How to use PROSTHERA

1. Use the left sidebar to move between major areas. Collapse it to icons with the button at the top of the screen (or Ctrl/⌘ + B); the choice is remembered.
2. Home → New patient creates a case. Each case keeps one persistent anatomy that every tool reuses — nothing is imported twice.
3. Cases are stored locally in this browser. Use Settings → Data & privacy or the Files page to export a .prosthera backup.

1. New patient → enter the patient identifier → CBCT · DICOM → select the scan's DICOM folder.
2. Uncompressed DICOM (implicit/explicit little endian), single- or multi-frame, is supported. Compressed DICOM is rejected with an explanation.
3. Build patient from CBCT runs the real processing stages. Stages that are not built (teeth, canal, sinus) are shown as NOT AVAILABLE, never faked.
4. No CBCT at hand? Load test volume creates a synthetic volume that is labelled DEV TEST VOLUME — NOT PATIENT DATA everywhere.

1. Imaging, Anatomy, Tray, Identify and Axis share one 3D viewport with axial, coronal and sagittal slices.
2. Rotate: left-drag · Pan: right-drag · Zoom: scroll. Click a slice to move the crosshair; scroll on a slice to page through it.
3. Shortcuts: F fit view · 1 axial · 2 coronal · 3 sagittal · 4 3D (press again to return) · M measure distance · Esc cancel tool.
4. Window/level presets (Bone, Soft tissue, Wide) and W/L sliders sit in the bar between 3D and slices.
5. Panoramic reconstruction is reserved in the layout and will arrive with arch-curve detection.

1. Open Anatomy. Every structure starts as REVIEW REQUIRED.
2. Check it in 3D and slices, then CONFIRM — or EDIT the separation plane or HU thresholds. Edited structures show MANUALLY EDITED and must be confirmed again.
3. Corrections regenerate every draft tray. Approved trays are never changed.
4. Segmentation in this build is deterministic HU thresholding, not a trained model; no confidence values are shown because none are computed.

1. Tray requires a confirmed separation plane and a confirmed maxilla or mandible.
2. Choose MAXILLARY / MANDIBULAR and COMPLETE / PARTIALLY EDENTULOUS, then Generate proposed tray.
3. Use the section tabs — Design, Border, Paint, Fit map, Check, Approve — so only one group of controls is visible at a time.

1. Tray → Paint. Pick EXTEND, REDUCE, RELIEF or BLOCK OUT and drag on the tissue surface. Rotation is locked while painting.
2. Extend/Reduce move the border locally; Relief adds space by the Relief amount; Block out fills undercut/sensitive areas.
3. Clear removes all painting for the current draft. Esc leaves paint mode.

1. Fit map colours the tray's inner surface by its distance from the reconstructed tissue surface.
2. Too close = less than target spacer − tolerance · Target = within ± tolerance · Excessive = more than target + tolerance.
3. Percentages and clearance range are computed from the actual geometry.

1. CBCT does not record muscle-moulded (functional) borders or mobile mucosa reliably.
2. The printed tray is deliberately a starting point: border moulding and the definitive impression remain clinical steps performed chairside.
3. Border extension in Tray → Border sets how far below the ridge crest the tray reaches before moulding.

1. Run check evaluates wall thickness, disconnected geometry, sharp edges, undercuts, printability, handle integrity and material clearance on the current geometry.
2. Any change after the check invalidates it. Failed checks block approval. With Settings → Manufacturing → Strict, warnings also block approval.

1. Approve opens a three-point clinical confirmation. Approval generates STL and 3MF, re-reads the STL to verify it is a watertight 2-manifold, then locks the version.
2. The preferred format (Settings → Manufacturing) downloads immediately; both files stay in Files → Exports.
3. To change an approved tray, create a new version. The approved version is never overwritten.

1. After the clinical impression procedure, open Impression and import the scanned impression (STL / PLY / OBJ), optionally linked to the tray version used.
2. The file is stored with the case, versioned, and logged in the timeline.

1. In Impression, choose the impression and the tray (jaw) it belongs to, then press Register. The scan must be in millimetres.
2. PROSTHERA rigidly aligns the impression to the CBCT tissue surface, ignoring the tray side of the impression, and reports residual, coverage and the area captured beyond the tray border.
3. Review the colour map and numbers, then accept or reject. Decisions are locked; registering again creates a new record. Material thickness is not measured yet.

1. Open Identify and select a detected implant. Measured length/diameter and calculated axis and fingerprint are shown with their provenance labels.
2. Automatic manufacturer matching needs a verified implant library, which is not loaded — IDENTIFICATION NOT CONFIRMED is shown instead of a guess.
3. If you know the system from records (implant passport, notes), record it; it is labelled CLINICIAN CONFIRMED.
4. Additional evidence (PA, panoramic, photo, IOS/platform scan) can be attached to the implant.

1. Axis shows each detected implant's measured long axis in 3D and on a parallelism map: the centre is the scan's vertical axis; rings are 5°, 10°, 20°.
2. Lines between implants show pairwise divergence. Angles are relative to the scan axes; true mesiodistal/buccolingual angles need the arch curve (future).
3. Prosthetic axis and screw-access trajectory need a prosthetic target (PLAN, future).

1. Start from the planned restoration: place the tooth you want first, then let the implant follow it (prosthetically driven planning).
2. Check the CBCT is usable: field of view covers the site, little scatter from restorations, no movement blur. Record this in Scan & CBCT quality checks.
3. Confirm safety anatomy near the site in Anatomy: canal and mental foramen (lower jaw), sinus floor and nasal floor (upper jaw), and neighbouring roots.
4. Look at bone along the planned axis on the cross-sections: available height and width, and whether the axis exits through the planned crown.
5. Keep safe distances to neighbouring teeth, implants and nerves; choose a shorter or narrower implant, or grafting, when the bone is not enough.
6. Record the tooth prognosis and the restorative choices (retention, healing, impression) so the plan and restoration agree.
7. Automatic site measurement and implant proposals come with the PLAN phase; until then these decisions are entered by you.

1. Coming in a future phase (PLAN). Requires tooth, canal, foramen and sinus segmentation.

1. A guide is only as good as the plan: make sure the plan is prosthetically driven and approved.
2. Choose the guidance type: fully guided, pilot-drill only, dynamic navigation or freehand.
3. Choose the support: tooth-supported is the most stable; mucosa- or bone-supported guides need fixation pins.
4. Pick the sleeve concept (single sleeve with drill keys, sleeve-in-sleeve or sleeveless) that matches your drilling kit.
5. Before surgery, try the guide in the mouth and confirm it seats fully and does not rock.
6. Expect some deviation even with a guide — larger at the implant tip than at entry, and larger in fully edentulous jaws — so keep a safety margin to nerves and roots.
7. Record all of this in the Guided surgery checklist on the Guide page. Guide design and export come with the GUIDE phase.

1. Coming in a future phase (FULL ARCH). Requires PLAN and GUIDE.

References

Clinical sources behind PROSTHERA's checklists and option lists. Figures quoted are published literature, not values measured by PROSTHERA.

• Wismeijer D, Barter S, Donos N (eds); Gallucci GO, Evans C, Tahmaseb A. ITI Treatment Guide Vol. 11: Digital Workflows in Implant Dentistry. Quintessence, 2019.
  Used for: Scan & CBCT quality checks, guided surgery checklist, digital prosthetic workflow.
  Literature (not measured in PROSTHERA): Tahmaseb et al. reported mean static-guide deviation of 1.12 mm at entry (max 4.5 mm) and 1.39 mm at apex (max 7.1 mm); guided systems were less accurate in fully edentulous jaws (§7.2.3).
• Drago C. Implant Restorations: A Step-by-Step Guide, 4th ed.
  Used for: Connection, healing, impression and retention options; tooth prognosis factors; restorative checklist.