Aligner Step 4
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Step 4 - Review the staged model sequence

Next, you need to review the staged models. Go to the Displacements tab and verify that the series is feasible and meets your treatment objectives.

The stages are automatically numbered 1, 2, 3, etc. and are listed across the top left as small tabs within the Displacements tab. When this area first appears, the displacement values are displayed as cumulative amounts and the last stage is selected. It contains the total displacements. You have many options for viewing displacements to ensure that the values are appropriate. 
Stages that have an asterisk indicate that manual changes were made in that stage.
Cells highlighted indicate the following:

- Adjusting movements in the previous or next stages

- Adding stages as needed

The Staged Timeline tab shows the starting and ending stages for each group of movements. The system shows the maximum actual movement per stage in each cell. 

 

You can also view the movements by tooth. Switch between upper, lower or select individual teeth at the top left of the Staged Timeline tab.

You can change the starting (first stage) or ending point (last stage) for each set of movements by choosing Start or End, or choose Spread Out to spread the movements throughout the stages. Start and ending stages for a movement type can extend over multiple groups.

 

Choose a Displacement Type

 

Choose whether to view values cumulatively or incrementally:

 Check model movements in Single Stage view:

  1. Select the Displacements tab then select the upper or lower arch.
  2. Display and view the 3D model as needed so that you can watch the model as it changes from stage to stage.
  3. Select the Single Stage view. Click the model numbers in the small tabs (or use the animation player discussed in the next section). The displacements are shown for each model in the sequence.

 

  1. Examine the displacement values. If needed, adjust the numbers using the table.
  2. Repeat for the opposing arch.

Animation player:


Use the animation player to view the movements in the staged model sequence. It is available on both the Displacements tab and the Staged Timeline tab. The animation player runs an animation of the entire treatment plan, showing tooth movement from the initial state to the final tooth position.


Add stages as needed:

  1. Select the upper or lower arch.
  2. Select a model number to follow the new stage you are adding. 
  3. Click the Add Stage button to insert a new stage. The displacements for the new stage are set to a midpoint between the preceding stage and the following (new) stage.

 
Copy stages as needed:

  1. Select the upper or lower arch and select a model number. 
  2. Click the Copy Stage button. A new copy of the selected stage is created following that stage.

 
Remove stages as needed:

  1. Select the upper or lower arch and select a model number. 
  2. Click the Remove Stage button. The incremental movements for the subsequent stage are recalculated to include the movements that took place in the removed stage.

Recalculate staging as needed:

  1.  Select the upper or lower arch and select a model number. 
  2. Click the Recalculate Staging button. The Constraints dialog box opens. You can change the constraints setting from the drop-down menu and/or click Edit to modify the groups and/or maximum rates of movement for this patient.

Recalculate attachments as needed:

  1. Select the upper or lower arch and select a model number. 
  2. Click the Recalculate Attachments button.

The Constraints dialog box opens. You can change the constraints setting from the drop-down menu and/or click Edit to modify the automatic attachment placement for this patient.

Update Previous Stages as needed:

  1. Select the upper or lower arch and select a model number. 
  2. Click the Update Previous Stages button. 

The Constraints dialog box opens. You can change the constraints setting from the drop-down menu and/or click Edit to modify the groups and/or maximum rates of movement for the stages previous to the selected stage. If no edits are needed, click OK.

Update Next Stages as needed:

  1. Select the upper or lower arch and select a model number. 
  2. Click the Update Next Stages button.


The Constraints dialog box opens. You can change the constraints setting from the drop-down menu and/or click Edit to modify the groups and/or maximum rates of movement for the stages after the selected stage. If no edits are needed, click OK.

Edit Target:

Click the Edit Target check box to edit the target, passive and retainer stages as needed.

Re-check movement with multi-stage view


Now examine the movements per tooth through the stages:

  1. Select the Multi Stage view. 

  1. Select the upper or lower arch.
  2. Select the tabs as needed to view types of movements (Mesial/Distal, etc. ). 
  3. Repeat these steps for the opposing arch.

Adjust displacements manually:

  1. Select the upper or lower arch. 
  2. Select the Cumulative or Incremental option as needed. 
  3. Enter new values according to your clinical judgment. 
  4. If you have manually changed values that affect previous or later stages, click the Update Previous Stages or Update Next Stages buttons to adjust the numbers. 

Over-correction


Over-correction can be applied to the staged model sequence. You can specify in your Preferences how many Over-correction stages to apply as well as thresholds for particular movements.

 
Click the settings icon , then click Preferences.


Click the Aligner Overcorrections tab. Next to Over-Correction Type choose Amount or Percent. Use the check boxes under Include Over to include or exclude particular movements. Change the movement thresholds under Threshold as needed. Change over-correction values under Over Amount or Over % (depending on which over-correction type you chose). Choose how many over-correction stages to apply next to Apply Stage Count Maximum. Click Save.

 


    
 
Over-correction stages


Over-correction stages are applied to the end of the staged model sequence and are highlighted in green with the letter “O” before the stage number. The last stage before the over-corrections is denoted with a “#” before the stage number. 


The Overcompensation Stages icon found in the Display palette can be used to hide/show the over-correction stages.

 
Blockouts

Blockouts are automatically applied to block out undercuts. Blockouts may need to be applied to the staged models when there is spacing, gingival recession, exposed roots, black triangles and/or lingual retainers. The system provides automated aligner tray blockouts as a post-processing step.

Using Aligner Tray Cut-outs

For Class II or Class III cases, the Digital Lab places aligner tray cut-outs for elastics as specified in your prescription or notes.You can manually adjust these aligner tray cutouts placed by the Digital Lab. You can also add new cutouts  or remove cutouts . Make sure you review the placement of the cutouts as part of your review of the staged models.

Attachments - Cuts & buttons panel

Use the Attachments - Cuts & buttons panel to add or remove cut-outs to your aligner trays. This panel is displayed by default when the Staged Models workspace if the staged model are in a not ordered state.

You can place a slit or a button with a button cutout in any quadrant and in any combination to cover different clinical scenarios such as Class II, Class III, Upper, Lower, Lingual, and Labial elastics. You can place cutouts on labial and lingual surfaces.

In addition, to help improve aligner retention, you can place an attachment on the same surface as a cutout.

 
When placed on a tooth, the cut-out will be oriented automatically based on the segment where it was placed. The system uses basic placement rules for Class II labial elastics. You can adjust the placement of your cut-outs and slits as needed by moving and the rotating cut-outs in the 3D window.

Tip: Show or hide the Attachments/Cut-outs panel by clicking on the Assign Attachments icon located in the Aligners menu. 

 

Cut-outs are only visible on the Staged Models. The cut-out slit is placed on the tooth at a 45-degree angle by the system. You have several preset sizes to choose from when placing cutout buttons and slits;

 
If cutouts can only be visible with the whole trim line being shown, the user will show/hide them as they show/hide trim line. 
The user shouldn’t be able to resize them.  For now, we will keep resizing and reevaluate this mm for default button and 1 mm or 1.5 mm for slit.
 

To Add Cut-outs and Slits to an Aligner Tray

Before you begin:

To place the cut-out button or slit:

  1. Click the Cut-out button in the bottom row of the Attachments - Cuts & buttons panel. Your cursor should turn into a cross.
  2. Position your cursor on the tooth and click. A button is placed on the tooth. Note that the yellow trimline has been automatically adjusted to make room for the button.

  1. Click and drag the button or slit to adjust its position.
  2. Click the button or slit and then click the small menu icon to make other changes.

  1. To remove the button just from the stage displayed, click the button or slit once to highlight it, then click the trashcan icon on the Attachments - Cuts & Buttons panel.

Class II Correction with Straight Trimline

For elastic cut-outs on U3s with straight trim-line, slit is placed:

Class II Correction with Scalloped Trimline

For elastic cut-outs on U3s with scalloped trim-line, the slit is placed:

Button Cut-outs

For button cut-outs on L6s, button is placed: