the unit to the floorplan.
6. If needed, you can rename the operatory as follows.

6.a. Right-clicking the unit and select Rename operatory.
6.b. Enter a new name for the operatory in the Input field.
6.c. Click OK.

10 Clinic module
7. Exit layout mode by re-clicking the Configure layout button.
NOTE
For detailed instructions on how to configure floorplan, see Planmeca
10.6.2 Using simulation tool
About this task

Follow these instructions to use the simulation tool.
Steps
1. In the Clinic view click on Plan1.
2. On top of the window, select Floorplan (Plan 1).
3. Start the simulation by clicking on the desired device action.

See sections "Dental units" on page 529 and "Milling units" on page
531.

10 Clinic module

10 Clinic module
Results
The simulation opens in Monitoring view.
Clicking the Foot Control and Usage Graph display tabs to switch views.
• To view usage times, click on Summary (see section "Summary" on

page 516).
• To view event log, click on Logs (see section "Logs" on page 514).
10.6.2.1 Dental units

• Treatment
Normal dental unit functions including chair movement, instrument,
operating light and suction usage.
• Cleaning programs
Automated cleaning programs for instruments and suction system.
• Events:

10 Clinic module
Other dental unit usage related events.

10 Clinic module
10.6.2.2 Milling units

• Milling jobs
Milling different types of job (veneer, crown, bridge, onlay, inlay)
• Events
Tool state, air pressure and water level status notifications

10 Clinic module
10.6.2.3 X-ray units

The following actions can be simulated:
• Panoramic imaging
• Panoramic beam check
• 3D beam check
• 3D teeth
10.6.2.4 ProSensor HD
The following actions can be simulated:
• imaging with size 0 pediatric sensor
• imaging with size 1 periapical sensor
• imaging with size 2 bitewing sensor
• Offset calibration

10 Clinic module
10.6.2.5 DTS
• DTS server
• DTS reader

11 Report module
11 Report module
11.1 Report generation
About this task

Follow these instructions to generate reports.
Steps
1. Select the type of report from the drop-down menu.
• Images by capturer
• Images by date range and type
• User events by date range and type
• X-ray log book sorted by patient
• X-ray log book with original exposures
• DICOM status report
• ProScanner images by plate serial number
2. Click Generate.
3. Select query parameters and OK.

11 Report module
Results
The report opens.
To update the list, click Refresh.
11.2 Opening image and patient links
About this task

Follow these instructions to open image and patient links.
Steps
1. Click Open Link(s).
2. Select Image or Patient.

11 Report module
• If you clicked Image the selected image opens in the embedded

viewer.
Click Prev Image(s) to open the previous image in the report list.
Click Next Image(s) to open the image in the report list.
Click Open copy to open a copy of the current image.
Click Set layout to choose a new layout for currently open images.
• If you clicked Patient the selected patient file opens in the respective
module.
11.3 Printing reports
About this task

Follow these instructions to print reports.

11 Report module
Steps
1. Select the report to print on the list.
2. Click Print.
3. Preview the pages to print.

4. Click the Print button.
11.4 Export report
About this task

Follow these instructions to export reports.

11 Report module
Steps
1. Select the report to export on the list.
2. Click Export.
3. Select the columns to show in the report, the range and whether to
include column names.
4. Select where to save the report by clicking the square next to Output File
field.
5. Click OK.

11 Report module
6. Click OK to close the dialog.

12 Order services
12 Order services
Planmeca Romexis offers direct links to some 3rd party service providers for
ordering surgical guides or radiological reports.
The services must be enabled in the Admin module, see section "Local
settings" in the Planmeca Romexis technical manual.
NOTE
DISCLAIMER Planmeca takes no responsibility for 3rd party services.
Check the availability and support of order services directly with the service
provider.
12.1 Launching 3D Diagnostix order service
Before you begin

Enable the launch button in the Admin module (see section “Local settings”
in the Planmeca Romexis technical manual for details.)
About this task

Follow these instructions to launch 3D Diagnostix order service.
For more information on 3D Diagnostix services, see: https://www.3ddx.com/
planmeca.
Steps
1. Click the Launch button on the top toolbar.
2. Select 3D Diagnostix Order service.

12 Order services
3. Follow the instructions in the order dialog.
12.2 Launching 360Imaging order service
About this task

Follow these instructions to launch 360Imaging order service.
For more information on 360imaging services, see www.360imaging.com/
packages/planmeca-integration

12 Order services
Steps
1. Click the Launch button on the top toolbar.
2. Select 360 imaging Order Services.
3. Follow the instructions in the order dialog.

13 Planmeca Romexis Viewer
13 Planmeca Romexis Viewer

Planmeca Romexis Viewer is a freely distributable software designed for
viewing images exported from Planmeca Romexis desktop software.
The following images can be viewed and exported:
• 2D and 3D images in DICOM or DICOMDIR format
• 3D photos in Planmeca .pro format
• Surface models in .stl format
• 4D Jaw motion cases in Planmeca format
The images can be exported from the following modules or menus:

• 2D and 3D DICOM images
File menu / DICOMDIR Export
"Exporting multiple patients with DICOMDIR" on page 122
• 2D images
2D Imaging module / Export
"Export all patient images" on page 121
• 3D images
3D Explorer module / Export
"Exporting volumes" on page 440
• STL and ProFace images
3D Surface module / Export
"Exporting surface models in Surface module" on page 443
"Exporting CBCT volumes in STL format" on page 443
• 4D Jaw motion cases
3D Jaw motion module / Export
"Exporting jaw motion files" on page 414
Planmeca Romexis Viewer can also be downloaded at:

https://www.planmeca.com
Planmeca Romexis Viewer has limited functionality compared to full

Planmeca Romexis software, see also Planmeca Romexis Viewer user's
manual at:
https://materialbank.planmeca.com

14 Mobile applications
14 Mobile applications
The mobile applications can be used to open and view images on mobile
platforms
14.1 Planmeca mRomexis

The Planmeca mRomexis is a software intended for displaying and
visualizing dental and medical 2D and 3D images from imaging devices,
such as radiographs, CBCT images and photographs.
Planmeca mRomexis is compatible with iOs and Android tablets and web
browsers.
NOTE
Planmeca mRomexis software is not intended for diagnostic purposes.
To access the Planmeca mRomexis user’s manual online go to http://

manualkit.planmeca.com/.

15 DDX Cloud
15 DDX Cloud
The DDX Cloud is a 3rd party image transfer service which is integrated
with Romexis. For instructions on how to enable the DDX Cloud button, see
The DDX Cloud button can be set to 2D imaging, 3D imaging and CAD/CAM
modules. The DDX Cloud button allows sending images and scans from
Romexis to DDX Cloud. It is also possible to receive images and scans from
DDX to Romexis.
15.1 Exporting images to DDX Cloud
About this task

Export images to DDX Cloud as follows.
Steps
1. Go to CAD/CAM module.
2. Select the case to be exported to DDX cloud.
3. Click DDX Export.
3.a. Select the file format for scans (only available in CAD/CAM
module).
3.b. Click Create New Case.
A new case to DDX portal is created and images are automatically
uploaded to DDX. The DDX portal is automatically launched.

15 DDX Cloud
To view the uploaded images in DDX portal you may need to

refresh the DDX page.
3.c. Make following selections if necessary.
• Click Add more images if you want to add additional images to
the case. Select the images and click Update case.
• Click Add to Open case if the images are added to an existing

DDX Romexis case. A list showing the cases for the current
patient opens. Select the case and click Send.
Results
When images are successfully uploaded to DDX, Romexis shows a dialog
with the link to view the case in DDX.
15.2 Importing case from DDX Cloud
About this task

Import cases from DDX Cloud as follows.

15 DDX Cloud
Steps
1. Log in to DDX Cloud as recipient.
2. Download the case.
3. From the File menu select Import and DDX Case from Lab or Practice.
4. Select the case to be uploaded from the OPEN Cases list.
5. Click the Download button.

16 System administration
16 System administration
The settings in Admin module are described in detail in Planmeca Romexis
technical manual.
The access to the settings is protected. For more information, please contact
your local dealer.

Planmeca Oy | Asentajankatu 6 | 00880 Helsinki | Finland
tel. +358 20 7795 500 | fax +358 20 7795 555 | sales@planmeca.com | www.planmeca.com

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User's manual Planmeca Romexis 6

3.12 Cloud Management...................................................................................................................... 35

Planmeca Romexis 6 User's manual

5.13 Setting layout................................................................................................................................90

User's manual Planmeca Romexis 6

5.31.5 Viewing account information and ordered tracings.................................................... 140

Planmeca Romexis 6 User's manual

7.4 Implant module (optional)........................................................................................................... 258

User's manual Planmeca Romexis 6

7.10.3 Recording workflow templates................................................................................... 403

Planmeca Romexis 6 User's manual

8.9.1 Creating 3D printable models.....................................................................................473

User's manual Planmeca Romexis 6

14 Mobile applications................................................................................................................................. 544

Planmeca Romexis 6 User's manual

Planmeca Romexis is a registered trademark of Planmeca Company.

Consult electronic instructions for use (Standard ISO 7000-1641).

1.1 Indications for use

User's manual Planmeca Romexis 6 1

medical training in implantology and surgical dentistry. Use of the software

1.2 Introduction to digital imaging

1.2.1 Dimensional accuracy

2 Planmeca Romexis 6 User's manual

User's manual Planmeca Romexis 6 3

1.3 Securing image data

Image data can be secured by backing up the folder C:/

1.4 Image acquisition

1.5 Recovering images

• re-establish the connection by clicking Try to reconnect

1.5.1 Recovering 2D images

About this task

4 Planmeca Romexis 6 User's manual

1.5.2 Recovering 3D images

About this task

User's manual Planmeca Romexis 6 5

1.6 Archiving images

1.7 Processing and restoring images

1.8 Measuring images

1.9 Annotating images

1.11 DICOM support

6 Planmeca Romexis 6 User's manual

see section "DICOM Query/Retrieve (optional)" on page 33.

User's manual Planmeca Romexis 6 7

1.13 Usage data tracking

For more information on data processing, please see Planmeca Romexis

Data Being Tracked

8 Planmeca Romexis 6 User's manual

User's manual Planmeca Romexis 6 9

2 Getting started with Planmeca Romexis

2.1 Activating Planmeca Romexis license

10 Planmeca Romexis 6 User's manual

2.1.1 Manual activation

2.1.2 Installing license

About this task

User's manual Planmeca Romexis 6 11

2.1.3 Updating license

About this task

12 Planmeca Romexis 6 User's manual

2. Click Install License button and browse to the .lic file.

2.1.4 Managing license

About this task

User's manual Planmeca Romexis 6 13

The License management window opens.