planmeca romexis cephalometric analysis

Planmeca Romexis® Cephalometric Analysis

user's manual

EN

30025615

Surdent - Distribuidor exclusivo Planmeca en Chilehttps://surdent.cl

[email protected]

The manufacturer, assembler and importer are responsible for the safety, reliability andperformance 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 ismade to produce up-to-date product documentation this publication should not beregarded as an infallible guide to current specifications. We reserve the right to makechanges without prior notice.COPYRIGHT PLANMECAPublication number 30025615 Revision 1Released 20 April 2020

Table of contents

1 Introduction.................................................................................................................................................12 Starting new analysis from Planmeca Romexis..........................................................................................3

2.1 Opening image for analysis............................................................................................................32.2 Positioning landmarks manually.....................................................................................................4

2.2.1 Group repositioning........................................................................................................42.2.2 Positioning landmarks using sequential tracing............................................................. 52.2.3 Positioning landmarks using automatic tracing.............................................................. 72.2.4 Creating report and saving analysis to Romexis database............................................ 8

3 Continuing previous analysis....................................................................................................................104 Opening all patient images in Cephalometric Analysis Module................................................................125 Starting new analysis from Cephalometric analysis module.....................................................................146 Documents tab..........................................................................................................................................15

6.1 Add treatment stage..................................................................................................................... 156.2 Automatic superimposition........................................................................................................... 166.3 VTO.............................................................................................................................................. 166.4 Copy to clipboard..........................................................................................................................16

7 File tab......................................................................................................................................................178 Analysis tools............................................................................................................................................18

8.1 Layers...........................................................................................................................................188.1.1 Showing/hiding layer element groups.......................................................................... 188.1.2 Adding layers............................................................................................................... 188.1.3 Deleting layers............................................................................................................. 198.1.4 Adding/removing elements to / from a layer.................................................................19

8.2 Adjustments..................................................................................................................................208.3 Selected element indicators......................................................................................................... 218.4 Zooming........................................................................................................................................228.5 Displaying element information.................................................................................................... 23

8.5.1 Element settings...........................................................................................................238.6 Locking analyses..........................................................................................................................268.7 Inverting radiographs....................................................................................................................26

9 Design tools..............................................................................................................................................289.1 Analysis elements.........................................................................................................................28

9.1.1 Point............................................................................................................................. 289.1.2 Plane............................................................................................................................309.1.3 Split angle.................................................................................................................... 329.1.4 Arc................................................................................................................................339.1.5 Silhouette..................................................................................................................... 349.1.6 Teeth............................................................................................................................ 36

9.2 Wiggle chart..................................................................................................................................389.3 Harmony box................................................................................................................................ 39

9.3.1 Using harmony box (example)..................................................................................... 409.4 Measurement table.......................................................................................................................40

9.4.1 Data..............................................................................................................................40

User's manual Planmeca Romexis 6 Cephalometric Analysis

9.4.2 Columns....................................................................................................................... 419.5 InfoBox......................................................................................................................................... 42

9.5.1 Aligning InfoBox........................................................................................................... 429.6 Positioning landmarks using group reposition tool....................................................................... 439.7 Measurements..............................................................................................................................44

9.7.1 Distance....................................................................................................................... 449.7.2 Angle............................................................................................................................ 449.7.3 Function (calculated value).......................................................................................... 45

9.8 Element library..............................................................................................................................469.8.1 Adding elements.......................................................................................................... 47

9.9 Calibration.................................................................................................................................... 479.10 Advanced tools.............................................................................................................................50

9.10.1 VTO-ready check......................................................................................................... 509.10.2 Defining superimposition links......................................................................................509.10.3 Sequential tracing sequence setup.............................................................................. 52

10 Analysis phases........................................................................................................................................5510.1 Navigating between phases......................................................................................................... 5510.2 Workflow.......................................................................................................................................55

11 Analysis superimposition.......................................................................................................................... 5711.1 Starting new superimposition....................................................................................................... 5711.2 Superimposing photographs over analysis...................................................................................6011.3 Manual positioning of images and analyses.................................................................................6111.4 Analysis and superimposition relation.......................................................................................... 6211.5 Analysis settings...........................................................................................................................6211.6 Exporting superimposed images.................................................................................................. 63

12 Visual treatment objective (VTO)..............................................................................................................6412.1 Workflow for making VTO from analysis...................................................................................... 6412.2 Preparing for VTO........................................................................................................................ 65

12.2.1 Selecting analysis........................................................................................................ 6512.2.2 Adding image............................................................................................................... 65

12.3 Simulation.....................................................................................................................................6512.3.1 Selecting elements.......................................................................................................6512.3.2 Moving element............................................................................................................6612.3.3 Moving Deltabox.......................................................................................................... 6812.3.4 Prediction image.......................................................................................................... 6812.3.5 Creating measurements...............................................................................................6812.3.6 Layers.......................................................................................................................... 6812.3.7 View states...................................................................................................................6912.3.8 Layer management and element view toggle buttons..................................................70

12.4 Saving VTO.................................................................................................................................. 7012.5 Creating VTO reports................................................................................................................... 70

13 Skull Growth Projection............................................................................................................................ 7213.1 Starting growth projection.............................................................................................................7213.2 Preparing growth analysis............................................................................................................ 7313.3 Running growth projection............................................................................................................7313.4 Results..........................................................................................................................................7413.5 Saving the growth.........................................................................................................................74

14 Creating reports........................................................................................................................................7614.1 Automatic report creation............................................................................................................. 76

14.1.1 Report options..............................................................................................................7714.2 Creating printouts......................................................................................................................... 7714.3 Creating PDF reports....................................................................................................................78

Table of contents

Planmeca Romexis 6 Cephalometric Analysis User's manual

14.4 Creating Excel reports..................................................................................................................7814.4.1 Exporting analysis to Excel.......................................................................................... 7814.4.2 Creating Excel templates............................................................................................. 7914.4.3 Starting new template (example)................................................................................. 81

14.5 Creating analysis specific reports.................................................................................................8315 Creating custom analysis type..................................................................................................................85

15.1 Creating analysis type by modifying existing analysis..................................................................8515.2 Creating analysis from beginning................................................................................................. 86

16 Editing standard values............................................................................................................................ 8816.1 Using buttons in Standard values window....................................................................................8816.2 Linking standard values and deviations with angles and measurements.....................................89

16.2.1 Editing standard values from Standard values - linking window.................................. 9016.3 Customising reports......................................................................................................................9116.4 Adding measurements to groups..................................................................................................9216.5 Deleting measurements from groups........................................................................................... 9316.6 Adding groups for printouts.......................................................................................................... 9416.7 Deleting groups from printouts..................................................................................................... 9516.8 Editing groups in printouts............................................................................................................9516.9 Print preview.................................................................................................................................95

17 Creating custom analysis type from beginning (example)........................................................................9717.1 Choosing phantom....................................................................................................................... 9717.2 Positioning landmarks.................................................................................................................. 9717.3 Creating planes............................................................................................................................ 9817.4 Creating dimensions.....................................................................................................................9817.5 Calculating measurements...........................................................................................................99

17.5.1 Measuring WITS appraisal (example)........................................................................10018 Settings...................................................................................................................................................103

18.1 Settings tab.................................................................................................................................10318.2 Colors tab................................................................................................................................... 10318.3 Video.......................................................................................................................................... 10418.4 Image formats.............................................................................................................................10518.5 E-mail......................................................................................................................................... 106

19 Sharing and backing up analysis types.................................................................................................. 10719.1 Analysis type synchronization between server and clients.........................................................10719.2 Regular user...............................................................................................................................10719.3 Admin user................................................................................................................................. 107

20 Using lateral face photo for soft tissue landmarks in cephalometric analysis.........................................108

Table of contents

User's manual Planmeca Romexis 6 Cephalometric Analysis

Table of contents

Planmeca Romexis 6 Cephalometric Analysis User's manual

1 IntroductionThis manual describes how to use the Planmeca Romexis CephalometricAnalysis module.In the Planmeca Romexis® Cephalometric Analysis module, cephalometricanalyses and superimpositions can be composed of 2D cephalometricimages, facial photos and views of the dental arch. The analyses are usede.g. in orthodontic growth analysis, diagnosis, treatment planning andmonitoring as well as in treatment outcome evaluation.The Planmeca Romexis Cephalometric Analysis module contains severalanalysis types including Ricketts, Downs, and Steiner among others. To suitthe different needs of dentists, orthodontists or surgeons additionalcustomised analyses can be created.The software is created by Audax d.o.o. and fulfils the requirements ofDirective 93/42/ EEC.

NOTEThis manual is valid for the Planmeca Romexis software revision 6.0. orlater.

NOTEAlways review positions of anatomical landmarks after automatic tracing.

NOTEAlways check that the image is correctly calibrated.

NOTEThe predefined analysis types delivered within the software are created bysoftware manufacturer. Before using the predefined analysis types confirmthat the content of the analysis type corresponds your view of the respectedanalysis type and that the norms delivered within the analysis type are validfor your region.

NOTEThe analyses or analysis types saved with current version are notcompatible with previous versions of the software.

NOTEAnalyses created with analysis types constructed with older versions of thesoftware might not be compatible with all functionality introduced in the latestversion of the software.

NOTESome of the predefined analysis types include automatic reports. Theautomatic reports can be configured in the Analysis Type tab.

NOTEPlanmeca Romexis Cephalometric Analysis module can be used with Win8.1 Pro / Win 10 Pro operating systems. Planmeca Romexis CephalometricAnalysis module conforms to Windows user interface standards. Mac OSoperating systems are not supported.

1 Introduction

User's manual Planmeca Romexis 6 Cephalometric Analysis 1

NOTEUser organization must take care of protecting the computer and the networkby using up-to-date virus and malware protection software and fire wall.

NOTEIMPORTANT SAFETY NOTICE! Planmeca claims no responsibility for theend user’s data security or for any malfunction in the computer system thatmay lead to data loss. Since image processing and digital subtractionradiography can significantly alter the visibility of both large and smallstructures (i.e. bone loss and caries), which may result in either too manyfalse positive or false negative findings, Planmeca claims no responsibilityfor the software use, actions or diagnoses made by the end-user. Thequalities of the monitor can strongly affect the image quality. The monitorquality deteriorates with time.

1 Introduction

2 Planmeca Romexis 6 Cephalometric Analysis User's manual

2 Starting new analysis from Planmeca Romexis1. Open the patient from Patients module by clicking the patient on the list.

2. Double-click the image to use for the analysis.

The selected image opens in Romexis.

3. Adjust the image as needed for analysis using the tools underHistogram, Adjust and Image Processing tools on the toolbar on the rightof the screen.

2.1 Opening image for analysis1. Click the Ceph Module button on the top tool bar.2. Wait for the Cephalometric Analysis Module to start.

2 Starting new analysis from Planmeca Romexis


The selected image(s) open(s) in Cephalometric Analysis Module.

Previously used analysis type is automatically opened.3. Click Analysis type on the top toolbar to change analysis type, if needed.4. Select analysis and patient type and click OK.5. Continue to positioning landmarks.

2.2 Positioning landmarks manuallySelect from two tracing methods:• group repositioning ("Group repositioning" on page 4)

or• sequential tracing ("Positioning landmarks using sequential tracing" on

page 5)You can switch from one method to the other anytime while positioninglandmarks. To position landmarks automatically see section "Positioninglandmarks using automatic tracing" on page 7.

2.2.1 Group repositioning

Steps1. Click Group reposition on the top toolbar.

NOTEWhen making a new analysis the group reposition tool is active bydefault.



2. Resize the group reposition layout by dragging the points at the cornersand on the sides of the dashed frame.

3. Click somewhere in the group reposition area to move the elements as agroup.

4. When satisfied with the approximate positioning, turn off the groupreposition tool by clicking outside the group positioning area or re-clickthe Group reposition button in the main tool bar.

5. Drag the landmarks into their accurate locations by dragging with the leftmouse button. When satisfied with the positioning you can continue tocreating reports.

2.2.2 Positioning landmarks using sequential tracing

About this taskIn sequential tracing method the points are placed on the image one by oneaccording to the order defined in the analysis type.

Steps1. Start the tracing by clicking the Sequential tracing button.

A list of all points to be traced opens in Sequential Wizard.



2. To change the tracing order of points check the point and click the Upand Down button to move a point in the list.

3. Start the tracing by clicking Play. The first point in the sequence appearsas the mouse cursor.

4. Click on the x-ray image in the area where you want to place the point.

When a point is placed the next one in the order automatically appearsat mouse cursor.



You can pause the sequential tracing by clicking the Stop button.To re-continue the tracing click Play again

5. Continue placing points until you reach the end of the list.6. When finished click Done.

2.2.3 Positioning landmarks using automatic tracing

About this taskWith automatic tracing all landmarks are automatically placed.

Steps1. Start the tracing by clicking the Automatic Tracing button in the toolbar.

2. Wait until the tracing is completed.

3. Click OK and agree to verify the result after automatic tracing.After the automatic tracing the points are green.



If necessary you can move the points manually. The currently selectedpoint turns to red.

2.2.4 Creating report and saving analysis to Romexis database

NOTEIf there are distance measurements in the analysis, the calibration needs tobe done before printing.

NOTECheck that the image is correctly calibrated.

NOTEExisting calibration information is transferred automatically from PlanmecaRomexis 2D module.

Green calibration button indicates that calibration information exists.

Red calibration button indicated that calibration is necessary. For detailedinstructions for image calibration see section "Calibration" on page 47.



To print out a report, click the Print button

To export and save the report into Romexis database in PDF format click thePDF button

To export the report in xls format click the Excel button.

Click Save button to save the analysis to Romexis database.If the analysis type contains automatic reports they are stored in theDocuments timeline under the analysis during the ceph module session andtransferred to Romexis database as attachments after the session.



3 Continuing previous analysisSteps

1. Go to 2D imaging module by clicking the 2D module button on the left ofthe screen.

The image browser opens.The previous analyses, superimpositions and VTOs are marked with theT symbol.

2. Double-click the thumbnail you want to continue with.

The selected analysis opens in Romexis.3. Click the Ceph Module button on the top toolbar.

The selected analysis opens in the Planmeca Romexis CephalometricAnalysis module.Also the other images, analyses, superimpositions and VTOs which arecurrently open in Planmeca Romexis and which were already opened inPlanmeca Romexis open in the Planmeca Romexis CephalometricAnalysis module.

3 Continuing previous analysis


4. Continue analysis from where you left.

3 Continuing previous analysis


4 Opening all patient images in Cephalometric AnalysisModule

In case the patient has a lot of 2D images, it is recommended to open onlythe images that will be used in making the analyses in Romexis 2D modulebefore opening the cephalometric analysis module as previously instructed.This way only the cephalometric image is transferred to the cephalometricanalysis module and the start-up is faster.If no images have been opened in the 2D module all images are importedand can be opened in the Documents tab.

ExampleNo images open in the 2D Imaging module

ExampleAll images are transferred to Cephalometric Analysis module and theirthumbnails are shown in the Documents tab

ExampleOne cephalometric image open in the 2D imaging module. Patient has manyphotos in addition to the open image.

4 Opening all patient images in Cephalometric Analysis Module


ExampleOnly the open cephalometric image is transferred to Cephalometric Analysismodule.

4 Opening all patient images in Cephalometric Analysis Module


5 Starting new analysis from Cephalometric analysismodule

Steps1. Select a cephalometric image and either click the New Analysis button

on the top tool bar in the Documents tab or right-click on the radiographyand select New Analysis.

2. Continue analysis as instructed in previous sections.

5 Starting new analysis from Cephalometric analysis module


6 Documents tabTo access the Documents tab, click the Documents button at the bottom ofthe screen on the left.

The Documents tab displays patient data, cephalometric radiographs,analyses, superimpositions, VTOs and reports.

Images are placed on stage based on the image capture date. An analysis isplaced on the same stage with the original image and the date below theanalysis indicates the date the analysis was made.

6.1 Add treatment stage

Steps1. To add a new treatment stage click Add Stage on top toolbar.

6 Documents tab


2. Click on the Date and select a date from the calendar.

3. Drag the image or analysis to the new stage.

6.2 Automatic superimpositionTo create an automatic superimposition, drag and drop one analysis overthe other.All required documents are generated with the superimposition.

NOTEThe automatic superimposition can be configured for the analysis type in theAnalysis type tab.

6.3 VTO

NOTEThe VTO is only available for analyses.

Use VTO to create a new treatment simulation, plan and prediction based onthe selected analysis.

6.4 Copy to clipboard

Steps1. Right-click on the image and select Copy to clipboard.

2. Paste the image to the desired location.

6 Documents tab


7 File tabIn the File tab you can:• Create a new document by clicking the New button• Save the current document• Open an existing document• Delete a document• Configure current application settings.

For more information see section "Settings" on page 103.

7 File tab


8 Analysis tools8.1 Layers

An analysis visualized on the screen is composed of different layers. InLayers tab you can select which layers are visible in the image, whichelements are visible in each layer and add new layers.The following layers have been predefined

RadiographWhen hidden, the radiography image is not visible (100% transparency).

All elementsContains all geometric elements including measurements. When selected,all the elements are shown.

AnalysisThe analysis layer enables to visualize together all required elements formaking an analysis. When making analyses, the group is visible, but all theother elements are hidden. When creating a new analysis type from thebeginning or when creating a new element, no element in the analysis typeis included in the analysis layer. It is recommended to add all the elementsthat need to be visible when making an analysis to the analysis layer.

ReportThe report layer can be used to combine all elements shown in the printoutimage for printing an analysis. For the element to show in the printout, it hasto be included in the report layer. It is recommended to add elements to thereport layer when creating the analysis type. Outlines are by default includedin the report layer.The window for layers and displaying elements is located in both theAnalysis and Superimposition tab.To show or hide elements and to save elements as a group, use the buttonson top of the window.

8.1.1 Showing/hiding layer element groupsTo show the layer / elements in specific groups check the Visible box next tothe selected layer.To hide it uncheck the box. Multiple layers can be set visible simultaneously.

8.1.2 Adding layers

Steps1. Click this button.

A new row appears on the list.

8 Analysis tools


2. Enter a name for the new layer.

NOTEFor the new layer to be available the next time the same analysis is doneadd and save the analysis in the Analysis type tab.

8.1.3 Deleting layers

Steps1. Select the layer to delete and click this button.

2. Click Yes to confirm the removal.

8.1.4 Adding/removing elements to / from a layerThe window layout appears different depending on whether any elementsare selected or not. After selecting an element, the boxes in the Element onlayer column are checked for layers containing the selected element.To add an element to a layer first select the layer and then check the box inElement on layer column of the layer on which you want to place theelement.

8 Analysis tools


8.2 Adjustments

Background

Unmoved

Brightness, contrast and transparencyBrightness, contrast and transparency can be adjusted by moving thecorresponding slider to the right (increase) or to the left (decrease).

To reset the previous setting click Reset.

Image sizeTo adjust the size of the image on the screen click the - and + buttons ormove the slider to the left or right by clicking and dragging it with the leftmouse button.To fit the image to the size of the screen click Fit.To zoom the image scroll the mouse wheel.

Element properties windowThe window can either float on top of the main application window, or it canbe hidden on the side.To hide the window click this button on the top right corner of the window.

8 Analysis tools


To restore the window to its original place, click the corresponding tab an re-click this button.

8.3 Selected element indicatorsThe selected element is highlighted on the tree and coloured red in theimage.

8 Analysis tools


When the selected element depends on other elements all these otherelements turn purple.Red: element is not placed into layoutYellow: element in its initial position.Green: element moved to the designated position.

NOTEIf default colours have been modified these colours may not be valid.

8.4 Zooming

Steps1. Click the Zoom button in the Advanced tab under the X-ray tools on the

top tool bar (or press the F2 key on your keyboard).The window opens in the size and location as last used and can beresized and moved on screen.

2. Move the mouse cursor on top of the image in the area where you wouldlike to zoom in.The view around the mouse pointer is magnified.

NOTENo elements are displayed in the zoom view. However if a point isselected, the Zoom window displays a cross hairs marking at the centreof a point.

8 Analysis tools


To invert the vicinity of the cross hairs click the Negative button.To change the magnification ratio use the magnification buttons on theupper right corner of the Zoom window.

8.5 Displaying element informationOpen/close the element information window by pressing the F3 key on yourkeyboard.The name and image of the currently selected element with a note isdisplayed.The window opens in the last used position and can be dragged on thescreen.

8.5.1 Element settingsTo show the element setting options right-click the element in the tree or onthe image.

8 Analysis tools


An element's context menu (a. InfoBox, b. Point, c. Plane, d. Silhouette)

Show/Hide elementsElements can be hidden and re-shown as necessary. The element's buttonin the tree changes accordingly.

Show textAll element labels can be visible or hidden in the analysis. Use thiscommand to toggle a label's visibility.

Rotate to horizontalThe image can be rotated to horizontal according to a plane.Select and right click the plane.Select Rotate to Horizontal from the context menu. The selected plane turnshorizontal and the image is rotated to match.

Aligning silhouettePlanmeca Romexis Cephalometric Analysis module comes with predefinedsilhouettes (see section “Drawing and editing tooth outlines” on page 39).The silhouette is aligned according to the previously entered points. Right-clicking the silhouette opens a menu where you can select the Alignsilhouette option.

The corresponding alignment tool is opened depending on the type of theselected silhouette. See follow-up for interfaces on silhouette alignment.

8 Analysis tools


Upper incisor Lower incisor

Upper first molar Lower first molar

Sphenoid Orbit

Nasal bone Acoustic meatus

Pterygomaxillary fissure Nasal spine

Mandible

Enter the points for alignment.In the open alignment interface select the desired points.

8 Analysis tools


After the point is selected for silhouette alignment it is displayed on the list.All points must be entered. To remove any point from the alignment list clickthe adjacent dash sign.Silhouette alignment selected points, one point, two points

One point Two point

After identifying reference points and defining outlines, the analysis can beprinted, exported or saved.

8.6 Locking analysesTo prevent from accidentally moving the element in an analysis the analysiscan be lockedClick the Lock button in the Analysis tab.The button turns yellow and geometry cannot be moved any more.To edit the tracing re-click the Lock button.After saving the analysis the lock icon appears on the analysis thumbnail.

8.7 Inverting radiographsUnder X-ray Tools click the Negative button.

The X-ray is inverted.

8 Analysis tools


8 Analysis tools


9 Design tools9.1 Analysis elements

The analysis elements consist of points, planes, arcs and silhouettes. Theyappear as independent elements or are dependent on other elements (e.g. apoint on a plane).To add single points, planes, arcs and silhouettes to the analysis click thecorresponding button.To select a different type of element click the arrow under the button andselect the appropriate type.

TIPTo recreate the same element press the F4 key on your keyboard.

9.1.1 Point

To add a point, click the Point tool and then in the image where to add thepoint. The points can be moved by dragging.Single points are not dependent on other elements and can be freely movedin the analysis.To move a point, drag it to the desired position. Predefined elements turnred when moved. You can also move a point by clicking on the point’s labeland dragging it to the desired position.

Point on planeTo move a point on a plane select Point on plane and place the point on thedesired plane.A point on a plane is distinguished from single points by colour. A point on aplane is by default cream-coloured with olive green label and outline.To differentiate between elements it is recommended to set different coloursfor same type of elements but with different characteristics.

NOTEIf default colours have been modified these colours are not valid.

9 Design tools


If the point is added on the plane (the plane is added first) deleting the planealso deletes the point. Similarly, moving the plane also moves the point.

1. Position the point between the first and the second end point on theplane by percentage value.

2. Double-click the point on a plane which you want to position. Thefollowing window opens.

3. To set the value check the Fixed cutting coefficient box.Fixed cutting coefficient can have a value between 0-200. The valuerepresents the distance of the added point from the starting point of theplane. Value 100% is equal to the distance between the start and endpoint of the plane.

4. Set the percentage by typing the suitable number in the percentage (%)field or click the arrows to select appropriate percentage.

Point on cross-sectionTo place the point on the cross section of two planes select Point on cross-section.To add convergence points select two or more planes in the analysis, thenselect Convergence.To add/remove extra planes hold down the Ctrl key and select plane.The colour of a point (border of the point and label) and fill colour (pointsurface) can be edited.The default colour changes according to the type of point whether on theplane or cross-section.The default colour of the point at the intersection of planes is cream and itslabel and outline are dark grey. If the intersecting planes are deleted, thepoint in the intersection is also deleted.

NOTEIf default colours have been modified these colours are not valid.

Similarly moving any of the planes also moves the point to the newintersection.

9 Design tools


NOTEPlanes are infinite in length in both directions. However they are displayedas plane segments with small extensions at both endpoints. The intersectionof two planes can therefore be outside the displayed plane segments.

9.1.2 Plane

There are three types of planes:• Independent plane (simply click any two points)• Point-dependent plane: click on an existing point and then anywhere in

the image• Plane depending on two points: click on two existing points in the image.

Independent planeTo move an independent plane you can• Move one of the two green endpoints.

The other endpoint remains in place, the plane is resized and rotated tofollow the moving endpoint.

• Selecting a plane anywhere in between the endpoints.The whole plane is moved without resizing it.

9 Design tools


Parallel planeThrough a point1. Select the plane to which you want to create a parallel plane.2. Select a point through which the parallel plane should cut.

To create a custom plane, select an existing plane to which you want tocreate a parallel plane and click anywhere in the image.

Moving parallel planesA parallel plane is brown by default.The parallel plane of the selected plane turns purple. Plane can bemoved byclicking anywhere between endpoints and dragging.

NOTEIf the default colours have been modified these colours are not valid.

In case the position of a parallel plane is defined with a point, moving theparallel plane also moves the point.

Perpendicular planeThrough a given point1. Select a plane to which you want to create a perpendicular plane.2. Select a point through which the perpendicular plane should go.

To create a custom plane, select an existing plane, and click anywherein the image.

Custom planeFirst select an existing plane, and then click anywhere in the image toadd the perpendicular.

Moving perpendicular planesA perpendicular planes are brown. The perpendicular plane turns purplewhen selected.Move the plane by clicking and dragging anywhere between theendpoints. In case the position of a perpendicular plane is limited with apoint, you can move the perpendicular by moving the point.

9 Design tools


Moving plane crossing one pointIf the plane is dependent on the point, it can be moved by:• moving the green endpoint. The point remains in place; the plane is

resized and rotated to follow the moving endpoint.• moving the independent point. The green endpoint remains in place;

the plane is resized and rotated to follow the moving point.These planes cannot be selected as a whole and moved around.

Move point to either direction

Moving plane crossing two pointsA plane that is dependent on two points can only be moved by movingone of the two points. Such planes are coloured blue by default.

Vertical and horizontal planesVertical and horizontal planes always remain vertical or horizontal no matterhow the image is rotated.To move vertical and horizontal planes, click anywhere between endpointsand drag the plane to the desired position.

9.1.3 Split angle1. To draw a plane which runs under a certain angle together with the plane

or intersects the angle in a set percentage ratio, select the Split anglefrom the drop-down menu.

2. To create the plane splitting an angle, select the angle.

9 Design tools


The image shows a plane which intersects the angle. Two planes and anangle are required.

Double-click the dividing plane to open the Settings window where you candefine the plane properties.Set half-angle, angle portion in percentage value or exact angle value (e.g.when defining a horizontal plane in the Burstone analysis).

9.1.4 ArcAn arc can be drawn in three different ways:• Independently on other structures: click anywhere in the image• Based on a single point: click on an existing point and then anywhere in

the image.• Based on two points: click two existing points in the analysis.To switch between inner and outer arc, press and hold down the Ctrl keyand select inner or outer line with left mouse button.

9 Design tools


Concentric arcSelect Concentric arc tool and click on an existing arc.

To adjust the arc radius, double-click on the arc.In the Arc settings the Concentric Arc radius can be set as Radius portion(radius portion of independent arc), as distance from independent arc or asparameter.

NOTEParameter in Concentric Arc settings is set in parameter settings. Foradditional information on parameter settings see section “To open a windowfor adding parameters click this button.” on page 49.

9.1.5 Silhouette1. Click the Silhouette button on the top tool bar.

9 Design tools


2. Define outlines by selecting it in the tree, clicking in the image and startcreating the outline.Additional clicks create new nodes of the outline.To finish the silhouette doubleclick in the image where you want thesilhouette to end.Right-click in the area where you want to start drawing the outline.Click around the structure you wish to outline.Double-click in the area where you want to finish the outline.

An outline can be edited by:• Clicking and dragging nodes• Deleting nodes (hold down the Ctrl key and click a node).

1 Selected outline2 Deselected outline

NOTEDeleting any of the two end nodes will delete the whole outline.

All outlines are by default on the print layer and therefore appear on theprintout. To remove the outlines use the editing tools.

9 Design tools


NOTESilhouette outlines cannot be connected to other elements.

To change the shape of a silhouette drag and drop points on a silhouetteor delete a point by selecting it and pressing Delete on your keyboard.

NOTEDeleting an endpoint deletes the entire outline.

To move the outline, click anywhere between the endpoints and move it.To change the label, name, description, colour or layer of the outline, seesection "Element settings" on page 23.An existing point cannot be a point on the outline.Besides the regular silhouette there is also the Magnetic Silhouetteoption. The special feature of this type of silhouette is that it requires atleast 4 defining points. The NURBS curve is used to display the curve.

9.1.6 TeethTo add a tooth outline into an analysis, select it from the Silhouette drop-down menu in the main tool bar.There are three predefined teeth outlines available:• Incisors• First molars• Second molars

The outlines are predefined and are set in the default position in theanalysis. A tooth outline consists of three components: two points andoutline. The outline is dependent on the points and thus deleting a point alsodeletes the outline.

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To change the position of a tooth outline move points 1 and 2.To change the width move the blue squares which appear when clicking theoutline. Change the name, label, description, colour and layers of visibility ofa tooth as for all the other elements.A tooth outline cannot be connected to any other element. However all otherelements can be connected to the points on the outline.Plane is connected to the apical point and incision inferius (plane -1 inanalysis type MF UNI-LJ)

Drawing and editing tooth outlinesSelecting a predefined tooth adds three interdependent elements to theimage as well as two points and the outline of a tooth. These also show inthe Tree: the points are dependent of outlines; if either point is deleted, so isthe outline.To delete an element select it and press the Delete key on you keyboard.The newly added tooth is marked with a blue dashed bounding box aroundit.

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The width of the tooth can be changed by clicking a tooth’s outline (it turnsfrom pink to red and the bounding box appears) and dragging the resizehandle on the bounding box to the desired position.

The position of a tooth can be adjusted by dragging its two points to thedesired position.

9.2 Wiggle chartTo open a wiggle chart, click the Wiggle button.The wiggle chart opens on top of the current image.

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NOTEThe wiggle chart should always be placed on the report layer.

9.3 Harmony boxFor defining floating norms, correlation equations and standard errors needto be available. To create floating norms there are several scientific methodssuch as Segner, Hasund, Tollaro, Baccetti, Franchi etc. The softwareprovides tools to create harmony according to any kind of correlationequation.1. Click Harmony box on the top toolbar.2. Click on the image where you want to add the box.

An empty Harmony box appears.

3. Open the harmony box definition dialogue by double-clicking on the box4. To add new norms click the + (plus) button.5. Select the measurement from the drop-down menu.6. Enter the correct values and click OK.

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9.3.1 Using harmony box (example)

First ordinateShows SNA angle with standard error 0,92. The ordinate will start at SNAvalue 58 and end at SNA value 103.

Second ordinateShows NL-NSL measurement connected to SNA with equation.NL-NSL = -0,387SNA +38,92. It has standard error 2,52. The axis is definedthrough calculation from SNA and neither start nor end ordinate values arespecified.The same is done for correlation equations for other measurements:• NSBa = -0,741SNA+190,93 (std err. 3,89)• ML-NSL = -0,328SNA + 61,43 (std err. 2,94)• SNB = 0,901SNA + 4,26 (std err. 1,07)The font, size and colour of the Harmony box can also be changed.If the same equations are valid for other patient types click the Copyregression to other patient types button.To change the size of the Harmony box drag the box from its lower rightcorner.Smaller box will maintain the same number size and font, only less numbersare displayed to prevent overlapping.

9.4 Measurement tableA measurement table displays an analysis report in table format.To create a measurement table click the Table button on the top toolbar.A table with all measurements and groups defined in the report is displayed.To modify the content and appearance of the table double-click on it.

9.4.1 DataIn the Data section you can define which measurements and measurementgroups are displayed in the measurement table.

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MeasurementsIn Measurements are listed all the measurements included in the analysistype.To add a measurement to the measurement table double-click ameasurement in the Measurements list.A measurement is added to the Print list into a currently selected group.

GroupsThe measurements in the measurement table can be grouped. For exampleyou can create a group named Sagittal Relations, add the group to themeasurement table and then add appropriate measurements from theMeasurements list.To add a group to the measurement table, double-click the group in theGroups list.

PrintThe measurements in measurement table are displayed in the Print list.To change the order of measurements, click the up and down arrows on theleft side of the Print list.To change the order of groups, click the up and down arrows on the rightside of the Print list.

9.4.2 ColumnsIn the Columns section you can to customize the left to right order ofcolumns and the appearance of group names.To customize different sections in the measurement table by selecting thedesired element in the left navigation panel.By selecting the desired column you can customize the content of eachcolumns separately:• Name – measurement name• Unit – measurement unit• Value – measurement value• Normal – normal value• Difference – standard deviation

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• Wiggle chart

9.5 InfoBoxClick mBox on the top tool bar and click anywhere in the image.The box now shows in the analysis

To modify the element settings, double-click the box.

Select the measures showing in InfoBox and modify font settings.To show/hide the name of the selected measurement in the analysis, check/uncheck the Show measurement tag.

9.5.1 Aligning InfoBoxAfter selecting the element mBox, you can select mBox Align option from thecontext menu.Select the point to which you want to align the mBox.

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The information on the selected point is displayed in InfoBox.To move the location of the InfoBox, hold down the Ctrl key and drag theInfoBox to a new relative position in relation to the point of reference.If you delete the point to which the InfoBox is linked the InfoBox becomes afloating element and cannot be deleted.

9.6 Positioning landmarks using group reposition tool

About this taskGroup reposition tool is used to move all landmarks simultaneously as groupfor approximate positioning.

Steps1. Click the Group reposition button on the top tool bar.

When making a new analysis the group reposition tool is active bydefault. The reposition tool appears.

2. Resize the group reposition layout by dragging the points from thecorners and from the sides of the dashed frame.

3. Click somewhere in the group reposition area to move the elements as agroup.

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4. When satisfied with the approximate positioning, turn off the groupreposition tool by clicking outside the group positioning area or re-clicking the Group reposition button in the main tool bar.

5. Drag the landmarks in their accurate locations.6. When the landmarks are accurately positioned proceed to section

"Creating reports" on page 76.

9.7 MeasurementsThe measurements can be used to measure distances and angles betweengeometric elements included in the analysis and to create calculations basedon the elements.The name, label, description and image of the measurement can be edited.Also visibility and colours can be modified. The measurement can also behidden or it can be used only in calculation or printout.Both distance or angle measurements can have two statuses. Eachmeasurement is undefined when newly added.Coloured in red, the measurementwas inserted in the structure and hasundefined status.

Coloured in green, the measurement was inserted in the structure and hasdefined status.

9.7.1 DistanceDistance measurement can be determined as between two points, betweena point and plane and between two planes.1. Distance between two points: Click Distance and measure the distance

between two points.2. Distance between a point and a plane: Click Distance and measure the

distance between a plane and a point. The order of selection does notmatter. You have obtained a perpendicular distance (that is, the shortestdistance between the point and plane).

3. Distance between two planes: Click Distance and measure the distancebetween the two planes.

9.7.2 AngleAngle measurement can be determined between three points or betweentwo planes.

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1. Angles are determined by three points. The first point determines the firstray, the second point determines the apex and the third determines thesecond ray.The order of setting the points must be observed. On the left select K1,Apex, K2; and on the right K2, Apex, K1.

2. The angle can be determined by two planes (p1, p2): first click plane 1(p1) and then the second (p2).

The planes intersect each other forming two adjacent angles (α and ß). Thefollowing calculation α=180-ß can be used. To recalculate simply select thecorresponding adjacent angle holding down Ctrl key and clicking theadjacent angle.The angle consists of dependent elements. Deleting the elements deletesthe measurement.

9.7.3 Function (calculated value)To open a window for creating calculations click this button.Enter the name of the calculation, tag (label), description (comment) andselect unit of measurement. Select between millimetres (mm), degrees (°),percentage (%) or leave the field empty.On the Measurements in analysis field are displayed all measurements andcalculations included in the analysis type.On the Measurements in calculations field are displayed all measurementsused for creating the calculation in question.The Add number can be used to add number constant to the calculation.The arrow buttons between these two fields can be used to select whetheror not to include the measurements in the calculation.The other 5 are calculation buttons.

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The Calculation field displays the formula used in calculation.

To open a window for adding parameters click this button.Enter the name of the parameter, tag (label), description (comment) and setmeasurement unit. Select between millimetres (mm), degrees (°),percentage (%) or leave it blank.Parameter value may depend on patient’s sex and/or age (check thecorresponding boxes).

9.8 Element libraryTo open a window showing predefined elements click the Element librarybutton.

The predefined elements are divided in four tabs:

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• Measurement• Points• Planes

and• Arcs.Use the filter to narrow down your search or click to display predefinedelements in panels (see above) or in rows.The details of the specific elements are shown on the left.The changes done in here cannot be undone.On the right are shown elements included in the analysis type divided in tabsaccording to the element type.

9.8.1 Adding elementsTo add a new element into the analysis type, select the element it in thepredefined elements window and click on the element to add.To remove the element from the analysis type re-click it.When adding more complex elements their constituent elements are addedas well. For example, when adding Wits appraisal, an occlusal plane, twoauxiliary planes and three points are added as well.To add all selected elements into the analysis type click the Add elementsbutton.

These elements can be applied in the same way as the ones addedmanually. The only difference is that their values are preset (name, label,picture, description). You can repeat the procedure of adding as many timesyou need.

9.9 CalibrationIf there are some distance measurements in the analysis, the calibrationneeds to be done before printingThe images taken with Planmeca X-ray units are automatically calibrated.Green calibration button indicates that no calibration is required.

If calibration is necessary the calibration button shows in red.

NOTECalibration information may not be available for cephalometric imagesimported to Planmeca Romexis, images that are not in DICOM format, andfor images acquired with other manufacturers’ imaging devices.

1. Start calibration by clicking the Calibration button:• If the image was not calibrated (the calibration button indicator was

red) the fields in the Calibration window are empty as in the imageon the left.

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• If the image was already calibrated (the calibration button indicatorwas green) the calibration values are shown.

2. Choose the calibration method:• Use the X-Ray ruler (default option):

• Click on the ruler to mark the first and the second point and entertheir distance in millimetres into the Distance field

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• To modify the points close the calibration window by clickingCancel and repeat the procedure.

• Enter the pixel size manually

• Enter distance and the number of pixels manually

By selecting Save to preset, the next time you import an image of thesame size the image is automatically calibrated.

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The calibration info is shown in the Image format window, see section“Image formats” on page 108.

NOTEThe calibration can only be done in the Analysis tab, not in the Analysistype tab as analysis types cannot be calibrated.

9.10 Advanced toolsAdvanced tools include tools for checking whether the analysis type is VTOready, creating predefined superimposition links.

9.10.1 VTO-ready checkUse With VTO Ready to check whether the created analysis type supportsVTO.For the analysis type to be VTO Ready it must contain the followingelements:• Nasal Spine• Mandible• Incisors• Face profile

9.10.2 Defining superimposition linksSuperimposition links are used to predefine link(s) which will be used insuperimposition. Link(s) defined in analysis type will be applied in allanalyses using selected analysis type. You can also define superimpositionlink(s) at analysis level. In this case only selected analysis will have definedsuperimposition link(s) which will be used when creating superimposition.

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To create superimposition link click the Superimposition button.In the following window you can add, remove and edit links.To add a link select• two points on analysis type (or analysis)

OR• one point and one planeSelected points and planes names are displayed under Element 1 - Pointand Element 2 column.A point-point and a point-plane examples are shown below.

Superimposition combined reportsOn the Report tab you can define reports that combine reports for differentsuperimposition links.A definition for Rickett’s report that combines reports for 4 differentsuperimposition links.

To define a combined report, click on this icon at the top of the window. Anew line will be created on the top of the list a name for the created report isassigned. To display these elements in the report header, select ShowHeader and Show Scale options.

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9.10.3 Sequential tracing sequence setup

About this taskIn tracing sequence setup you can define which points need to be tracedand in what order.

Steps1. Click Sequential Tracing button.

2. Start adding points by clicking the Add button.

Unmoved elements are coloured grey by default.

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3. Click on points on the image to add them to the tracing sequence.A clicked point is added to the list in the Sequential Input Wizard windowand coloured with the default colours (green by default).

4. Continue clicking points until all the points you want to include in thetracing are added and show in grey.

5. When done re-click Add.

To change the order of points in the tracing sequence select a point inthe list and click the Up and Down buttons.

9.10.3.1 Editing setup• To change the order of points in the tracing sequence select a point in

the list and click the Up and Down buttons.

• To remove a point from the list select the point and click Remove.

• To place all points currently visible in the image click the Auto Populatebutton and then rearrange the order of points as desired using the Upand Down buttons.

Some points can only be traced if some additional elements are visible. Forexample the Constructed Gonion point requires Mandibular and Ramalplanes to trace it correctly.

Defining elements visible when tracing particular point1. Right-click the point on the image.2. Select Sequential tracing > Add Element to Helper Visible List.

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3. Click on the element that should be visible when tracing this point.In the case of Constructed Gonion this definition needs to be performedtwice, once for Mandibular plane and once for Ramal plane.To remove all elements from the Helper Visible List of a particular pointselect Clear Helper Visible List.

In the Sequential Input Wizard settings you can choose from thefollowing options:• Cursor on Element’s Tag – the mouse cursor appears on the tag of

the point instead of being centred on the point.• Play Sound – a voice recording will be played when tracing an image

for each point in the sequence.

• Element Info – a window with additional information on the elementappears.

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10 Analysis phasesAnalysis can be in three different phases: Cephalometric analysis, growth orVTO.

Cephalometric analysisCephalometric analysis means that the cephalometric elements (landmarks,planes, silhouettes) are traced and the results saved. After saving a newdocument appears in the Documents tab, see section "Documents tab" onpage 15

GrowthCephalometric analysis is first converted into initial Ricketts growth analysistype. As it may differ from the analysis type used for analyzing radiographs,additional tracing may be required. After applying the initial and final skeletalages growth tracing occurs.

VTOVTO can be created either from cephalometric analysis or from calculatedgrowth projection.

10.1 Navigating between phasesNavigate between different analysis phases by clicking the Cephalometricanalysis, Skull growth and VTO mode buttons in the middle of the screen.

10.2 WorkflowAlways make analysis first. Then continue to skull growth projection or VTO.Navigation icons indicate the status of the phase of the analysis.

10 Analysis phases


Growth projection needs additional parameters

Growth projection done and applied for downstream applications

VTO done and applied

When skull growth projection is partially done, additional information isneeded in order to be used for downstream applications. If either growthprojection or VTO is done and a change is made to cephalometric analysis,both growth projection and VTO are reset. If a VTO is done and a change ismade to growth projection, the VTO is reset.

10 Analysis phases


11 Analysis superimposition11.1 Starting new superimposition

1. Select an analysis in the Documents tab.

2. Right-click on the thumbnail and select Superimposition

ORClick the New superimposition button in the main toolbar.The analysis opens.

11 Analysis superimposition


3. Add another analysis for superimposition by clicking the Analysis button.A new window Please select analysis opens.

4. Select an analysis by double-clicking it.The analyses are added one by one and displayed side by side so thatthe analysis that was opened latest is the rightmost on the screen.To keep track of the superimposition process it is recommended tosuperimpose each added analysis one after another.

The analyses are opened with default colours.The first analysis shows in red, the second in green, then third in skyblue, the fourth in purple and so on.The colours can be temporarily modified by changing the colour inSuperimposition tab.

5. Select an analysis in the tree to superimpose it over the first analysis.Right-click to access link settings.

6. Select superimposition type.



7. Click the Define elements button in Link Settings.

8. Select the corresponding points from both analyses and click Assemble.

The linked fields will appear in yellow.



To return to the window for linking more analyses click the Link buttonand select Add and repeat the procedure.

NOTEBy using predefined superimposition links the link is applied immediatelyafter the second analysis is added. To use predefined superimpositionlinks see section "Defining superimposition links" on page 50.

11.2 Superimposing photographs over analysis1. Add a photograph by clicking the Image button.

2. Select Add.The window for adding image is opened.

3. Select the photograph for superimposition.4. Click OK.

The image opens with two marked points, First point and Second point.

5. Drag both points to the positions used as superimposition referencepoints.

6. Click Save analysis and return to return to the Superimposition window.To superimpose photographs over analysis follow the procedure “Select ananalysis in the tree to superimpose it over the first analysis.” on page 62.When linking the images select the points corresponding to First andDependent analysis.



NOTEIn case the first analysis does not include points included in thesuperimposed photograph, select it from the tree, right-click and select Editanalysis. A window is opened where you can change elements as desired.They can be added and deleted. All changes can be viewed in theSuperimposition window, see section"Analysis and superimposition relation"on page 62

11.3 Manual positioning of images and analysesThe analysis or the photograph can be positioned manually for more precisematch.

Moving imagesSelect the analysis or the photograph and drag it anywhere on the screenwhile holding down the left mouse button.

Rotating imagesRotate the analysis or photograph by clicking the green cross hairs by theFirst point, while holding down the left mouse button.The analysis or image is rotated around the First point.To resize and rotate an image or superimposed analysis drag it from itscorner.

Reset positionTo reset the position of the analysis or image, click the Reset button in theLink box on the dashboard.



11.4 Analysis and superimposition relationAny changes made to the analysis can be observed in the correspondingsuperimposed image. Moving the linking points will modify the interrelatedpositions of the superimposed analysis.An analysis can be edited by:• Saving it in the Analysis tab and opening the corresponding

superimposition containing the analysis• Clicking the Analysis button and selecting Edit.

The superimposition opens in a new window where the analysis can beedited.To accept the changes and return to the previous window, click Saveanalysis and return, otherwise click Cancel.

The original version of the analysis is saved even if you deleted the linkingpoints by mistake.

11.5 Analysis settingsYou can set specific settings for each analysis in the Superimposition tab onthe left side of the screen.

You can set:• tracing color• radiograph color



• transparency levels• visibility of analysis, points, planes, measurements, info boxes, layers• teeth silhouette coloring

11.6 Exporting superimposed imagesYou can export the superimposed image by clicking the Snapshot button.Doing so, current view will be stored in clipboard.

Click on the arrow Save as under the Snapshot button. Enter name andlocation where to save the image file containing current view in the explorerwindow.



12 Visual treatment objective (VTO)NOTEVTO and prediction image are tools for simulating and estimating treatmentoutcome. They are not meant to be taken as accurate treatment outcomepredictions.

A given analysis type contains the following data:• Landmarks and planes• Measurements and their correlations to standard values• Printout• VTO• Template for exporting to ExcelWhen making an analysis, the data is applied to certain radiography. Whenmaking a VTO they are applied to certain analyses.

12.1 Workflow for making VTO from analysis

1. Check for VTO readiness.This is optional and it is done at analysis creation.

2. Create a VTO.3. Add a lateral image to VTO:

• from patient data• by selecting the image• by placing the image on initial analysis network.

4. Create simulation as follows:• move elements to desired position• calculate prediction• create/show a desired view state• save.

NOTEIt is not necessary to place a lateral image to VTO in order to create asimulation and treatment plan.

12 Visual treatment objective (VTO)


12.2 Preparing for VTOTo check if an analysis contains elements and data necessary for VTO, usethe VTO ready? button in the Analysis view’s Advanced tab.

12.2.1 Selecting analysisStart a new VTO by clicking the VTO button on the canvas in the Analysistab.

12.2.2 Adding imageIn order to create a prediction a lateral photograph of a patient before thetreatment, must be added.1. Click the Photograph button in the VTO tab.

2. Select the image and click OK.The added image does not necessarily fit directly into the initiallandmarks.

3. Position the image by using a prominent feature of the face (for examplethe tip of the nose) as a guide.

4. Align the tip of the nose on the image and on the initial network (bydefault the grey one) as follows:

• Place the red dot of the alignment tool on a prominent place of theface (for example the tip of the nose).

• Align tip of the nose on the image and on the initial landmarks (bydefault the grey one)

• Drag the image from a corner to resize and rotate until correctlyaligned (use soft tissue profile as reference).

12.3 Simulation

12.3.1 Selecting elementsThere are elements in three different states:• Untouched



• Highlighted – an element is highlighted when the mouse pointer (greencrosshairs) is placed on it; the element turns light blue. An element canbe highlighted by moving the mouse pointer next to it.

• Selected – an element is selected after left-clicking on a highlightedelement. The element turns red.

The elements in VTO are predefined and the analysis should be VTO readyso that a VTO can create.

Elements in maxillaThe maxilla can be moved as a whole, or only an anterior part with upperincisor or upper incisor alone.To select:• whole maxilla, select a region of posterior part of maxilla on image A• anterior of maxilla and upper incisor, select anterior part of maxilla on

image B• upper incisor, click on it on image C.

Elements in mandibleThe mandible can be moved as a whole, anterior part with lower incisor andchin, chin alone and or lower incisor alone.To select:• the entire mandible, click on the posterior part of the mandible in the

image A.• anterior of maxilla, upper incisor and chin, select the anterior of the

mandible in the image B.• the lower incisor, click on it in the image C.• the chin click on it (image D.)

12.3.2 Moving elementThe elements can be moved either interactively or numerically.When moving an element a box indicating the relative distance and rotationin relation to the dependent element or global origin is shown.



TranslationSelect an element. When moving it with the left mouse button the elementwill follow.Double-clicking on a box opens a dialog box, where X and Y distances canbe manually entered.

RotationSelect the element with the right mouse button. From the opening menuselect VTO rotate.

A circle with a red point appears. Select the point and rotate it. The wholeelement (in red) will rotate.

To change the rotation centre drag the red dot in the middle of the circle withthe left mouse button.Double-clicking on a box opens a dialogue box, where angle of rotation canbe manually entered.

ConnectionsSome elements are connected which means that the elements which aredependent of another element are also moved with that element that is beenmoved. This is valid for both translation and rotation.

For example if the Mx Blue Mx orange is moved the upper incisor will follow.



12.3.3 Moving DeltaboxTo move a deltabox simply drag it to the desired location.The created deltaboxes are automatically added to the treatment plan on theAdditional layer.

12.3.4 Prediction imagePrediction calculation can be done if the initial lateral image is inserted byclicking the Prediction button.After any additional treatment simulation, the image has to be created againin order to meet the actual treatment.

12.3.5 Creating measurementsMeasurements can be created in the same way as described in section"Measurements" on page 44. They can be created between elements insideTreatment plan analysis, but also between initial and VTO analysis. Whencreated they are automatically added to the treatment plan into theAdditional layer.

12.3.6 LayersLayer tree consists of two or three nodes:• Analysis (initial analysis used to start the simulation, shows usually in

grey)• Treatment plan (at the beginning the same as analysis used, shows

usually in green)• Profile image if inserted



The same rules apply for layers as described is section "Layers" on page 18.

12.3.7 View statesThe following tools can be used for presenting the planning and simulationresults.

Tracing tools• Analysis• Growth• VTOIf no tools are selected, no image is shown or the view state is controlledfrom the Layers tab.

Image view tools• Before - when selected will show initial lateral photograph• After - when selected will show treatment prediction photograph

X-ray• X-Ray – when selected will show X-Ray image from initial analysis

If no tools are selected, no image is shown or the view state is controlledfrom the Layers tab.If no prediction image has been calculated, the After button will initiatethe calculation.



12.3.8 Layer management and element view toggle buttons

Buttons are divided into three groups:• Layer management buttons – manipulating layers in Treatment Plan only• Element view button – toggle view states for elements both in Analysis

and Treatment Plan• Tag view button – toggle view states for element tags both in Analysis

and Treatment Plan.For more information on using the visualization tools see section"Layers" on page 18.

12.4 Saving VTOTo save the VTO click this button.This also saves analysis and growth (if applied).

12.5 Creating VTO reports

NOTEIn order to use VTO reports the analysis type must be created usingpredefined analysis types which come with Planmeca Romexis softwarerevision 4.1.1 or later.

A VTO report containing original analysis measurements and themeasurements after the VTO can be created.To create a report click the Print, PDF or Excel button on the main toolbar.The report shows the analysis and VTO measurement values anddifferences form norms side by side, as well as the bias of the VTO values tothe norms.



Patient

Toulous Fanny, M - 24y 6m Date of birth 5.9.1989

17.3.2014

Status Stage 1 (0y 0m)

Date of image

Demo_Analysis_V VTO ...Analysis type

MEASUREMENT VALUENORMAL VALUE DIFFERENCE BIAS

SAGITAL RELATIONS

AngleSNA 78 | 7880 -2 | -2° |

Angle SNB 76 | 7677 -1 | -1° |

Angle ANB 2 | 24 -2 | -2° |

Wits -1 | -1-1 0 | 0mm |

Angle SN - Ba 139 | 139130 9 | 9° |●

Angle SN - Pg 78 | 7880 -2 | -2° |

Facial convexity 0 | 03 -3 | -3mm ●|

VERTICAL RELATIONS

SN/FH 11 | 116 5 | 5° |●●

Angle NL-NSL 11 | 117 4 | 4° |●

ML-NSL Mandible inclination 25 | 2534 -9 | -9° ●|

ML-NL Interbasal Angle 14 | 1428 -14 | -14° ●●|

Facial axis 100 | 10091 9 | 9° |●●

PFH/AFH 72 | 7264 8 | 8% |●

Bjoerk 385 | 385396 -11 | -11° ●●|

Gonial angle 113 | 113128 -15 | -15° ●●|

DENTAL ANALYSIS

Angle+1/NL 116 | 116111 5 | 5° |

Angle +1/NA 28 | 2824 4 | 4° |

Distance +1/NA 3 | 32 1 | 1mm |

Angle -1/ML 107 | 10795 12 | 12° |●

Angle -1/NB 28 | 2827 1 | 1° |

Distance -1/NB 2 | 24 -2 | -2mm |

Angle -1/A-Pg 31 | 3122 9 | 9° |●●●

Distance -1/APg 1 | 11 0 | 0mm |

Interinc. angle 123 | 123127 -4 | -4° |

SOFT TISSUE

Upper lip/E line -1 | -1-2 1 | 1mm |

Lower lip/E line 0 | 01 -1 | -1mm |

25 maalis 2020, 15.23 RomexisCeph



13 Skull Growth Projection

Skull growth projection is used for predicting the growth from skeletal age upto maturity.A Skull growth projection is applied to certain analysis. Making a projectioninvolves the following steps:1. Checking for projection readiness. This is an automatic step. Additional

tracings are suggested if needed.2. Creating a Growth analysis.3. Adding projection parameters:

1. skeletal age (initial age)2. final age3. cranial base to mandible correction angle

4. When growth projection is done it can be:1. exported2. printed3. saved

NOTESaving growth projection saves analysis as well.

13.1 Starting growth projectionClick the Growth button in the middlle of the screen.



13.2 Preparing growth analysisCephalometric analysis is being replaced with a growth analysis which hasall the elements needed for growth projection to be done (according toRicketts).

Elements (landmarks) can be either deleted or added or both. Untracedelements need to be additionally traced. Growth Analysis dialogue showsthe tracing options. Select the most appropriate for you.Three different options can be used in order to trace additional points whichare needed for growth projection based on Ricketts researches: automatic(using an add on module AudaxCeph TINA), concurrent and sequential.Please see details about the tracing methods in section "Positioninglandmarks manually" on page 4.Before running growth projection, changes to initial skeletal age tracing canbe made. Use layers to set appropriate view state for tracing.

NOTELandmark elements in the growth analysis can be traced and retraced again.If growth analysis is retraced after the growth projection calculation is done,recalculation is needed.

13.3 Running growth projectionAfter the growth analysis is done, the system needs growth projectionparameters:• skeletal age• forecast age• cranial base to mandible angle of correction.

After entering parameters, select Calculate button to perform the calculation.



NOTEMd./CB correction depends on mandibular behavior. For example in anaverage Class II case the Y axis tends to open about one degree per yearduring the treat-ment. In prognatic or strong mesognatic patterns the chintends to come forward and Y axis closes one degree per year during theorthodontic treatment.

13.4 ResultsResults can be seen as a superimposition of growth analysis and projectionanalysis:• superimposition NBa registered in CC point• superimposition NBa registered in N point• superimposition NL registered in ANS point• superimposition XiPM registered in PM pointA PDF can be created. It the PDF report is printed with Page sizing optionset to Actual size, the print is done in natural size if calibrated correctly.

13.5 Saving the growth

Click the Save Growth button to save the growth projection. This savesanalysis, growth analysis and growth projection.



The deliverables such as measurement report, enhanced metafie (vectorformat) and PDF superimposition report are also saved and can be found inDocuments (see section "Documents tab" on page 15).



14 Creating reportsNOTEIf there are some distance measurements in the analysis, the calibrationneeds to be done before printing. The images taken with Planmeca X-rayunits are automatically calibrated. The red calibration button indicates thatno calibration is required. For more information refer to section "Calibration"on page 47.

NOTEThe saved reports show in PDF format in the Planmeca Romexis Filemodule's Attachments tab. The views can also be saved and automaticallytransferred to Planmeca Romexis.

14.1 Automatic report creationReports can be configured to be saved automatically every time the analysisis saved. The configured automatic analyses can be seen through the Autoreports button in the Advanced tab. All listed reports will be automaticallygenerated every time the analysis is modified and saved.The saved reports show in the Documents tab under the respective analysis.The reports are stored into Planmeca Romexis File module's Attachmentstab after the Planmeca Romexis Cephalometric Analysis module is closed.To add, remove or modify a report use the following buttons. Clicking theadd button (+) opens a new window where you can select between Report orExport options. For additional options see image below.

14 Creating reports


NOTEThe automatic report creation can be configured in the Analysis Type tab.Some of the existing predefined analysis types have automatic reportcreation configured.

14.1.1 Report optionsThere are three different report options to choose from:

One page reportOne page report includes patient information, radiography, elements on thereport layer and measurement groups in table format.

No image reportOne page report including measurement groups in table format

Two page reportTwo page report including patient information and elements on the reportlayer on one page and radiography and measurement groups in table formatin another.

Tracing image report

14.2 Creating printoutsIf you need to calibrate the image (the button is red) refer to section"Calibration" on page 47 for more information.1. Click this button.

A preview window is opened with the last used printout option.2. To print the report click this button on the top left corner of the window.

3. In the following window select the necessary settings and click OK.

14 Creating reports


To edit printout continue to section "Creating custom analysis type" onpage 85.

14.3 Creating PDF reportsTo create a default or last used PDF report click on the PDF report button.To create another type of a PDF report click on the small arrow and selectthe desired report type from the drop-down menu.The PDF report opens in a PDF reader and shows in the Documents tabunder the respective analysis. The report is stored into Romexis Filemodule's Attachments tab after the Cephalometric Analysis module isclosed.

14.4 Creating Excel reports

14.4.1 Exporting analysis to ExcelThe excel tool can be used to export measurements, patient information,radiography and report layer to MS Excel.The data is exported in to three different worksheets: Measurements , Imageand Patient . The Measurements worksheet shows measurements andcalculations. The Image worksheet shows the radiography and print layerand the Patient worksheet shows patient information.To export an analysis to Excel click the Excel export button.The data is automatically saved in the predefined template before printing.To select another template click the arrow under the Excel button to showother template options.A template can be included in each analysis type. The worksheet shows theradiography, patient information and measurements.

14 Creating reports


14.4.2 Creating Excel templatesTo create a template, click the Excel export button.

An Excel document opens and displaying the following three worksheets:Measurement (M), Image (I) and Patient (P).

Measurement worksheetThe Measurements (M) worksheet lists the following measurements in theorder you defined in the Printout customization window:• Group• Name

14 Creating reports


• Value• Normal value• Difference• Bias• ValueS (standard value)• Measure unit• Std. deviation

Patient worksheetThe Patient worksheet lists the following columns in the order you defined inthe Printout customization window:• Patient's name• Patient's birthday• Date of image• Sex• Status• Age• Date of analysis• Licence Info

Image worksheetThe Image worksheet shows the radiography and image of analysis.

Save the template in *.xlt format.

14 Creating reports


NOTEFormat *.xltx is not supported.

Quit MS Excel.You can use all the available template options. For detailed description, see"Starting new template (example)" on page 81.

14.4.3 Starting new template (example)Open an analysis and export data into the template. The open Excel file hasthree worksheets containing exported data:• Measurements – where all measurements are exported according to the

print customization• Image – where the X-ray image and analysis image are exported• Patient – where the patient data is exported

Adding new worksheetAdd a new worksheet (Shift+F11) and rename it to Analysis. You may usethe Insert Worksheet button to insert a new worksheet.

Right-click on a new sheet tab and rename it to Analysis.

Drag the Analysis worksheet to the first position (you may leave it where it isas well).

ImageTo display the patient's radiography and print layer in the Analysisworksheet, do the following:Select cells of the image in the Image worksheet (or, delete the image tomake selecting easier.). The radiography covers cells from A1 (top leftcorner) to E14 (bottom right corner). Mark them.

14 Creating reports


Right-click outside the image and somewhere inside the marked fields area.Select Copy from the right-click drop-down menu.

Select the Analysis layer and choose appropriate field for pasting. Paste thecopy by using Paste > Linked picture.

Changing anything inside A1 to E14 area will reflect in this linked copy. Theimage is like a dynamically changing snapshot of A1 to E14 area.You may do the same with analysis image.

MeasurementsYou can copy other measurement values, that is, standard values, names;plus, patient information and examination data (date the radiography wastaken, analysis date).

14 Creating reports


Copy exported values in the following way: Select a cell in the Analysisworksheet and enter the equals (=) sign. Then select for example the Patientworksheet, select the desired data and press Enter. The cell value in theAnalysis worksheet is “=Patient!A2” if you copied the patient’s name.Edit the exported values according personal preferences. That is, changefont, use them in calculations, etc. Do the same, to copy for example namesof measurements, measurement values, etc.

For saving the template delete all data in Measurements, Images andPatient worksheets. Leave the Analysis worksheet as is.Proceed by saving the template. Select template and save analysis typeas .xlt file.

NOTEYou need to save a template as template file format *.xlt.

Leave Excel and load the saved excel template by clicking the Excel buttonand selecting Choose template.

NOTEIn order to make the template file smaller and faster to load, you shoulddelete both images from Image worksheet before saving.

NOTEWe recommend selecting Analysis worksheet before saving for it to open onexport.

14.5 Creating analysis specific reportsPredefined reports can be used to automatically obtain some deliverablesfrom analysis. The results change when the tracing is changed and saved.To create associative reports click the Report tab.

The view status of all elements and the radiograph are maintained in thereport.When analysis is stored, the report is updated with new tracing results.To access the report select Related Documents in the Documents tab.

14 Creating reports


14 Creating reports


15 Creating custom analysis typeThe synching of analysis types is by default off and the new analysis typesare stored locally in the Planmeca Romexis client computer folder /ProgramFiles/Planmeca/Romexis/client/cephmodule/AnalysisTypes with a file nameextension _local.

NOTEA user with administrator rights can later synchronize analysis types toserver by enabling analysis type synchronization in Planmeca RomexisConfig App and by removing _local extension from the analysis type filename. Note that this should be done while the module is running. Theanalysis types are synchronized to the server when the module is closed.

NOTEThe synchronised analysis types are stored in the Romexis server folder /server/share/ AnalysisTypes, see section "Creating analysis from beginning"on page 86 for more information.

A custom analysis type can be created in one of the following three ways:• by modifying a previous analysis type,• using predefined elements,• from the beginning.

15.1 Creating analysis type by modifying existing analysis1. To create a new analysis type select New from the Analysis type tab.2. Enter the name for the new analysis type and select the appropriate

analysis type from the list.

15 Creating custom analysis type


3. Click OK.To add elements to or remove them from the analysis use the DesignTools as described in section "Design tools" on page 28.

15.2 Creating analysis from beginning1. Repeat the procedure in the above section but do not choose any

analysis type.2. Repeat the process of creating a new anaysis type as described in

section "Creating analysis type by modifying existing analysis" on page85.

3. Open a window showing predefined elements by clicking the Elementlibrary button.

For detailed description on Element library, see "Element library" onpage 46.

4. To add a new element into the analysis type, select the element in thepredefined elements window and click on the element to add. To removethe element from the analysis type re-click it.When adding more complex elements their constituent elements areadded as well. For example, when adding Wits appraisal, an occlusalplane, two auxiliary planes and three points are added as well.



To add all selected elements into the analysis type click the Addelements button.These elements can be applied in the same way as the ones addedmanually. The only difference is that their values are preset (name, label,picture, description). You can repeat the adding procedure as manytimes you need.When analysis type is created using predefined elements introduced inPlanmeca Romexis 4.1.1 or later, the analyses can be switched so thatthe position of the elements remains.

NOTEFor more information on how to share or not to share the updatedanalysis types with other users, see section "Creating custom analysistype from beginning (example)" on page 97.



16 Editing standard valuesTo open the window for editing standard values and deviations click the Editstandard value button in the Analysis type tab.

NOTEThe content in the window may vary depending on from which tab the Editstandard values window is opened.

NOTEWhen modifying the values from the Analysis tab the changes will affect onlythe current analysis. To permanently modify the values the window must beopened from the Analysis type tab. Set standard values for each analysisseparately.

16.1 Using buttons in Standard values windowUse the following buttons to:Save table

Add a standard value

Delete a standard value

Add a new patient type (for example mixed dentition, adult,…)

Export to Excel

Import from Excel

To add standard values in an analysis at least one patient type need toadded, by selecting this button. New window is opened:

16 Editing standard values


To add new patient type, select and enter name for patient type. Whenpatient type(s) have been entered you can start adding standard values.

NOTENewly added patient type(s), will show in standard value window.

When patient type(s) are in standard values window, you can start addingstandard values for these patient types. To add standard value, simply clickin each cell and enter data.

NOTEYou can add standard values manually or import an excel document withthese values.

To delete patient types select the type to delete and click this button.Select OK.

16.2 Linking standard values and deviations with angles and measurementsTo open a window for linking standard values and standard deviations withmeasurements click the Link button.In the Measurements field are listed all measurements included in theanalysis or analysis type. In the Standard values field are listed all standardvalues included in the analysis or analysis type.



To open the window for editing mean values, click this button.New window with standard values appears, see "Editing standard valuesfrom Standard values - linking window" on page 90 for details.To link measurement with standard value, select the measurement in theMeasurements field on the left and the standard value in the Standardvalues field on the right.Click the blue arrow pointing downwards to link measurement with standardvalue.

To remove a link select it and click the blue arrow pointing upwards.To export linked standard values, click Export to Excel button.

16.2.1 Editing standard values from Standard values - linking windowAfter pressing this button in the Standard values - linking window, a newwindow where you can edit standard values, mean values, deviations andpatient type, appears. Values can also be exported/imported to excel sheetvia for export and for import from excel sheet.

To export values and corresponding deviations to a spreadsheet applicationclick this button.Select the name and location where to save the exported values and underwhat will they be exported.Click Save. To check excel file for exported values and correspondingdeviations open the exported excel file.



To import values and corresponding deviations click this button. System willthen offer you to select previously exported excel file (or any other) byselecting and open it. After importing standard values and deviations,Standard values window will be populated with them.

16.3 Customising reportsBy customising reports you can define which measurements and groupsshow in the final report.

NOTEIf the print customizations are done in the Analysis type tab they will beavailable next time the same analysis type is used. If they are done in theAnalysis tab, they wont be available later.

To open the Print customization window click the Page button.All the measurements included in the analysis type are listed in theMeasurements field.In the Groups field are listed all the available groups.The Print field shows the measurements and groups selected for the currentprintout.



16.4 Adding measurements to groups1. In the Print field select the group to which you want to add the

measurement

2. In the Measurements field select the measurement you want to add tothe printout.

3. Click the arrow pointing downwards.



The selected measurement now shows in the Print field under theselected group.

16.5 Deleting measurements from groups1. In the Print field select the measurement you want to delete from the

printout.

2. Click the arrow pointing upwards under the Measurements field.



The selected measurement is deleted from the printout and shows in theMeasurement field.

16.6 Adding groups for printouts1. To open a window for editing groups click this button.

2. Add new group by clicking + button3. Enter the name for the group and click OK.

The new group now shows in the Print field.



16.7 Deleting groups from printouts

Steps1. Open the Groups window by clicking this button.

2. In the following window select the group you want to delete in the list andclick this button

16.8 Editing groups in printouts1. Select the group to edit and click this button2. Enter a name for the new group.

3. Click OK.

16.9 Print previewTo view a preview of the printout click this button.The printout shows the radiography, elements on print layer andmeasurement groups in table format.



17 Creating custom analysis type from beginning(example)

Below you can see the process for creating an analysis type.

17.1 Choosing phantomTo display a lateral view of the phantom image, click the Phantom button.

17.2 Positioning landmarks1. Set four single points.

2. Rename the points as:• Sella Turcica: S• Nasion: N• Point A: A

17 Creating custom analysis type from beginning (example)


• Point B: B

17.3 Creating planesConnect points S-N, N-A and N-B to create planes SN, NA and NB.

17.4 Creating dimensionsSet two angles between the created planes (between planes SN and NA;and between planes SN and NB).To select adjacent angles, use <Ctrl> and click the corresponding adjacentangle. Enter names for measurements SNA and SNB. Name SNA SNBLabel as SNA SNB



17.5 Calculating measurements1. Start by entering the name, label, and the unit of measurement.2. Select SNA.3. Double-click it or click the button to move it to the Angles in calculation

field.4. Click this button.5. Select SNB.6. Double-click it or click > button to move it to the box on the right.7. Confirm the result by clicking OK.

The new ANB angle now shows in the tree and image.



17.5.1 Measuring WITS appraisal (example)The method entails drawing perpendicular planes from points A and B on themaxilla and mandible, respectively, onto the occlusal plane. The points ofcontact of the perpendicular planes onto the occlusal plane are labelled Aand B, respectively. The Wits appraisal is the distance between the twoplanes. The appraisal can be assigned positive or negative value. In theillustrated case the value is negative. If the plane crossing the point A goesthrough the point B the value is positive.

1. The analysis includes points A and B.2. Select plane and set it in the direction of the occlusal plane as shown on

the image.3. Enter the name Ocp.4. Click on a point and place it on the occlusal plane.

Enter the name PntWits.



5. Set planes perpendicular to the occlusal plane (Ocp) through points Aand B.

6. Enter names A-Pln Wits and B-Pln Wits.7. Create two distance measurements:

• From point PntWits to plane A-Pln Wits.Name the distance as wa

• From point PntWits to plane B-Pln Wits and enter the name wb

8. Enter the name, tag, measurement unit and equation.9. Select wa and double-click it

orclick the > button to move it to the Measurement in calculation field.



10. Click the - button.11. Select wb and double-click on it

orclick the > button to move it to the Measurement in calculation field.

12. Click OK to finish.The new measurements now show in the image and in the tree.



18 Settings

18.1 Settings tab

GeneralAnti-aliasing is a technique for minimizing the distortion artifacts known asaliasing when representing a high-resolution image at a lower resolution.

InfoBoxIn this field you can define the font properties (type, formats and size) usedin the InfoBox texts.

18.2 Colors tabThe colour of an element type in an analysis can be modified.1. Go to the Colors tab.2. From the Element column select the element type you want to modify.3. In the Color column select the colour you want to use for the element

type and click OK.

NOTEColours can be set separately for reports.

4. To change the default colour of a certain element click on it.5. Choose the new default colour from the drop-down menu

orClick the square button next to the menu.

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6. Select the colour by clicking in the colour matrix window.Also hue, saturation, and luminosity of the colour as well as red, greenand blue tones can be adjusted.

7. When satisfied with the new colour click the Add to Custom Colorsbutton.

8. Save the settings and quit by clicking OK.To discard the new settings, click Cancel.To define new custom colours click the Define Custom Colors button.

To set new default colour, select a custom or basic colour and click OK.9. Click the Save as defaults button.

18.3 VideoSelect codec and resolution from the drop-down menus.

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18.4 Image formats

NOTEWhen using Planmeca X-ray units for image acquisition it is not necessary todefine image formats.

Image format list includes a list of calibration information for different sizeimages.To add a new image click the + button and enter the name of the image inthe description field.Define width, height, calculated pixels and millimetres.Click OK.To save the formats as defaults click the Save as Defaults button.

18 Settings


18.5 E-mailTo avoid entering the data separately for every e-mail you can create atemplate containing information repeating in all e-mails.Fill in the Subject and Body fields with the information repeating frequently.The text in the fields can be modified at any time.To save the e-mail template as default click the Save as Defaults button.

18 Settings


19 Sharing and backing up analysis types19.1 Analysis type synchronization between server and clients

The admin user can enable synchronization of analysis types from clients toserver by enabling synchronization in the Configuration application.If the synchronization is enabled when the Cephalometric Analysis module isstarted, the analysis types are copied from the server to the client and theclient copies will be overwritten (excluding the analysis types with _localextension).

19.2 Regular userWhen an analysis type is edited or a new analysis type is created by aregular user without admin rights, the analysis type is saved as a local copy(with the file extension _local) to the client workstation under the folder /Program Files/Planmeca/Romexis/client/ cephmodule/AnalysisTypes.The local copies are not synchronized with the server. To save a back-upcopy of the analysis type a back-up copy of the folder needs to be taken.

19.3 Admin userWhen an analysis type is edited or a new analysis type is created by anadmin user, the analysis type is saved to the client workstation under thefolder /Program Files/Planmeca/Romexis/client/cephmodule/AnalysisTypes.When the user closes the cephalometric analysis module the software asksif the new/modified analysis types should be synchronized to the server (ifthe synchronization is enabled):• By selecting Yes the updated analysis type is uploaded to the server and

the existing analysis type at the server is updated with the clientversions.The analysis types are saved to the folder /Program Files/Planmeca/Romexis/Server/share/ AnalysisTypes on the Planmeca Romexis servercomputer. To store back-up copies of the analysis types a back-up copyof the folder is required.

• By selecting No the new and edited analysis types are saved as localcopies (with the file extension _local in the client workstation folder /Program Files/Planmeca/Romexis/client/ cephmodule/AnalysisTypes).

NOTEThe admin user can later synchronize the local analysis types to server byenabling synchronization in the Configuration application and removing any_local extension from the analysis type file name while the module isrunning. The analysis types are synchronised to the server when the moduleis closed.

19 Sharing and backing up analysis types


20 Using lateral face photo for soft tissue landmarks incephalometric analysis

The following instructions describe how to use a lateral face photograph toobtain the pronasale (pn’) and other soft tissue points when making ananalysis using a cephalometric image that does not show full soft tissueprofile.1. Start an analysis as usual (for more formation see section "Starting new

analysis from Cephalometric analysis module" on page 142. Position the landmarks as described in section "Positioning landmarks

manually" on page 43. When all landmarks have been correctly placed check that a point on

soft tissue profile line (e.g. soft tissue pogonion) is included in thevolume.

4. Start another analysis using a lateral face photo. Do NOT use anytemplate, just draw silhouette and add the needed soft tissue landmarkssuch as pronasale etc.

5. Superimpose the analyses using a common point (e.g. soft tissuepogonion) and the point to rotation method.

6. After superimposition right-click on the elements on the face image in thesuperimposition that you would like to transfer to the first analysis.

7. Save the superimposition by selecting Copy element to.8. Re-open the first analysis and align the points that have not been

positioned using the points transferred from the face photo in thesuperimposition.

20 Using lateral face photo for soft tissue landmarks in cephalometric analysis
