T-Scan User Manual

8/18/2019 T-Scan User Manual

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12/14/05 T-Scan II User Manual (Rev I) i

T-Scan® User Manual

computerized occlusal analysis system


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12/14/05 T-Scan II User Manual (Rev I) i

T-Scan® User Manual

v. 8.1x

computerized occlusal analysis system

Tekscan, Inc. 307 West First Street, South Boston, MA 02127

Tel: 617.464.4500/ 800.248.366 9 fax: 617.464.4266

Email : [email protected] web: www.tekscan.com

mailto:[email protected]://www.tekscan.com/http://www.tekscan.com/http://www.tekscan.com/mailto:[email protected]


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Table of Contents

WELCOME TO T-SCAN ......................................................................................................................... 5

INTRODUCTION ............................................................................................................................................ 6

HARDWARE & INSTALLATION ............................................................................................................... 7

COMPUTER R EQUIREMENTS .............................................................................................................................. 7 E VOLUTION COMPONENT IDENTIFICATION .............................................................................................................. 7

SENSORS .................................................................................................................................................... 8

E VOLUTION H ARDWARE INSTALLATION ................................................................................................................ 11

SOFTWARE ...................................................................................................................................... 13

M AIN SOFTWARE V IEWS................................................................................................................................. 13

M AIN MENU .............................................................................................................................................. 19

“P ATIENT LIST” W INDOW .............................................................................................................................. 28

"P ATIENT R ECORD" W INDOW .......................................................................................................................... 30

A RCH, A RCH OUTLINE & EMBRASURE LINES ......................................................................................................... 33

FORCE OUTLIERS ........................................................................................................................................ 34

CENTER OF FORCE TRAJECTORY ........................................................................................................................ 36

GRAPHS ................................................................................................................................................... 37

OCCLUSION & DISCLUSION TIME ...................................................................................................................... 41

K EYBOARD SHORTCUTS ................................................................................................................................. 42

SOFTWARE U PDATES..................................................................................................................................... 43

SCANS ............................................................................................................................................ 45

SCAN T YPES .............................................................................................................................................. 45

PERFORMING A SCAN .................................................................................................................................... 47

R EVIEWING A SCAN ...................................................................................................................................... 50 INCLUDING NOTES WITH A SCAN ....................................................................................................................... 53

A TTACHING AN IMAGE TO A SCAN ...................................................................................................................... 53

CREATING A R EPORT .................................................................................................................................... 54

APPENDICES ................................................................................................................................... 58

DENTRIX G5 INTEGRATION FUNCTIONALITY .......................................................................................................... 58

BIOEMG INTEGRATION MODULE ...................................................................................................................... 62

BIBLIOGRAPHIC D ATA ................................................................................................................................... 64

THIRD-P ARTY SOFTWARE SUPPORT D ATA ............................................................................................................ 64

W ARRANTY INFORMATION .............................................................................................................................. 65

MEDICAL E VOLUTION-B ASED CERTIFICATIONS STANDARDS & S AFETY ............................................................................. 66

GLOSSARY ....................................................................................................................................... 71


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WELCOME TO T-SCAN

Technical Support

Support is available Monday through Friday from 8:30am - 7:00pm EST.

Phone support: (617) 464-4500 or (800) 248-3669 x359 (USA and Canada)

Email Support: [email protected]

Fax Support: (617) 464-4266

Website: www.tekscan.com

Mail: Tekscan, Inc. 307 West First Street. South Boston, MA 02127-1309

Tekscan, Inc. will provide technical assistance for any difficulties you may experience using your T-Scan system for 90days from the system shipping date. After 90 days, Tekscan offers annual Technical Support and System MaintenancePlans or customer support at our standard rates per incident. An incident is defined as one single issue or problem.

Product Feedback

Your feedback about our software is welcomed. Please email any feedback to: [email protected]

Contact Tekscan for additional T-Scan sensors. Standard sensors are available in two sizes; small and large. Contact usfor current pricing and availability.

Copyright © 2012 by Tekscan, Inc. All rights reserved. No part of this publication may be reproduced,transmitted, transcribed, stored in a retrieval system, or translated into any language or computer language, in anyform or by any means without the prior written permission of Tekscan, Inc., 307 West First Street, South Boston, MA02127-1309.

Tekscan, Inc. makes no representation or warranties with respect to this manual. Further, Tekscan, Inc. reserves theright to make changes in the specifications of the product described within this manual at any time without notice

and without obligation to notify any person of such revision or changes.

T-Scan is a registered trademark of Tekscan, Inc.

Microsof t Window s

is a registered trademark of Microsoft Corporation.

mailto:[email protected]:[email protected]:[email protected]://www.tekscan.com/http://www.tekscan.com/http://www.tekscan.com/mailto:[email protected]:[email protected]:[email protected]:[email protected]://www.tekscan.com/mailto:[email protected]


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INTRODUCTION

This manual describes how to use Tekscan’s T-Scan system. T-Scan is a reliable and easy-to-use clinical diagnosticdevice that senses and analyzes occlusal contact forces using paper-thin, disposable sensors. The T-Scan system comes

with a full-featured Patient File Management system, which makes storing patient records and tracking occlusal scanssimple, and makes the system an integral component of the clinical workstation for occlusal diagnosis and treatment.

The T-Scan Occlusal Analysis system can be incorporated into your office in the following ways:• Hygiene• Initial Patient Exam• Identify Premature Contacts• Achieve Bilateral Simultaneity• Anytime you use Articulation Paper• Increase Implant Longevity• Establish Anterior Guidance• Case Finishing• Patient Education/Documentation

The T-Scan system is a valuable tool that aids in the diagnostic process of analyzing a patient's bite and showing what isand what is not functioning properly. When a bite is unstable it can cause pain, teeth and dental restorations to crackand break, gum disease, tooth loss, headaches, and TMJ Disorder.

The T-Scan software offers features that allow the user to:

• Scan the patient’s occlusal contact data• View the patient’s tooth contacts and associate them with specific teeth• Analyze the data, with the force and time relationships of the contacts displayed as color contour images

showing:

o Instant MA (Maximum Area Frame)o Center of Force

o

Center of Force Trajectoryo More advanced features, such as: Max, Graph, Graph Zoom and 3D Force Columns

• Manage patient records and scan files through the use of an intuitive database

The T-Scan system is comprised of the Microsoft (MS) Windows-based T-Scan software, the associated hardware, andpatented Tekscan sensors. The system’s versatility allows you to copy occlusal contact data (as an image) and paste itinto other Windows applications, or to create a PDF report that can be printed or sent out via email.

This manual provides a thorough description of the system’s features and capabilities. Follow the Quick Start section asa guideline, and refer to specific sections for more detailed instructions on how to use each feature.


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HARDWARE INSTALLATION

This section presents instructions for hardware installation, and also provides the system requirements necessary tosupport the T-Scan Occlusal Diagnostic system.

COMPUTER REQUIREMENTS

For your T-Scan system to function properly, it is recommended that your computer meet or exceed the followingminimum requirements:

• Windows 7• Microsoft .NET Framework 4.0• Intel Core 2 Duo Processor, or newer (Intel

Celeron Processors are not recommended)

• 2gb RAM• 5gb of disk space• Dedicated video card

T-Scan is certified to run on Apple computers using VMware Fusion 5 or Parallels Desktop 7. To sufficiently run T- Scan in a virtualized system, we recommend the following minimum requirments:

• MacBook Pro 13" or larger (early 2011 models and newer)• 8gb RAM•

75gb of disk spaceT-Scan can also run on an iMac or Mac Mini, similarly configured.

EVOLUTION COMPONENT IDENTIFICATION

The following table provides a view of all the components that ship with your T-Scan Evolution System:

Evo lu t ion Han dle

(10) Small Sensors (Part # ZSEN (2501) T1-HD)

an d (10) Large Sensors (Part # ZSEN (2001) T1-HD)

(2) Sma ll Sensor Supports (Part # ZSEN-SUPPORT-SM)

an d (2) Large Sensor Supports (Part # ZSEN-SUPPORT-LG)

Sys tem So f tware


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User Manual

Evo lu t ion Sys tem Carry ing Ca se

Prac t ice Marke t ing K i t

Optional:

USB Cable length can be extended to 30 or 45ft. with the following optional components:

(1) 4-Port USB 2.0 Powered Slim Hub for PC(1) or (2) additional 15 ft. USB Cable(s)

SENSORS

The T-Scan sensor is an ultra-thin (.004", 0.1 mm), flexible printed circuit that detects your patient’s occlusal forces.These sensors are made up of 1370 active pressure sensing locations for the large sensor (#2001), and 1122 pressuresensing locations for the small sensor (#2501). These sensing locations are referred to as ‘sensing elements’, or‘sensels’. The ‘sensels’ are arranged in rows and columns on the sensor. Each sensel can be seen as an individualsquare on the computer screen by selecting the 2D display mode.

Note: The T-Scan sensor should not be cut. Cu tt in g the sensor would expose the pati ent to the

sensor's inter ior , and would allow saliva, other l iquids and foreign mater ia l to enter the sensor.

The followi ng shows the small ( le f t) and

large (right) T-Scan Sensor:

The followi ng shows the small ( le f t) and large (right) T-Scan

Sensor Support:

Note: Sensor supports are not i nt erchan geable. The sm all support mu st be used wi th the sma ll

sensor, an d the large support wi th the large sensor.


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Sensor Specifications

Large Sensor (#2001):


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Sma ll Sensor (#2501):

Sensor Maintenance and Care

• The same sensor can be used on the same patient across multiple sessions, and it is recommended that sensorsbe cleaned with a 70% Isopropyl Alcohol solution between each use. To do this, slightly dampen a cloth with

the alcohol solution, careful not to soak or saturate the cloth. Then wipe the sensor. The same sensor shouldnot be used on different patients. Sensors are disposable after their useful life. Research has proven that oursensors can be used approximately 15-25 times each while still retaining our high standards of reliability.

•

The T-Scan scanning handle cannot be sterilized but may be wrapped in plastic wrap for isolation from thepatient. The sensor supports can be autoclaved or placed in cold sterilization liquid. The sensors, sensorsupports, and handle can be cleaned by wiping them down with isopropyl alcohol swabs or cloth dampened

with isopropyl alcohol. Care should be taken not to oversaturate the cloth.

• Sensors should always be stored flat in either the box in which they were shipped, or some other protectivecover. Improper storage can adversely affect sensor life.

• Sensor Replacement/Disposal: Always dispose of sensors in accordance with Federal and State guidelinespertaining to medical biohazardous waste.


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EVOLUTION HARDWARE INSTALLATION

The Evolution Handle gathers the data from the sensor and processes it so that it can be sent to the computer. Thebuttons on the sensor handle may also be used to start or stop a scan.

The fo llowing d isp lays the bu t t ons an d the ir

fun c t iona l i t y for the Evo lu t ion Han dle:

The fol lowi ng shows an im age o f the Evo lu t i on

Handle with at tached USB cable:

The followi ng label is pr int ed on all Evoluti on Han dles

d isp lay i ng the compl iancy , m odel num ber, warn i ngs

and parameters :

• Sensor OK Green LED Indicator: A green light here indicates that the sensor is correctly inserted into thehandle and a new scan can be opened.

• Scan Mode Green LED Indicator: A green light here indicates that the sensor is scanning force data andtransferring that data to your computer.

• New Scan Button: This will open a new scan window in the software, so that you can begin scanning forcedata.

• Scan Start & Stop Button: Use this button to start a scan or stop a scan that is in progress.• Power Green & Yellow LED Indicator: When yellow, this light indicates that the handle is receiving power,

but is not yet initialized. When Green, this light indicates that the handle is receiving power and has beeninitialized by the computer (i.e.: the device shows up under the Windows device manager).

Inserting a sensor into the Evolution Handle

1. Select a sensor support (either large or small to match the sensor to be used with the patient).

2.

Insert the sensor support into the Evolution Handle, with the sensor support's central locating pointer facingin the "up" position.

3. The Evolution Handle has a latch on its topside. In the"up" position, the latch retracts the contact pins insidethe handle to allow insertion of the sensor tab. Ensurethat the Evolution Handle latch is lifted to the upwardposition.


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4. Slide the sensor tab (with ‘This Side UP’ facing upwards) under the central pointer on the support, through themiddle of the support, and into the handle. Slide the sensor in until it reaches its mechanical stop. Do not

force the sensor into the handle!

5. Close the latch completely to its downward position; flush with the Handle.

Connecting the Handle to the Computer

Once the sensor is inserted into the handle, connect the attached USB cable to the computer’s USB port. Your computershould automatically detect the new hardware and configure it. If the driver is not found, insert the Tekscan software CDthat came with your system and have the computer locate the driver on your CD. Then follow the on-screen instructions.

After following this procedure and starting the software, the message on a new scan window should read "Sensor OK."If the message is "MISALIGNED," re-insert the sensor using the above procedure.

Cau t ion Do no t a l low the handle to hang from the sensor . The handle may become dam aged,

resu l t in g in a m isa l igned sensor.

Evolution Handle Maintenance and Care

• The Evolution Handle cannot be autoclaved.•

Do not let any liquid drip onto the electronics inside the handle. If this occurs, the handle will stop workingand must be allowed to dry for 24 hours. You can use your air syringe, however, to reduce this drying time. Donot attempt to dry out the handle using any other method, or you may destroy the delicate electronics.

• To properly clean the device, be sure to wipe down the handle and sensor supports with a 70% Isopropyl Alcohol solution. To do this, slightly dampen a cloth with the alcohol solution, careful not to soak or saturatethe cloth. Then wipe the handle and sensor supports after each use.

Evolution Handle Specifications

COMMUNICATION/DATA ACQUISITION:

COMMUNICATION PROTOCOL TO HOST COMPUTER USB 1.1 or 2.0 Compatible, 12 Mbps

SCAN SPEED Up to 100 Hz (~500 Hz with Turbo Mode).

DIGITAL PRESSURE RESOLUTION 8 BITELECTRICAL:

POWER SOURCE Host Computer’s USB BUS

POWER CONSUMPTION 200mA MAX at 5V

USB CABLE:

LENGTH in (mm) 180 (4572)

WEIGHT lbs (kgs) 0.40 (0.18)

HANDLE ENCLOSURE:

SIZE LxWxH in (mm) 5.42x2.25x1.88 (137.7x57.2x47.6)

OPEN LEVER HEIGHT in (mm) 4.30 (109.2)

WEIGHT lbs (kgs) 0.40 (0.18)

AMBIENT OPERATING CONDITIONS:

TEMPERATURE:oF (

oC) 14 to 131 (-10 to 55) Prolonged use at high

Temperatures should be avoided

HUMIDITY: % 0 to 90 (non condensing)

PRESSURE: psi (kPa) 1.7 to 14.7 (11.6 to 101.3) (sea level to 50,000 ft.)

STORAGE AND TRANSPORT CONDITIONS:

TEMPERATURE:oF (

oC) -4 to 131 (-20 to 55) Short-Term

41 to 104 (5 to 40) Long-Term

HUMIDITY: % 0 to 90 (non condensing)

PRESSURE: psi (kPa) 1.7 to 14.7 (11.6 to 101.3) (sea level to 50,000 ft.)


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SOFTWARE

This section is an overview of the components that make up the software.

MAIN SOFTWARE VIEWS

The Main Window consists of the Title Bar, Menu, Toolbar, Scan Page View, 2D and 3D ForceView, Occlusal TimeTable, Graph, and Navigation Bar. The Main Window, and its components, is shown in the figure below.

Title Bar

Each window has a Title Bar along the top, which displays the name (Title) of that window. Each Title Bar has the usualMS Windows control button at the left end, and Minimize, Maximize and Close buttons at the right end (see figureabove). Only one window may be active at any one time.

Menu

The Menu provides the pull-down menus used to control the T-Scan program. Each Menu Bar option is described indetail in the Main Menu section. Some menu items contain shortcuts that can be used on the keyboard. Refer to theKeyboard Shortcuts section for a complete list of shortcuts.

Toolbar

The Toolbar is where you will find easy access to most of the common tasks performed in the software. Not all Toolbar

functions are available at all times. For example, if you've already saved a scan, the "Save" icon is unavailable and is"grayed out" (as shown below).


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Toolbar icons also have "Tool Tips" associated with them. When the cursor remains over anicon for a brief period, the "Tool Tip" will appear under the cursor location (shown right).

The following provides an explanation of the options found on the Toolbar:

• Patient List: Opens the Patient List dialog, where you can add, edit, and deletepatient records, and open or delete patient scans.

•

Patient Avatar: Displays the patient's gender. The icon displays a male face for male records, or a female facefor female records.

• Patient Name & Patient ID: The patient's full name is listed on the top, and if they have an ID associated withtheir record, the ID is listed on the bottom below the name.

• Save Recording: If a scan has been taken, this icon becomes visible. To save the scan, press this button. Scansare automatically saved under the Patient Record.

• Scan Type: Associate a procedure to the scan. Refer to the Scan Types section for further information.

• Add Images: Allows you to attach Images to the scan. Refer to the Attaching an Image to a Scan section forfurther information.

•

Add Notes: Use this option to add notes that are associated to the scan. Refer to the Including Notes with aScan section for further information.

• BioPAK: If BioPAK is installed on your computer, this button opens the BioEMG software module to allow for aconnection between the scan within T-Scan and BioEMG . Refer to the BioEMG Integration Module section.

• Graph: This toggle button allows you to show or hide the Graph on-screen. By default, the Graph is visible.

• Occlusal Time Table: This toggle button allows you to show or hide the Occlusal Time Table on-screen. Bydefault, the Table is hidden. The visibility of the Table is remembered even after you exit and reopen theprogram. For instance, if you make the Table visible, then close and reopen the program, the Table remains

visible.

•

Close Recording: If a scan has been taken or is opened on-screen, you can close it using this button. Likewise, if you havetaken a scan and do not wish to save it, press this button. Thesystem will prompt you to either save or discard the scan (seeimage at right).

Scan Page View

If you have multiple scans open on-screen, you will see each scan represented as a scan thumbnail along the left side ofthe main window. Click the thumbnail to select and view it within the main window. If you have multiple scans fromdifferent patients open, a Title bar above the Thumbnails indicate patient name. Each Patient's thumbnails are groupedtogether.


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2D ForceView

The 2D ForceView displays the bitemark in two dimensions; left and right,as well as anterior and posterior. As thepatient bites down, the sensor's color-coded tooth force data is displayed inreal-time with lowest force (blue) tohighest force (red or saturated pink).The resolution of the pressure is 255levels of raw data, which is translatedinto these colors. The T-Scan softwareprovides numerous options fordisplaying, recording and analyzing thisreal-time data.

As you play the scan back, you can viewthe patient's bite over time, and hone inon any time during the bite to view theamount of force on the left or right sides of the Arch. In the example below, the left side shows 68.7% of the force whilethe right side shows 31.3% of the overall force. You can also view the force placed on each tooth as a percentage, whichis written on the inside of the Arch Outline. Tooth numbers are written on the outside of the Arch Outline. In theexample above right, we can see that 13.4% of the bite force is attributed to tooth number 12. Each of the straight edgelines that divide the teeth are called "Embrasure" lines, and the circular green line that encompasses the teeth and Archis called the Arch Outline.

The 2D ForceView is displayed by pressing the New Scan button on the Handle. Alternately, clicking the New Scan button on the Patient List window initiates a new scan.

If you hover your mouse over the embrasure line between two teeth, the tooth width is shown in a Tool Tip (shownbelow left). You can click and drag the line to move it, thereby extending or contracting the space between the two teethadjacent to the embrasure line.

In addition, you can right-click over the 2D ViewForce and select Copy from the context menu (shown below right).This copies the 2D ViewForce as an image that can be pasted into other programs, such as Microsoft Word or Excel, forexample.

3D ForceView

The 3D ForceView displays the bite mark in three dimensions (shown below left). Force data is displayed as forcecolumns in three-dimensional space.

You can move the 3D Forceview in all three dimensions by clicking and dragging on any position over the 3D ForceViewarea. In this way, you can hone in on a specific area of the Arch Model and locate specific areas of the patient's biteforce (shown below right).


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As you play the scan back, the 3D ForceView is updated along with the 2D ForceView. In this way, you can view thepatient's bite in 3-dimensional space over time, and hone in on any time during the bite to view the amount of force onthe left or right sides of the Arch Model.

Occlusal Time Table

The Occlusal Time Table allows you to view the measurements of the bite timing (shown below left), as well as eachindividual tooth's timing (shown below middle), and the Force outliers for each tooth (shown below right). TheOcclusal Time Table has a direct relation to what you are viewing in the Graph. Whereas the graph displays the visual

lines, the table provides the numerical values or measurements. The two; however, are providing the same data.

To view the patient's total occlusal bite timing, ensure the Timing and Arch buttons are pressed. This should be thedefault position. In this position, you can view the following:

•

Line: the A, B, C, and D lines. These lines are used to mark two separate sets of positions (frames) of the scan.The A-B Increment/Differential lines can be used to denote the start and end of the Occlusion Time (OT-A andOT-B) and the C-D Increment/Differential lines can be used to denote the start and end of the Disclusion Time(DT-C and DT-D). Refer to the Occlusion and Disclusion Time section for more information.

• Time: The time at which these Occlusion and Disclusion lines occur in the patient's bite, from the start of thescan.

• Force: The force exerted on the sensor at these Occlusion and Disclusion points, as it relates to the scan'soverall force

• Diff: The time differential from Line A to B (Occlusion) and C to D (Disclusion).


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You may also see indicator icons next to each of the Lines. This shows:

• Green checkmark: The green checkmark indicates that OT or DT is within an acceptable, user-defined range.• Yellow caution indicator: The yellow caution sign indicates that OT or DT is on the borderline of an

acceptable, user-defined range.• Red warning indicator: The red warning sign indicates that OT or DT is not within an acceptable, user-defined

range.

To view the patient's individual tooth timing, ensure the Timing and Tooth buttons are pressed. You will notice thateach tooth has its own color. Select the tooth number from the "Tooth #" column, and press the >> button, to move itover to the "Displayed" column. As soon as the Tooth number is placed in this column, the 2D ForceView updates toshow the corresponding tooth color outline surrounding the embrasure lines on that specific tooth, and the Timing ofthe tooth is displayed in the graph using a graph line of the same color. Using this same method, you can add multipleteeth into the "Displayed" column and view multiple tooth force and timing within the Graph. In this way, you can alsocompare teeth together in the same Graph.

To remove a tooth from the "Displayed" column (and thereby remove it from the Graph), select its tooth number in the"Displayed" column and press the or Arch in Quadrants, the left (green) and right (red) side of the patient's bite are replaced by fourquadrant lines that outline the patient's left anterior (dark blue), left posterior (light blue), right anterior (dark red),and right posterior (light red) quadrants.


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Navigation Bar

The Navigation Bar allows you to perform key operations for a new scan or review operations for an existing scan. Witha new scan, you can perform the following operations:

• Sensitivity: Use the Sensitivity slider to make the sensor more or less sensitive to bite forces. Each patient has amore or less forceful bite. The Sensitivity setting aligns the sensor’s output with the biting force of the patient.

Allowing the operator to change sensitivity leads to a more useful scan with less saturated sensels. Move theslider lower if too many saturated sensels are obtained in your scans. Move the slider higher if the force is toolow for a scan. Then re-scan the patient. The effective sensitivity range is 1 to 14. It is advised that when takingany recording, there are no more than 3 pink sensels displayed at MA (Maximum Area Frame).

• Scan Start / Stop Button: Initiates a patient scan. You will see the frame progression on the right side of the

navigation bar. After the patient has concluded their bite, pressing the Scan button again stops the scan. Bydefault, scans are 1200 frames and last approximately 1 minute (20 frames per second), giving you plenty oftime to obtain the patient scan.

• Sensor Indicator: Displays the status of the sensor. If the sensor status reads "Sensor OK," then you are readyto perform a scan. If instead it says "Sensor Misaligned," try readjusting the sensor and sensor support in theHandle and ensure the Handle is properly connected to the Computer's USB port.

Once the scan is performed, the scan is displayed on-screen, and the Navigation Bar options change to "review" mode.In this mode, the following options are available:

• Move to Start: Moves the position of the scan to the beginning (first) frame.

• Back One Frame: Moves the position of the scan backward one frame.

• Play / Pause: Plays the scan forward from the current timeline position according to the Frame Rate setting.Pressing the button while the playback is in progress will pause the playback. The Spacebar can be substituted

for this button; playing and pausing the scan. To play forward continuously, press Shift+Spacebar .• Forward One Frame: Moves the position of the scan forward one frame.

• Move to End: Moves the position of the scan to the end (last) frame.

• Timeline: The Timeline Slider allows you to move the Timeline manually to any position along the scan. Thisupdates all views dynamically. The Occlusion (A & B) and Disclusion (C & D) line markers are indicated onthis Timeline.


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• Force / Time Indicator: Shows the Force percentage (as a percentage of overall force for the entire scan) atthe current Timeline position along the top. The time indicator displaysthe current time of the Time Indicator as well as the total time for theentire scan along the bottom.

• Playback Speed: Allows you to select amongst three playback speeds:Fast, Medium, and Slow (see image at immediate right).

•

Central Width: Allows you to adjust the patient's Central Incisor Width(see image at far right). Use the Up / Down arrows to increase ordecrease the width.

• Force Legend Color Scale,Noise Threshold Adjustment Slider, and Upper Limit Slider: The Legend is asegmented force color scale, which shows the range of colors displayed in the scan, and their associatednominal forces. Differences in occlusal force displayed in the 2D and 3D ForceView is distinguished by thecolors ranging from red (highest forces) to blue (lowest forces). The Pink color above the red maximumindicates sensels that are fully saturated. It is advised that when taking any recording, there are no more than 3pink sensels displayed at MA (Maximum Area Frame).

All views are controlled by one legend, making it very easy to make comparisons between views. The Legend’skey does not have any units. The range of the color scale is a digital range distributed between 0 and 255 (for a

total of 256 levels of force or "Raw Sum").

Dragging the Noise Threshold Adjustment Slider to the right allows you to remove lower forces from view on-screen. Data is not removed, only its view on-screen. In this case, all sensed forces below the set level of thisslider are not displayed. The low end colors are filtered out from the Legend. This feature can be used tosuppress the display of low-level noise, which may be distracting. All views dynamically update as you move thisslider.

If the Upper Limit Slider is moved left, upper level force is filtered out, as are their related colors. All view windows dynamically update as you move this slider.

Note that the legend settings are saved until you exit the T-Scan program.

MAIN MENU

The Main Menu provides most command operations within the T-Scan system. The most frequently used items in the Main Menu also have an iconon the Toolbar.

File Menu

• Patient List: Opens the "Patient List" dialog, where you can create a newpatient, edit an existing patient, create a new scan under any existing patient,and open or delete a scan from any existing patient. Refer to the "Patient List"

Window for more information.

•

New Scan: Opens a new scan for the current patient.

• Save Scan: Saves the current scan to your patient record.

• Export Scan: Clicking the "Export Scan" command opens the "Save" dialog(shown below), where you can export the scan to any place you like on yourcomputer. The scan is saved in Tekscan's proprietary .fsx file format.


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• Save AVI File: Allows you to save thecurrent scan as an .avi file, which canthen be played as a video scan in other

video software, such as Windows Media Player , for example. When you click on

the "Save AVI File" command, the "ExportScan to Video FIle" dialog opens. You canselect from the following options:

o Filename: The file path where the video is to be saved on yourcomputer. Click the Browse button inorder to select a folder and filename for the video file on your computer.

o Window Frame: Allows you to save either the 2D ForceView or 3D ForceView to a scan file. Only oneoption can be selected.

o Resolution: Allows you to select from 3 different sizing formats. Depending on whether you select the 2D

ForceView or 3D ForceView, different sizes are available. The following table outlines the size options.

Small

(width x height, in pixels)

Medium


Large


2D ForceView 250 x 198 500 x 395 1000 x 786

3D ForceView 250 x 150 500 x 300 1000 x 600

o Frame Rate: Allows you to select a frame rate for the video. The Frame Rate options are Slow, Medium, or Real Time (actual time of the patient's bite). Only one option can be selected.

o Save: This button saves the video file on your computer to the filename/path you selected in the first field ofthis dialog automatically. When you press the Save button, a "Video Compression dialog opens (shown

below left). Ensure you select the "Microsoft Video 1" compressor codec from the drop-down list (shownbelow right).


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o Cancel: This button cancels the video file save, and closes the dialog.

• Quick Report: This option sends the report to the printer, and also creates a .pdf file, which you can then savefrom the Adobe Acrobat program. The Quick Report option does not save the report automatically to yourcomputer. Refer to the Creating a Report section for more information.

• Create Report: Allows you to export the contents of the currently active scan, including comments and graphs,

to an Adobe Acrobat (.pdf) file. From there, you can print the file or send the file out through email. The window is printed exactly as it appears on-screen. Refer to theCreating a Report section for more information.

• Exit: Closes the T-Scan application. If you have any unsaved scansopen, you will be prompted with a message asking if you wish tosave the recording(s) to the database (shown at right).

Edit Menu

• Scan Notes: Opens the "Notes" dialog, where comments can be enteredfor the current scan. Refer to the Including Notes with a Scan section forfurther information.

• Movie Photographs: Opens the "Scan Images" dialog, where you canassociate Images to the scan. Refer to the Attaching an Image to a Scan section for further information.

• User Settings: Opens the "User Settings" dialog, where the user can adjust several global software parameters.Click on a specific tab to access associated settings. The "User Settings" dialog is broken down into thefollowing tabs. Note that all images for the tabs below show the default settings. The Close button is universalon all tabs and closes the dialog while also accepting any changes that were made in the tabs. In other words,

you do not need to explicitly Save any changes. You can make all your changes to all tabs and press the Close button to accept these changes.

o Force Outliers: This tab allows you toincrease or decrease the relative forcebetween teeth during closure. This helpsto detect teeth that might have irregularforce and timing characteristics.Decreasing the relative force results inmore Force Outliers detected. Increasingthe relative force results in less ForceOutliers detected. The "High ForceOutliers" slider adjusts the high forcerange, while the "Low Force Outliers"adjusts the lower force range. Press the

Defaults button if you wish to return tothe default "Force Occlusal Time Outliers" which is a setting of 3, as shown below.For more information, refer to the ForceOutliers section.


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o Tooth Numbers: This tab lists the toothparameters that are displayed on the 2DForceView Arch. Selecting the "Hide toothnumbers on arch" option removes themfrom view. Tooth numbering Systemprovides three selections as follows. Noteonly one Tooth Numbering System can be

selected at a given time. Universal: Displays the "Universal"

numbering system (2-15 from right toleft, on-screen).

FDI/ISO: Displays the "FDI/ISO"numbering system (11-17 from thecenter to right; 21-27 from the centerto left, on-screen).

Palmer: Displays the "Palmer"numbering system (1-7 from the

center to the right; 1-7 from thecenter to left, on-screen).

o Graphs and Timing: The three checkboxoptions found on this tab allow you toshow or hide elements within the Force vs.Time Graph. Refer to the Graphs sectionfor more information on this tab.

o Warning Messages: This tab containssettings allowing you to enable or disable

warning messages in the software. You

can enable or disable the warning thatopens alerting you to the number ofsaturated sensels in the software, and youcan set the number of sensels that need tobe saturated (threshold) before the

warning opens.

There is also an option to enable ordisable the warning that opens when ascan contains low data output (too fewsensels or too little force exerted on thesensor).

o Advanced: The advanced tab containsadditional settings (shown below left).Most times, you will not need to changethese settings. However, if you wish, youcan enable "Turbo Mode" which allows

you to scan at a faster speed than normal.Turbo Mode allows you to maximize thenumber of frames that can be capturedper second.


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This can be beneficial for high-speed applications, when trying to achieve the maximum frame rate. Theframe rate depends on the amount of load on the sensor. Typical occlusion will be about 300 Hz (300frames per second). Turbo mode captures data at approximately 500 Hz (500 frames per second). Withturbo mode enabled, rapid, transitory events can be captured at the sacrifice of consistent frame rate.Scans captured using turbo mode will have many more frames than scans captured at slower speeds.

You can also Sort the Force Outliers to be deviation, which adjusts the Force outliers in the Occlusal TimeTable (deviation column). And you can elect to only open one patient's scans at a time. Selecting thisoption means that you can open any number of scans, but only for one patient. If you attempt to open thescans of another patient while a current patient is already open, the other patient's scans are closed infavor of the new patient. If you check the "Warn me before loading scans for another patient" setting, thena warning will open if you attempt to open a new patient's scan (see the warning below right).

If you enable the Use Triggered Scan Start checkbox (default), the system will arm the recording whenthe "Record" button is pressed. Then, when the user bites down on the sensor, the pressure on the sensortriggers the recording to begin. If this box is unchecked, the recording starts immediately when the"Record" button is pressed.

Finally, you can Select a Language for the software. Selecting a language ensures that the software Views, Windows, Dialogs, Menus, and Toolbars are displayed in the appropriate language.

o Dentrix G5: Allows you to integrate theDentrix G5 software with T-Scan by syncing

the two software databases together. Referto the Dentrix G5 Integration Functionality section for more information.


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View Menu

The view options are essential in the analysis of occlusal data. These options aredesigned to enable the clinician to summarize the occlusal contacts in useful formats,

with the force and time relationships of the contacts displayed as color images.Features, such as Maximum Bite Force and Maximum Intercuspation, assist thedentist in the diagnosis and treatment planning of occlusal disease, such as trauma

caused by transient forces and interceptive contacts. Center of Force Trajectory analysis allows the dentist to examine the total effect of restorative dentistry on thepatient’s maximum closure and excursions, and is as easy as the click of a mouse.

• Center of Force Trajectory: Illustrates the balance of the occlusion in the 2D ForceView, using a graphicCenter of Force (COF) target and Center of Force (COF) Trajectory line. This command is a toggle which showsor hides the COF and COF Trajectory on-screen. The default is set to show the COF and COF Trajectory. Refer tothe Center of Force Trajectory section for more information.

• First Contact (1): This brings the 2D ForceView, 3D ForceView, and Graph to the first frame of the scan whereinitial contact force appears.

• Maximum Bite Force: Moves all views to the frame in the scan which contains the maximum bite force for the

entire scan. The Graph Timeline moves to this location in the graph so you can see the maximum force exertedon the sensor during the scan. This is useful to quickly access the frame with the most force.

• Maximum Intercuspation: Moves all views to the frame in which maximum intercuspation occurs, or thelargest area of tooth contact. This can also be referred to as MA (Max Area). It is a useful reference for anumber of common dental procedures.

2D Contours: Displays a 2D Contours view of the scan in the 2D ForceView, with differences in occlusal forcerepresented by colors ranging from red (greatest) to blue (lowest). When enabled, the scan is shown as Contours(default), where the force is smoothed out. In this mode, each sensel element is represented by one square. Thisdisplay looks the closest to the actual raw output of the sensor.

2D Cont ours enab led (de fau l t) 2D Contours disabled


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This is the same Tooth Chart found on the "Edit Patient" dialog (at thebottom of this dialog). On this dialog, you can optionally adjust theCentral Incisor Width to be representative of the patient’s bite byentering a numerical width in the "Central Incisor Width" field. Youcan also adjust the patient’s tooth positions by clicking and draggingthe tooth numbers from the top row either left or right. Each individualtooth width can be assigned by entering a numerical width just beneatheach tooth number. Lastly, you can indicate each tooth’s status byusing the drop-down selection list next to each Tooth Number (shownat right).

• Timing Analysis: Toggles to show or hide the Occlusal Time Table.

• Show All: Toggles to show or hide all views. These views are the 2D ForceView, 3D ForceView, Force vs. TimeGraph, and Occlusal Time Analysis.

Help Menu

• About T-Scan 8: Displays a dialog box that provides basic information about theT-Scan software (see image below left).


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• Technical Support: Provides information on how to contact Tekscan for technical assistance and productfeedback (see image below right).

• Contents: Opens the Help File, where you can get T-Scan Hardware and Software information.

• Update: The Software Update feature is an automatic notification system that lets you know when there is anupdate for the T-Scan software. You can also schedule how often the system checks for updates using the"Available Updates" dialog. See the Software Updates section for more information about this dialog.


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“PATIENT LIST” WINDOW

The software comes with a full-featured patient file management system. This system can be used to store each patient’sinformation (first and last name, patient ID, etc.) in a Patient Record, as well as store and track each scan associated

with that patient. This system is a powerful tool for managing client records. It will help to cut down on paperwork andmake keeping track of your patient’s scans simple. The way in which the user accesses and edits Patient and Scan

information is through the "Patient List" window, explained below.

The "Patient List" window can be accessed via the Patient list icon on the Toolbar (shown below left) or via File >Patient List (shown below right).

This opens the "Patient List" window (shownright). Following are the features of the "PatientList" window.

• Search Field: If you have a very longlist of Patient Records, you can use thesearch field to locate a patient by all thepatient's information (first, middle, lastname, ID, Date of Birth, Created Date,etc.). Enter your term into the field. TheList is filtered and searched, with theresults displayed as you type. To clear asearch, delete any text entry input intothe search field.

• Patient List: The Patient List area of the window displays all the Patient recordsin your database. The followingcolumns are available in the Patient List,from left to right: Patient ID, First Name,Last Name, Middle Name, Date of Birth,Patient Record Create Date, and LastScan Date. Records are listed in reversechronology by the "Last Scan" date andpatient, so the most recent scan is at thetop. However, you can order the PatientList in according to any of theseparameters by clicking on any of the column headings. When a column heading isclicked, all records in the list are immediately reordered and sorted ascending bythat column. An arrow pointing upward indicates ascending order. If you then clickthe column heading once again, the arrow points downward, and the records in thelist are reordered and sorted descending by that column (shown at right).


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Clicking the New Patient button opens up a "New Patient Record" window, where you can enter a new patientinto the list. Refer to the New Patient Record window for more information. Selecting a Patient Record from thelist and pressing the Edit Patient button opens up the "Patient Record" for that currently selected patient. Thisis the same window with the same information, the only difference is that you are either creating a new patientrecord or editing an existing patient record.

• Scan List: The Scan list area of the window is where all the scans for the currently selected Patient are located.The following columns are available in the Scan List, from left to right: Scan Number, Date Recorded, ScanType, EMG (available only with optional BioEMG software package), Photo, and Note. Scans are listed indescending order by Scan Number, so that the most recent scan is listed at the top of the Scan List. As with thePatient List, you can reorder and sort your scans by any column listed here if you click on the column heading.Clicking once on the column heading sorts the Scan List ascending by that column. Clicking again will sort theScan List descending by that column.

The EMG (available only with optional BioEMG Integration Module), Photo, and Note field deserve a specialmention. A special icon in this field indicates whether or not a Scan is associated with BioEMG data, has anyassociated photos attached, or contains notes.

• New Scan: This button opens up a new scan window so a new scan can be recorded.

•

Open: This button opens the currently selected scan. You can also double-click directly on the Scan from theScan List to open it. If you wish to select multiple Scans, you can use the Ctrl Key (to select multiple non-contiguous Scans) or the Shift key (to select a group of Contiguous scans - select the first Scan, then holdingthe Shift key down, select the last scan. All scans in between are selected). Once the Scans are selected, clickthe Open button and they are all opened at once.

• Delete: This button deletes the currently selected scan.

• Cancel: This button closes the "Patient List" window without making any changes.

Menu Options

There are two menus in the "Patient List" window. These are the available commands:

•

File Menu

o New Patient: Opens up a "New Patient Record" window, where you canenter a new patient into the list. Refer to the New Patient Record windowfor information.

o New Scan: Opens up a new scan window so a new scan can berecorded.

o Close: Closes the Patient List window.

• Help Menu

o

About T-Scan 8: Displays a dialog box that provides basicinformation about the T-Scan software.

o Technical Support: Provides information on how to contactTekscan for technical assistance and product feedback.

o Contents: Opens the Help File, where you can get T-Scan Hardware and Software information.


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"PATIENT RECORD" WINDOW

The "Patient Record" window is used to enter patientinformation into the database. This window is also usedto edit patient information for an existing patient record.The following explains the window options:

•

Patient Information: The patient informationarea is located at the top of the window andprovides basic information for the Patient. Thisinformation will then be used to categorize thePatients within the Patient List. Fields marked

with an asterisk are required before saving thepatient. Other fields are optional. A briefexplanation of each field is listed below.

o First Name: Proper first name of thepatient.

o

Middle Name: Proper middle name of thepatient.

o Last Name: Proper last name of the patient.

o Gender: The patient's gender. Note the Patient Avatar on the Toolbar will reflect the patient's gender.

o Date of Birth (M/D/YYYY or D/M/YYYY): The date of birth of the patient. Note that the date can beentered either using the Day first (European), or using the Month first (American).

o Patient ID: If BioEMG software is used, or another third party software, this ID can be used to matchrecords across the two applications. If the ID exists in BioEMG, the two patient records are syncedtogether. You can also use the Patient ID if a proprietary ID system is used at your location.

• Tooth Chart - Patient Default: The Tooth Chart provides detailed settings for the Patient's tooth and Arch.Following are the parameters you can adjust for each patient's teeth:

o Central Incisor Width: The proportions of the teeth in the Arch Model are based on the rule of goldenproportions in reference to the width of the Central Incisors. Increasing or decreasing the "Central Incisor

width" field changes the proportions of all teeth. The software selects a default Central Incisor width of 8.5mm, which automatically addresses the majority of the population. The following procedure should befollowed in order to adjust the Patient's Central Incisor Width.

After measuring the patient’s incisor width, enter this value into the "Central Incisor Width" field. Note thatthe teeth widths automatically update. If you open a new scan for the patient, the Arch Model changes so

you can observe the new Arch Model directly on-screen. The standard deviations of +1 and -1 are +0.5mm and -0.5 mm; this range of 11 positions in 0.1 mm steps (8.0 to 9.0 mm) covers nearly 90% of thepopulation.

Note also that if you change the Central Incisor Width of a patient or teeth widths of a patient, all scansfrom this patient will update with the new information. You will not see the change take effect on any openpatient scans. First, close the scan, and then reopen them to see the changes.


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o Tooth Number and Position: You can also adjust thepatient’s tooth positions by clicking and dragging the toothnumbers from the top row either left or right. Eachindividual tooth width can be assigned by entering anumerical width just beneath each tooth number.

o Tooth Number & Status: This area lists each tooth'snumber and status. You can indicate each tooth’s status byusing the drop-down selection list next to each ToothNumber (shown below). Available statuses are - (No specialstatus), Crown, Full Denture, Pontic, Abutment, Implant,Inlay, Onlay, Partial Denture, Veneer, Missing Closed, andMissing Open.

• Create Button: Closes the "Patient Record" window and at the same time adds the new Patient Record to thedatabase. If a mandatory field (marked with an asterisk) is missing or invalid, a red square will surround therequired field, alerting you to the fact that it requires a properly-formatted entry (see below left). A warning

will open on-screen to indicate any required information (shown below right). Press the OK button, fill out therequired information, and then press the Create button once again.

• Cancel Button: Closes the "Patient Record" window without making any changes.

• Delete Patient Button: This button is only available from the "Edit Patient Record" window (which is exactlythe same as the "Patient Record" window, aside from this button). If you already have a patient record created,

and press the Edit Patient button from the "Patient List" window, you will see this button at the bottom leftcorner of the window (see below left). Pressing the Delete Patient button will delete the Patient and all relatedscans for that patient. For this reason, you will see a warning dialog (shown below right), asking if you are sure

you want to perform this action.

If you press the Delete button from this warning, the patientand all associated scans are deleted from your database, and

you will see a progress bar performing the deletion (shownbelow right). Note that you can press the Cancel button fromthe warning or progress bar dialog at any time to cancel theoperation and keep the patient and all associated files. Oncethe progress bar completes, however, there will be no way torecover the patient nor the patient's scans.


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Menu Options

There are two menu options located in the "Patient List" window. These are the available commands:

• File Menu

o Import Scans: This option isonly available after the patientrecord has been saved or if youopen up a currently existingpatient record through the Edit

Patient button on the "PatientList" window. This option allows you to open a scan or multiplescans directly from yourcomputer and import them intothe current patient's recordusing the "Import" window(shown at right). To select multiple contiguous scans, use Shift+Click when selecting files from the"Import" window. To select multiple non-contiguous scans, use Ctrl+Click when selecting the files fromthe "Import" window. Then press the Open button. This closes the "Import" window and associates thescans to the Patient Record.

o

Save: Closes the "Patient Record" window and saves the current patient record within your database.• Help Menu

o About T-Scan 8: Displays a dialog box that provides basic information about the T-Scan software.

o Technical Support: Provides information about contacting Tekscan for technical assistance and feedback.

o Contents: Opens the Help File, where you can get T-Scan Hardware and Software information.


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ARCH, ARCH OUTLINE &

EMBRASURE LINES

The Arch Model Superimposes a model of themaxillary arch, as well as an "Arch Outline" on

the tooth contact data in the active 2D ForceView.The Arch Model uses a combination of thecontact energy outline of the 2D Contour, whichdefines the arch, and the proportionality ofhuman teeth, to establish the tooth interfaceapproximations across the arch (source,

Ash/Wheeler).

The Arch Outline, which is drawn around the 2Docclusal force image, provides some additionalinformation for analyzing your recordings. The Arch Model and Arch Outline are both saved with a scan.

The arch outline is made up of the yellow lines in the 2D ForceView.Embrasure Lines

The embrasure lines are the black lines that define tooth locations and follow the Arch Model. It is important to notethat the active region for each tooth is defined by a four-sided polygon that can be drawn from the end of eachembrasure line to the corresponding end of the embrasure lines on either side. In the image below left, the black linesare the embrasure lines, while the red lines in the image below right denote a theoretical drawing of the active area forthe tooth. Note that the Red lines are purely theoretical, and will never be seen within the software. Any pressure sensedoutside this "Active" area is not included within any analysis.

Black embrasure l ines as they

are seen wi th in t he so f tw are :

A theoretical m odel of "Activ e" region of the sensor. Each

too th is enc losed wi t h in a four - s ided polygon.


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FORCE OUTLIERS

Force Outliers are individual tooth contacts with much higher relative force than others during closure; or an entiretooth with very low force at Maximum Intercuspation.

What is the idea behind Force Outliers?

A frequent goal of treatment is to achieve simultaneous bilateral closure, and balanced tooth forces when clenched.High force tooth contacts that occur early during the closure process are candidates for treatment. Teeth with low force

when the clench is maximal are candidates for treatment. Force Outliers identify and quantify these contacts and teeth.

When natural teeth with active nerves have high contact forces early in the closure, there is evidence that nerve signalsare generated signaling muscles to modify their contraction, lengthening closure time. One approach to treatment is toreduce high early force contact points. The closure time of subsequent recordings often is shorter.

If the high early contact force is on an artificial tooth, such an implant, that lacks nerve connections and has lowmechanical compliance, early high contact force is a cause of concern. These early high forces can lead to damage orcracked materials.

When the closure reaches maximum intercuspation, many dentists strive for balanced bite forces around the dental

arch. For example, they want the COF to settle near the target location. Low Force Outliers are teeth with relatively littlecontact force at MA. Adding material to them can raise the contact force on them, resulting in more even distribution offorces on the teeth.

Finding High Force Outliers

The search for High Force Outliers begins with the first frame that has 5% (five percent) of MF (Maximum Force) ormore, after the computer-set OT-A. The mean and deviation (σ) of relative force output from individual loaded senselsis calculated. If one sensel has an output more than “X” deviations higher than the population values, the programidentifies it as a High Force Outlier. It analyzes each individual sensel separately. Adjacent sensels are not considered.This process continues frame by frame until reaching 80% of MF.

If the scan is a lateral excursion or protrusion, there is one closure, so there is no ambiguity about which closure toanalyze, and maximum force is also the maximum scan force. If the scan is multi-bite, or otherwise has multipleclosures, then the program only analyzes the first closure. The program references maximum force of that closure,rather than the maximum scan force, which may occur in a different closure.

Finding Low Force Outliers

Finding Low Force Outliers only involves the MA frame (Maximum Area). The program analyzes MA because it has highforce, and because the 2D window has an “MA” icon that will bring the display to the Maximum Area Frame. Embrasurelines define the edge of each tooth. If an embrasure line cuts a sensel, the side with the most area gets its output. Teethmarked “missing open” or “missing closed” are not included in the calculation. Add the output from all sensels within atooth together. Then the mean and deviation of relative tooth force are calculated. If any tooth has less force than thelow force threshold, in deviations, identify it as a Low Force Outlier.

If the scan is a lateral excursion or protrusion, there is one closure, so there is no ambiguity about which closure toanalyze. If the scan is multi-bite, or otherwise has multiple closures, then the program only analyzes the first closure.

The default value for "x" High force contacts is 3.3. Similarly, the default value for low force deviations is 3.3. ThroughOptions > User Preferences the user can adjust X from 2.0 to 6.0 (one decimal point on standard deviation)separately for high and low forces (see image below).


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Setting the Detection Threshold

The user can select whether the program detects more or fewer Force Outliers. A smaller threshold will find more ForceOutliers and higher threshold will find fewer. The units of the thresholds are in relative force, the number of deviationsfrom the mean required for detection. To begin, click on Edit > User Settings and bring the Force Outliers tab to theforeground (this will be the first tab on the dialog and should open by default). The High Force Outliers Threshold isadjustable from 1.0 to 6.0 sigma (one decimal

point on deviation) The Low Force OutliersThreshold is adjustable from 0.5 to 3.0 sigma(shown at right).

The default High Force Outliers threshold value is3. The default value for Low Force Outliers is 1.5 .The threshold for High Force Outliers is usuallymuch greater than for Low Force Outliers becausethe distribution of sensel forces and tooth forcesare highly skewed. In a frame, many sensels havelow force values and a small number of high senselforce values can be very far above the mean. At MA,

it is typical for several teeth to have moderateforce. At MA, the lowest tooth force values cannotbe many deviations below the mean, because thelowest allowable force is zero (0).

Understanding the "Force Outlier Table"

The Force Outlier Table shows the first time a particular contact exceeds the relative force threshold. Earlier high forcecontacts may have more importance than those occurring later in the closure. The table shows the maximum relativeforce that sensel generates during the entire closure. Higher forces obtained by High Force Outliers give them greaterimportance. An ideal recording may have no high and no low force outliers. Force Outliers are shown numerically inthe Occlusal Time Table (shown below left), and are outlined by their tooth numbers within the 2D ForceView (shown

below right).


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CENTER OF FORCE TRAJECTORY

The "Center of Force (COF)" and "Center of Force (COF) Trajectory" illustrates the "balance" of the occlusion inthe active window using a graphic COF "marker" and "trajectory." The COF marker pinpoints the location of the sum ofthe total force of the occlusal contacts. This is done by calculating the sum of the medio-lateral and antero-posteriorforce moments of the recorded contacts, and presenting this data by superimposing the COF marker on the toothcontact data.

The COF is represented on-screen by a red and white diamond in the 2D ForceView. The COF Trajectory displays thehistory of the path of the Center of Force from the beginning of the scan to the current frame, in relation to the COFtarget. The movement of the COF as the patient closes his/her teeth together can be tracked by playing a scan one frameat a time with "Center of Force Trajectory" checked (under the "View" menu). The COF Trajectory is represented on-screen by a colored line that "trails" the COF marker within the 2D ForceView. Both the COF and COF Trajectory arepowerful analysis tools that can be used to determine the influence of interceptive contacts, estimate the stability of aclosure, and track the trajectory of an excursive movement.

How the Center of Force is Calculated

The location of the Center of Force marker is determined by calculating the sum of the medio-lateral force moment ofthe tooth contacts about the mid-sagittal axis, and the mean of the left and right leverage arms in relation to the incisiveplane, according to the following formulas:

Left-Right Moment = Sum (contact force x contactdistance right) - (contact force x contact distanceleft) and is displayed in Newton-millimeters (N-

mm).

The anterior-posterior location of the COF marker isfound by calculating the left lever and right leverstatistics from the incisal plane as follows:

Left Lever = Sum (force at contact x distance from the incisal plane) / Sum (left contacts), displayed in

millimeters.

Similarly the right lever is calculated, and the mean of the left and right leverage arms gives the average anterior-posterior distance of the marker from the incisive plane, which is described by the following formula:

Mean L-R lever = Right lever + Left lever / 2

These statistics allow the practitioner to identify the location of the Center of Force for any bite automatically by selectingthe COF option from the View menu.

Center of Force Target

The COF marker is shown in relation to a dual elliptical target, which represents the ideal location of the center of force

for any maximum intercuspation closure, and acts as a guide with respect to a normal occlusion. The inner ellipseshows the area within which the COF of 68% of a normal population is found, and the outer ellipse shows the area within which the COF of 95% of a normal population is found.

The COF target is displayed on-screen by two "target" circles and a crosshair to denote the center "target."

The relationship between the Center of Force marker and target is not intended to be an absolute measure of normalocclusion, but to serve as a guide for the dentist to compare the patient’s occlusion to that of a group of normalsubjects.


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The rationale for the center of force target came from the work of Maness et al, who described the mean location of thedistribution of occlusal contacts in maximum intercuspation; and from Mizui, et al, who quantified occlusal force in theintercuspal position (see Appendix. Background for COF Analysis).

Rationale for Center of Force Target

The rationale for the COF target came from the work of Maness, et al, who described the mean location of thedistribution of occlusal contacts in maximum intercuspation; and from Mizui, et al, who quantified occlusal force in the

intercuspal position. Both investigators described a left-right balance of occlusal contacts about the mid-sagittal plane with the center of the COF target located approximately in the region representing the mesial aspect of the first molar.Maness, et al, identified the anterior-posterior center of the distribution of contacts in maximum intercuspation as 28mm. distal to the incisal plane and Mizui, et al found the center at approximately 34 mm. The mean of these measures,31 mm., represents the center of the target on the mid-sagittal plane and is used as an approximation of the ideallocation of the Center of Force in a normal subject.

The size of the target is taken from the standard deviation of the anterior-posterior and medio-lateral measure of thedistribution of occlusal contacts described by Maness, and is 7.65 mm. and 6.48 mm., respectively. These dimensionsdescribe an ellipse with a radius represented by two standard deviations, which describes 68% and 95% of normalsubjects. The center of the target lies approximately 31 millimeters distal from the incisal plane. This is the location ofthe Center of Force target and is used as an approximation of the ideal location of the center of force in a normal

subject.

It must be emphasized that this analysis is provided to the dentist as an estimate of normal and the dentist mustdetermine the significance of the data in relation to other pertinent facts.

Footnotes:

Article #30 - Maness, W.L., Podoloff, R.: Distribution of Occlusal Contacts in Maximum Intercuspation, The Journal ofProsthetic Dentistry, August 1989, Vol. 62, No. 2,pp 238 - 242.

Article #32 - Mizui, M., Nabeshima, F., Tosa, J., Tanaka, M., Kawazoe, T.: Quantitative Analysis of Occlusal Balance inIntercuspal Position Using the T-Scan System, The International Journal of Prosthodontics, 1994 Vol. 7, No. 1, pp 62-71.

GRAPHS

The Graph displays the force versus time for the patient's overall bite, individual teeth, or Force Outliers. Each graphline is color coded to provide an easy visual reference to areas of the Arch Model or individual teeth.

Timeline

A thick grey line acts as a time indicator, and this can be moved to any location within the graph, allowing you to jumpto any point in time during the patient's bite, and view the force at that time. The 2D and 3D ForceView also updatesdynamically, depending on where the time indicator is located. Alternately, you can click at any point within the graph tohave the time indicator jump to that cursor point.

As with the A, B, C, and D lines, when selecting the Time indicator the cursor will change to a "hand" icon. Clicking withthe hand icon changes the cursor to a double-sided arrow. You can then drag the line to the new position and let go ofthe mouse.


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• D Line: The D line is placed at the point when Relative Force on the Posterior area of the arch equals zero(when there is no force on the posterior teeth). The posterior area of the arch is determined as posterior totooth numbers 5 and 11 (when using the Universal Numbering System) or greater than row 13 on the sensor.Note that this calculation is not tied to the position of the posterior line on the 2D ForceView. It is worth noting,however, that the default position for the Anterior/Posterior Line corresponds with the D Line calculationinasmuch as it crosses the arch plane at tooth numbers 5 and 11 (greater than row 13 on the sensor). If the

Anterior/Posterior line is not moved from this default position, it can act as a guide to indicate where the D line

is placed (and where Disclusion ends). When you see no more contacts in the posterior quadrants of the scan,this is where the D line is placed in the graph. The default for the D line is 0% of Maximum Scan Force.

Refer to the Occlusion and Disclusion Time section for more information.

Graph Zoom & Graph Reset

Using the Zoom magnifying glass icon, you can select a region of the Graph and zoom into that location. To do this, firstclick on the magnifying glass icon. Your cursor will change to a crosshair. Click and drag to select a square region ofthe graph. The graph will zoom into that region. To reset the Graph back to its full view, press the reset icon locatedbelow the magnifying glass icon.

Graph Zoom icon: Allows you to zoom into aspecific region of the Graph

Graph Reset icon: Resets the Graph to the defaultfull-view.

In the im age below le f t , the Gra ph Zoom i con wa s selected, an d a region i s being outl i ned. The

image below r ight shows the resultant Graph for this region.

When viewing the patient's overall bite, a black line maps the whole bite (Total Force), the green line maps the left side

of the arch, and a red line maps the right side of the arch.

The Total Force is relative. When a scan is taken, the software determines the point at which highest force was achievedand this is measured to be 100% of the total force. This measurement is then used for the Total Force line. On the otherhand, the left and right lines are absolute, measuring the absolute force at any point during the scan. For this reason,

you will often see the Total Force line lower than the left or right side force lines (as in the graph image below).

Gra ph display in g the Arch Model force vs . t im e for the patien t's overall bi te .

If you select View > Arch in Quadrants, the left (green) and right (red) side of the patient's bite are replaced by fourquadrant lines that outline the patient's left anterior (dark blue), left posterior (light blue), right anterior (dark red),and right posterior (light red) quadrants.


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Gra ph display i ng the Arch Model force vs . t im e for the pati ent's overall bi te , mapped in qu adran ts .

To view the individual tooth force and timing within the graph, select them from the Occlusal Time Table (discussedpreviously).

Graph d isp lay in g ind iv i dua l too th force v s . t ime f or f i ve tee th (9 , 10, 11 , 12 , and 13) from the le f t

s ide o f the same pa t i en t shown prev ious ly .

To view the teeth with Force Outliers within the graph, select them from the Occlusal Time Table (discussed previously).

Gra ph display in g the Force Outl iers for teeth nu m bers 11, 12, and 15 (force vs . t i m e) of the same

pa t ien t a bove .

There are two options available if you right-click over the Graph view: Copy allows you to copy the Graph as an image that can be pasted into other programs, such asMicrosoft Word or Excel, for example. Reset A/B/C/D Lines allows you to reset theposition of these lines to their default, in the event you have moved them to a newlocation within the Graph.

Graphs and Timing Settings

There are a few graph options available under the Edit > User Settings dialog that allow you to show / hide elements ofthe graph and calculate the timing of the Occlusion and Disclusion. You can show or hide the "Total Force" Curve

(black curve when viewing the arch), the A / B Lines (Occlusion), or the C / D Lines (Disclusion).

Pressing the Timing Settings button opens the "Timing Settings" dialog (shown below right). There are two sliders forthe Occlusal Time Range and two sliders for the Disclusal Time Range. Adjusting these sliders allows you to set therange for the Occlusal and Disclusal algorithm that the software uses to calculate the timing in the graph. In other

words, you can make the Occlusal and Disclusal timing more or less sensitive, which results in a wider or shorter graphline within the Force vs. Time Graph. In most cases, however, the default settings should be adequate.


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If you've changed any settings within this dialog, you can reset back to the default by pressing the Default button(located at the bottom left of the dialog). Press the Close button to accept any changes made in the dialog and close thedialog. You are taken back to the "User Settings" dialog.

OCCLUSION & DISCLUSION TIME

Occlusion Time is the elapsed time in seconds measured from the 1st tooth contact until when the last tooth contacts, asa patient closes all their teeth together from completely open ( no tooth contact) to complete contact (all teeth are incontact). Occlusion Time describes the degree of bilateral simultaneity present in a patient's occlusion.

Having bilateral simultaneity is considered a desirable state of occlusal health. It is advocated in dental school teaching,and by advanced dental educators, as a requirement for an optimum occlusal design. The T-Scan measures theOcclusion Time and can assist in its clinical improvement when it is deemed prolonged.

Disclusion Time is the elapsed time in seconds measured from the beginning of a jaw movement made in one direction,

when all teeth are in complete contact, through until only canines or incisors are in contact. Disclusion Time can bemeasured in 3 different jaw movements; the Right Excursion, the Left Excursion, and the Protrusive Excursion.

Disclusion Time describes the quality of the Anterior Guidance mechanism, present in a patient’s occlusion. Havingimmediate posterior disclusion is considered to be a desirable component of occlusal health. It is advocated in dentalschool teaching, and by advanced dental educators, as a requirement for an optimum occlusal design. The T-Scan measures the Disclusion Time and can assist in its clinical improvement when it is deemed prolonged.

In the T-Scan software there are 4 “time measurement” lines; 2 that measure the Occlusion Time (A and B lines) and 2that measure the Disclusion Time (C and D lines). All 4 lines can also be used to quantify other time measurements aclinician wants to measure (like the “time-to-muscle-shut-down”, or the “implant time delay).

The concepts of Occlusion Time and Disclusion Time haven studied and researched scientifically since the early 1990’s.

There are many published dental articles that detail both their scientific foundation, as well as the clinicalimplementation of techniques to improve prolonged Occlusion and Disclusion Times (see references below).


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References:

Occlusion Time:

1.

Kerstein, R.B., Grundset, K., Obtaining Bilateral Simultaneous Occlusal Contacts With Computer Analyzed andGuided Occlusal Adjustments. Quintessence Int. 2001;32:7-18

2. Kerstein, R.B., Current Applications of Computerized Occlusal Analysis in Dental Medicine. General Dentistry

2001;49(5);521-530. Disclusion Time:

1. Kerstein, R.B., Wright, N., An electromyographic and computer analysis of patients suffering from chronicmyofascial pain dysfunction syndrome; pre and post - treatment with immediate complete anterior guidancedevelopment. Journal of Prosthetic Dentistry 1991; 66(5):677 - 686.

2. Kerstein, R. Disclusion time reduction therapy with immediate complete anterior guidance development: thetechnique. Quintessence International. 1992;23:735 - 747.

3.

Kerstein, R.B., A comparison of traditional occlusal equilibration and immediate complete anterior guidancedevelopment. Cranio. 1993;11(2):126 - 140.

4.

Kerstein, R.B., Treatment of myofascial pain dysfunction syndrome with occlusal therapy to reduce lengthydisclusion time - a recall study, Cranio, 1995; 13(2):105-115.

5.

Kerstein, R.B., Chapman R., and Klein, M., A comparison of ICAGD (Immediate complete Anterior GuidanceDevelopment) to "mock ICAGD" for symptom reductions in chronic myofascial pain dysfunction patients.Cranio, 15(1):21-37,1997

KEYBOARD SHORTCUTS

Keyboard shortcuts are available to activate the most often-used software commands with a single keystroke orkeystroke combination. They are extremely useful for Reviewing a Scan and are often faster than using their Toolbar orMenu equivalents. The following lists all available shortcut keys for the software.

• A / B / C / D: Moves all views to the A / B / C / D line (most easily seen in the Graph). Note: If more than onebite is displayed in a scan, each bite will contain its own A / B / C / D line, and be numbered. For example, A1,

A2, A3, etc. for the amount of bites in the scan. Pressing A, then 2 will take you to the second bite's A line.

• Spacebar: Play / Pause the scan.

• Shift+Spacebar: Play Continuously in a loop. Once the scan's ending is reached, the play continues from thebeginning. Play only stops when the keys are released.

• Left Arrow: Moves back one frame in the scan.

• Right Arrow: Moves forward one frame in the scan.

• Ctrl+F12: Exits the T-Scan application.

•

Ctrl+S: Saves the current scan.• Ctrl+Tab: In the "Patient List" dialog, this toggles the focus between the "Search" field and the "Scan List."

When the "Search" field has focus, you can use the Up / Down arrows to scroll through the patients. When the"Scan List" has focus, you can use the Up / Down arrows to scroll through the scans.

• F1: Opens the help file.


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SOFTWARE UPDATES

The Software Update feature is an automatic notification system that lets you know when there is an update for the T- Scan software. You can also schedule how often the system checks for updates using the "Available Updates" dialog. Thefollowing outlines how this feature operates.

1.

If an update is available, a balloon opens from your Taskbar

(located at the lower right corner of your screen) to inform you. You can double-click this Link, where is states "T-ScanUpdate Available" (shown at right)

Alternately, you can manually check for updates by going into Help > Update (shown below):

2.

The "Available Update" screen opens (shown below).


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3. To set up scheduling to check for software updates, click the "Notify me of update" drop-down list (shownbelow left). Options are Always (each time the software is opened), in one day (checks performed day), in one

week (checks performed week), and in one month (checks performed monthly). When you have selected ascheduling option, the "Save and Close" button becomes available (shown below right). Click the Save andClose button to Save this setting and close the dialog. Note: you will h

T-Scan User Manual

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