Blue Sky Plan Manual

In this step, the target positions of individual teeth can be planned. You should start by selecting the active tooth – either by left clicking on a tooth in the schematic jaw image in the panel, or by clicking the tooth in the 3D view.

The active tooth has a visible tooth midline and a 3D manipulation widget shown around it. Using the widget, you can move and rotate the tooth in the following types of movements: Mesial/Distal tipping, Buccal/Lingual tipping, Rotation along longitudinal tooth axis, Intrusion/Extrusion, Left/Right, Forward/Backward.

A couple of interesting functions can be activated in the orthodontic panel after this step. The "IPR" option will show a 3D view of the sizes of the over-limit Interproximal reductions, and the limits of the maximum allowed IPR can be set in Preferences. The red areas informatively visualise inter-teeth collisions. "Diastemata" shows the measurement of the space between the teeth. "Initial Teeth Positions" shows the original model before positioning the teeth. "Final Teeth Positions" shows the last model after positioning the teeth. "Teeth Midlines" allows the user to see the estimated tooth axis with its midline. Teeth widths and their sum is also displayed by checking "Teeth Widths".

The "Automatic" section (1) allows the final positions to be computed for the aligning treatment. This requires the user to upload and annotate both jaws. "Align Both Jaws Automatically" (2) runs the alignment algorithm repeatedly, trying to improve the final positions with every step. Collisions between jaws are not resolved. IPR is automatically applied afterwards. "Align without IPR resolving" (6) only runs the algorithm once and doesn't resolve IPRs. Each run only tries to improve the positions of the teeth. "Resolve IPR" (7) tries to resolve IPRs by arch expansion and teeth shifting. The "Alignment Repetitions" (3) slider shows the number of algorithm runs, 10 by default. The "Maximum Allowed IPR" (4) slider allows IPR up to a certain value, as the default is no IPR. Additional parameters can be edited in the leveling section for every jaw (5).

The "Snap to Curve" section (1) allows the user to adjust a curve representing an ideal teeth arch and snap one or all teeth to this curve. In order to straighten the teeth to the curve while keeping the IPR data in an acceptable range, select "Level to Curve" (2) and click on the "Snap All Teeth" button. When the user works with the mandible jaw and an opposing arch is available, the software allows the user to level the teeth to the opposing ones (3). Click on "Snap All Teeth" for snapping. Additional parameters can be edited in the leveling section for every jaw (4). The "No Levelling" (5) option snaps the teeth without extrusion or intrusion. By clicking on "Edit Curve" (7) the user edits the curve points symmetrically or asymmetrically. This button also enables "Move with Curve", where it is possible to move both the curve and the teeth at the same time. When "Edit Curve" is active, the measurements of the dental curve are visible. The "Reset Curve" (8) button resets the curve to its original position. If the user clicks on the "Edit Curve" button again, the curve can no longer be edited.

Clicking the "Adjust Curve Plane" (6) button activates the occlusal plane for adjusting the curve. It is possible to move the plane in the 3D scene based on the angle and distance of the plane. Additional parameters are available in the Preferences for Orthodontics, Tooth Movement section.

"Auto Position CT Slices With Selected Tooth" enabled, and "Always visible" widget enabled. Every tooth can be locked in position by right clicking on the tooth and selecting "Lock Tooth" from the content menu. Unlocking proceeds in a similar manner, or the user can unlock all teeth at once by clicking on the "Unlock All Teeth" button.

The user can also adjust the midline when the "Adjust Midlines" button is active. The "Reset All Teeth" button returns all the teeth to their original positions. As the active tooth is being moved, the "Orthodontics" panel shows information about the total movements in the form of distances [mm] and angles [°] from the initial position. Movement limits can be set as monthly, bi-weekly or weekly.

Multiselection allows multiple teeth to be manipulated at once - hold Shift key and by left clicking select multiple teeth. With multiselection, it is possible to utilize all the manipulation methods (via the manipulation widget, deviations table and arrow keys). Checking the "Transfer movement locally" checkbox, the tooth's local deviation is applied to other selected teeth. Context menu options (locking, snapping, changing teeth movement speed, etc.) can also be used with multiselection.

Milestone is a mandatory step across all teeth (i.e. "sync point"). Final and initial positions are implicit milestones, but it's possible to create additional milestones if necessary. Milestones can be created in two possible ways: by clicking the button "Insert Milestone" (2), or by duplicating the "Teeth movement" step. The slider (1) shows the sequence of individual milestones. Each milestone (excluding initial position) can be deleted (3). It's also possible to clear the custom milestones and return to default ones (4).

When positioning a tooth, it is sometimes useful to see the movement of the whole tooth, including its roots. Therefore, Blue Sky Plan allows you to add a virtual tooth with roots simply via the context menu > Show Virtual Tooth or by enabling the "Virtual Teeth" checkbox (note: This option won't be available if you import CT Data). To refine the shape and position of the newly added virtual tooth so that it closely matches the underlying teeth separated from the 3D scan, click on the "Adjust Virtual Tooth" button. Now, you may adjust the position and size of the virtual tooth using the in-scene widget. To hide the virtual teeth, click on the "Virtual Teeth" checkbox again.

To work with a selected tooth, right click on the tooth and choose the functionality. To hide the tooth, select "Hide virtual tooth". To reset the tooth to its original position, select "Reset virtual tooth position". It is possible to change the point of rotation of the 3D manipulation widget, i.e. to switch between the tipping and torque. The tipping and torque angles are tracked and reported separately. Pivot offsets can be set in Preferences.

Blue Sky Plan software allows the user to work with segmented CT data. Go to Preferences > Orthodontics > CT Teeth Segmentation to enable segmentation of CT teeth. To hide all the visible CT teeth simply click on the "CT Teeth" checkbox. To hide one (or more) CT tooth, right click the selected tooth and choose "Hide CT tooth". For better clarity of the roots, the transparency of the jaw can be increased by moving the slider in the panel (1).

The user can enable automatic jaw bone segmentation. This option is available in the Preferences > Orthodontics > Jaw Bone Segmentation. When entering the Teeth Moving step, the segmented jaw bone with CT teeth will automatically become visible. To hide the data simply use the "Jaw Bone" checkbox. For better clarity of the CT data you can increase the transparency by moving the slider in the panel (2). Airways segmentation can be enabled in Preferences > Orthodontics > Airways Segmentation. To hide the data use the "Airways" checkbox. For better clarity of the CT data you can increase the transparency by moving the slider in the panel (3). Note: The options "CT Teeth Segmentation", "Jaw Bone Segmentation" and "Airways Segmentation" must be enabled during the import step of the CT Data in order to produce segmented data!

BSP allows the user to correct ongoing treatment with original final positions. The user loads the new scans and proceeds to the "Tooth Alignment" step, and selects the original project via File > Import Final Tooth Setup from Existing Case (1). When the project is loaded, the final position planning from the new project is updated and a color map showing per tooth alignment accuracy is displayed. After loading the original project, the "Confirm Import" button (2) will appear, after clicking it the color map will disappear, but the final positions will remain.