Diagnostics with Gamma Dental Software^®
Diagnostics is the collection and evaluation of individual findings and other information with the goal of arriving at a diagnosis. A diagnostic system must be relevant to therapy and must meet the demands of running a modern dental practice. GAMMA provides a logically constructed system which makes the acquisition and administration of such information possible and fully supports the user in forming a diagnosis.
Gamma Dental Software^® is a system built up of modules, which comprehensively cover the requirements of modern clinical- and instrumental functional diagnostics and functional therapy.
· Anamnesis findings · Cephalometric diagnosis and planning · TMJ diagnoses · Articulator programming · Wax-up · Tooth and periodontal status
The close affiliation and compatibility to face-bows and articulators makes the software an ideal interdisciplinary communications medium during the practical course of therapy.
GDSW data management
The Gamma Dental Software Data Manager is equipped with a modern Windows^® database system. The system administers patient data and allows you to specifically classify data, whereby you may include as much information as you wish. The system is also set up so that you can save any other documents you choose (e.g., photos, MS-Word documents) and assign them to an individual patient. The contents of any selected data record are available for a quick scan, using the integrated Pre-View Function. Naturally, the system has an open interface available for the most common practice administration systems and it supports the following programs: Baumgartner, Dampsoft, Evident, Solutio, Lutz Hergestell. A fully integrated E-mail function allows you to send and receive GAMMA data, simplifying communication (e.g., between the dental practice and the lab), and eliminating the time-consuming printing of information.

Modular structure
The layout of Gamma Dental Software is modular and may be configured according to the needs of your practice and/or lab. This chapter describes some of the details of the individual modules.
Data manager	Database and data administration. The basis of the software, and an integral part of all the other building blocks in the software..
CADIAS^®	The central diagnosis- and planning module in Gamma Dental Software®. The focal point is the cephalometric analysis, which can be combined with other data, such as Clinical Functional Analysis or CADIAX®.
CADIAX^® Analyses	Processes registrations from CADIAX® compact 2 and CADIAX® diagnostics. Includes a variety of display options, as well as conversions for setting the articulator and wax-up technique. Especially suitable for CADIAX® compact 2 users who want to take advantage of the full potential of the system.
CADIAX^® Condylography	Set up on the CADIAX® Analysis module, to carry out condylograph registration with the CADIAX® diagnostics system.
Tooth- and periodontal status	Processes input from tooth status, plaque status, periodontal status, tooth mobility, tooth resilience and occlusal functions.
All versions of the software include the basic module Data Manager, incl. Tooth/Periodontal Status.

CADIAX^® Analyses
The CADIAX^® Analyses module processes and stores data from both CADIAX^® registration systems, CADIAX^® compact and CADIAX^® diagnostics. The program includes a variety of display options, as well as conversions for setting the articulator and wax-up technique. In addition to detailed diagnostic analyses of mandibular movement, it allows for expanded articulator calculations, including the setting of individual anterior guidance units.
The software is especially suitable for CADIAX® compact users who want to take advantage of the full potential of the appliance. The high-resolution screen clearly displays all of the details from the condylography data. The 3-dimensional displays of mandibular movement are clear and easily comprehensible for the patient. This is extremely helpful when explaining planned therapeutic measures to the layman (patient).
Movement simulation through ex-centric articulator programming
Using the CADIAX^® compact face-bow and the CADIAX^® diagnostics system, the coordinate system, defined by the hinge axis point and anterior reference point, is transferred directly to the articulator. So, the logical working procedure becomes a closed system. Through the mechanical connection between registration and the articulator, CADIAX provides a precise relation for maximum reproducibility. The data acquired with the registration systems can then be used in the calculation programs for individual patient settings in the articulator.		All calculations are based on the manufacturer’s geometry for the various articulators. Calculations for sagittal protrusion inserts are made with the protrusion track on hand, by evaluation of the X/Z diagram. Calculations for transverse inserts are made with the mediotrusive movements on hand, by evaluation of the X/Y diagram.
The mathematical adaptation of the given articulator characteristics is made according to the “best-fit” process. The articulator insert (blue) is turned until it coincides, as closely as possible, to the patient’s registration (red). If the articulator includes various inserts, the program will search for the best fit.
CADIAX^® always calculates values for 3, 5 and 10mm, always processing the total track progression from 0 (reference position) to the given value.		0-3 mm 0-5 mm 0-10 mmm excursion movement
	Compatibility In addition to the perfectly suitable Reference SL articulator, CADIAX users have several other articulator systems at their disposal, which are compatible with the software: ARTEX^®, DENAR^®, HANAU^®, IVOCLAR^®, KAVO^®, PANADENT^®, SAM^®, WHIPMIX^®
Pre-calculated occlusal guidance for diagnostics and wax-up
The simulation in the articulator is determined by three adjustable guidance units: the two condylar joints and the adjustable incisal table. Posterior guidance is already given with the CADIAX registration. Occlusion concepts and their implementation in wax-up are defined by means of the incisal table. By adjusting the guidance surfaces in the table, more or less rotation is brought into the movement, i.e., the inclinations of the guidance surfaces on the tooth are determined.
Gamma Dental Software^® includes suggested pre-set concepts, as well as the possibility of implementing an individual, computer-generated occlusion concept. R. Slavicek’s natural concept of sequential occlusion is included as standard value in the software.
	For the sequential table, the calculations are based on the values of the joint guidance, in relationship with the spatial cusp coordinates, determined by statistical means.
	For exact calculations, the cusp coordinates of the mandible are entered. Gamma Dental Software then calculates an incisal table setting for each tooth, depending on the desired concept.
In addition, the program calculates an idealized radius of the curve of Spee and, depending upon the occlusion concept and cusp angles, an optimal inclination of the occlusal plane, according to functional parameters.
TMJ diagnostics
CADIAX^® records the spatial movement of the hinge axis of both mandibular joints simultaneously, bilaterally and in elapsed time. Converted to the intercondylar distance, the system offers the possibility of using differential diagnostics for the static- and dynamic evaluation of the movement tracks. The advantages of condylographic diagnostics are apparent: · The method is non-invasive and carried out quickly · The patients are not exposed to radiation · The results are dynamically reproducible, independent of the therapist · The examination can be carried out in the dental practice; the results are immediately available · The ideal enhancement for interdisciplinary communication
Application of an individually adjustable mandible bow for setting the exact hinge axis is absolutely necessary in diagnostic condylography. When using the bow with CADIAX^® compact, the hinge axis is manually adjusted before registration. The foundation of diagnostics is the standardized orthopedic description of the mobility and motility of the TMJ, with the following parameters: Quantity · Quality · Characteristics · Symmetry · Timing (comparison between left and right TMJ) · Speed phenomenon · CPM · Functions und para-function The following movements will be evaluated: protrusion/retrusion, mediotrusion right and left, open/close, speech, bruxism, chewing.		Individueller, auf die Scharnierachse justierter Schreibbogen als Voraussetzung condylographischer Diagnostik

The principles of condylographic diagnostics
The first findings are purely descriptive. These are the basis for every other interpretation, and serve in the collection of diagnostic data. Subsequent interpretation requires the differential diagnostic evaluation of the results with clinical- and instrumental functional analyses, because the condylography registrations can not be evaluated separately, but only in conjunction with the other findings of the cranio-mandibular system.
The “normal“ joint
Condylography findings are based on the principle of comparative diagnostics with statistically obtained movement patterns of a “normal joint”. The following illustrations display non-guided movements, without tooth contact and without utilization of a bearing device:
Quantity
	Describes the maximum excursion distance of the translatory part of a movement track, measured from the reference position to the most excursive point of the movement. The quantity is described as reduced, average or hypermobile. With Gamma Dental Software^®, this value can be read quickly and clearly, by clicking on the maximal excursive point in the CADIAX^® curves.
	reduced	average					hypermobile
Protrusion	<= 8 mm	> 8 mm und < 12 mm					>= 12 mm
Mediotrusion	<= 9 mm	> 9 mm und < 14 mm					>= 14 mm
Open/Close	<= 10 mm	> 10 mm und < 16 mm					>= 16 mm
	Reduced quantity left during opening	average quantity of a protrusive record					Hypermobility shown in an Open/Close movement
Quality
	Normal registrations are reproducible, distorted and frictionless movements of synovial joints. Excursion- and incursion tracks practically overlap. The quality is described as excellent, average or poor. With a variety of view and zoom options, Gamma Dental Software offers an ideal and vivid program for evaluating the quality of joint track recordings.
	excellent				average					poor
	Excellent Quality of a protrusive record				Average quality of a left mediotrusive record					poor quality in open/close
Characteristics
	The characteristic is described as concave, straight, convex or changing. Normal tracks show an anterior concave characteristic.
	anterior concave				straight					changing
	anterior concavity in the sagittal tracing for both sides				mediotrusion right shown with straight characteristics					left mediotrusion with changing characteristics from convex to concave)
	Example of open/close and mediotrusion leftin an overlay display.				The differential diagnostics of joint track overlays have special importance in the evaluation of the characteristic. The illustration left shows the overlay of an open/close movement (blue), with a left mediotrusion track (green). The steep and extremely shortened opening track does not lie over the distinctly longer mediotrusion. An indication of anterior disk displacement of the left joint, with possible partial reduction.
Symmetry
	Right-left comparison of quantity, angularity, quality and characteristic of symmetrical registrations (protrusion/retrusion and open/close). In symmetrical movements, no noticeable transversal movements take place. In the examination for symmetry, it has to be considered that the “symmetric” patient is not the norm. Thus, slight asymmetries are to be expected and considered “normal”. The evaluation of symmetry can only be carried out for open/close and protrusion/retrusion. The clearly comprehensible Gamma Dental Software displays allow for evaluation of functional symmetry according to graphic and numerical standards.
	symmetrical joint track		sagittal asymmetry of track inclination					sagittal asymmetry in quantity
	symmetrical joint track, protrusion		protrusion with extreme differences in inclination					clearly extended tracing of left joint
	transversal asymmetry		sagittal and transversal asymmetry
	strong transversal asymmetry of a protrusion track, caused by occlusal interferences		extreme right-left differences in open/close
Timing and phenomena of speed
	Dynamic evaluation of symmetric and asymmetric movements in translation and rotation. Observing speed phenomena of the sagittal, transversal and rotational components of hinge axis movement. Normal joint movements generally register speeds of less than 60 mm/sec. Gamma Dental Software^® provides the possibility for evaluating elapsed time by means of the view aspects “Axis movements”, “Translation-Rotation” and “Time curves”.
	the „normal“ tracing		Axis movement seperated in ex- and incursion				Time curves show the condylographic parameters drawn over the time axis
	symmetric joint track		: the even hinge axis movement in excursion and incursion, separated				the time curves of a normal registration
	Leftside reciprocal TMJ clicking		Blockage and acceleration visible in the axis movements				exact localization of luxation, using time curves
	The significance of the hinge axis rotation in diagnostics
	normal open/close movement					Blockage free hinge axis movement in excursion and incursion					Translation-rotation diagram shows a harmonious development of translation and rotation
	locked joint on the left side					axis movements show the blocked joint					diagram of translation-rotation in a “locked joint” case
Condylographic diagnostics including functional occlusion
Prerequisite for these diagnostics: registrations carried out with the functional occlusal clutch CPM^®Condylar Position Measuring Unit
	With CPM you can measure the relation of the existent ICP to the joint, or make a post-reconstructive check of the new occlusion situation. For example, deviations in cranial direction during the measurement (compression) have diagnostic significance. These kinds of registrations are indications that the occlusion in the molar area is not bearing sufficient force. CPM measures the spatial difference between the reference position (centric) and a second mandible position (e.g., maximal ICP). The registrations are overlaid with a simple protrusion movement and evaluated. The ICP (or closed bite position) normally lies on the reference position or slightly anterior, on the habitual protrusion track
Recording of functions
	The following functions of the masticatory organ can be documented and evaluated using condylar track registration: mastication, speech, clenching and bruxism, swallowing. The relation of any movements to the border movements of the TMJ can be viewed and evaluated.
	Speech			Mastication					Bruxism
	speech recordings document the phonetic function			mastication: the very informative function of chewing					bruxism- a dominant function of the masticatory organ

CADIAS^®
CADIAS is the central diagnosis- and planning module of the Gamma Dental Software^®. The program links information from the far X-Ray program with the articulator, condylography, and other diagnostic findings.
Cephalometric analysis - interdisciplinary diagnostics and planning
Cephalometric analyses are often wrongly considered to be relevant only for orthodontic diagnostics and treatment planning. However, these analyses are being accorded more and more significance in diagnostics and treatment strategies involved in comprehensive interdisciplinary dentistry. Considering the statistical distribution of skeletal classes in the overall population, it is evident that skeletal Class I is not the “norm”, but rather, at only 37%, represents a clear minority. The majority of skeletal relations follow a Class II principle. Because of the considerable compensatory mechanisms involved during dento-facial development, most of these cases still achieve normal dentition, or a close facsimile. Nevertheless, after completion of development, this results in a large number of malocclusions and dysgnathias.
Therefore, when planning treatment for complex reconstructions, it is extremely important to analyze the relation in each individual case, before taking therapeutic action. This applies first of all to treatment of non-dysfunctional patients, but even more so for patients with dysfunction. All of these patients benefit from a systematic diagnostic procedure with standardized data-acquisition and evaluation, appropriate to the complexities of the stomatognathic system.
CADIAS® offers: · Statistical analyses, based on individual standards, taking into consideration the functional compensation mechanisms · Dynamic analyses by including the articulator’s reference plane and therewith a link to clinical- and functional analysis (CADIAX®) · Interactive case planning, with immediate feedback from all of the statistical and dynamic analyses
Point and contour input from the Ceph
Input is generally carried out directly on the computer screen. First, the X-Ray must be saved in the computer as a digital picture. Alternatively, you can also use a conventional digitizer, which can communicate with the program through the standardized WinTab drive. The program provides a list of points and contours, which should be entered one after another. Interactive help- and explanatory functions for the entries can be called up, if needed. A Zoom window is permanently blended in to magnify the current cursor position and simplifies identification of points on the screen. Using standardized picture editing functions, you can modify important parameters, such as brightness, contrast, or magnification, adjusting them to your needs.
Further input in CADIAS^®, which can be linked to the lateral X-Ray analysis: · Frontal X-ray · SMV X-ray · Anterior guidance · Condylography (CADIAX®) · CPM (CADIAX®) · Dental arch · Diagnosis sheet, preliminary diagnostics
Frontal and SMV X-ray
These aspects are entered similarly to the lateral X-Rays, and extend the possibilities for analysis, especially with regard to symmetrical skeletal and dental aspects.
Anterior guidance
Input of the anterior guidance allows exact functional diagnostics of the incisors. With the tooth shaper (06-231800), filled with hard silicone , an impression is made of the upper incisor, cut on the lingual concavity, and entered in the program.
Condylography
The appropriate protrusion tracings are selected from the list of CADIAX® condylography registration data and, using Copy/Paste, entered into the CADIAS® program.
CPM
CPM is also input from CADIAX®, or by graphic registration, using an input form.
Tooth arch
To digitize the arch, the models are placed on a scanner, with occlusal surfaces facing down, and transferred as pictures to the computer.

Examination sheet- initial diagnostics
	This easily clearly arranged form is designed to cover all of the questions in dental anamnesis. The user can process the form with the mouse or fill out the fields with the keyboard. The occlusal index is calculated automatically, based on the input information: · The patient’s main concern · Special medical anamnesis · Dental anamnesis · Occlusal index The occlusal index reflects the patient’s own subjective feelings, regarding his/her complaints. A comparison of the subjective and objective situation is a key to evaluation. Comparative muscle analysis is geared to an evaluation of the differences of the two sides. Palpation is carried out symmetrically, simultaneously and evenly while the patient is sitting comfortably. The patient indicates any differences between left and right, and indicates any possible pain in the palpated areas. After the bilateral comparison, an evaluation of asymmetry can be made. This can offer insights into any possible disharmonious functional processes. The examination sheet for chronic pain, tooth status and the possibility for including myofunctional problems, round out the program into a complete anamnesis package.
CADIAS® Analyses
Based on the input data, CADIAS provides a variety of static and dynamic analyses, which are generally offered as tracings and/or numerical lists from specific authors.
Norm calculations
Most of the standards used in CADIAS have been calculated according to the patient’s age and gender. Values lying within the 1^st standard deviation are displayed in green; values lying between the 1^st and 2^nd standard deviation are displayed in blue; values lying outside the 2^nd standard deviation are displayed in red.
System- and user defined analyses
The program is equipped with a number of pre-defined points, values, numerical analyses and tracings. With all of these system settings, you will almost always find what you need. However, if further individualization of the analyses is necessary, you can do this through the program, easily and without complications.
Tracings The digitized X-Ray is displayed in tracings. The program shows the input contours, as well as the most important measuring planes and values. The following author-specific tracings are included in the program’s basic equipment: · Slavicek · Sato · Ricketts · Jarabak · Sassouni · Bergen · Björg · Steiner In addition, it is possible to overlay a patient’s scanned, lateral picture to the X-Ray tracing.
Numeric Analyses
These author-specific analyses give a list of values, which are generally sorted in chapters, thus offering a diagnostic overview, from a cephalometric point of view. By simply clicking on any value, you will get an explanation of the value and the calculation of the trend.	extract of the skeletal measurement from the Slavicek analysis
Interactive Slavicek verbal analyses
In the Slavicek verbal analysis, values of individual problem groups are summarized and diagnostic statements formulated. Click on any of these statements to arrive at an explanatory field, appearing under the list, which displays the determining- and interrelated values. With this option, the program offers an excellent possibility for recognizing the interrelationships among individual values and for analyzing their evaluation.
Graphical Analyses
In the graphical analyses, various areas of analysis are displayed in spreadsheets: Skeletal relation, Compensation, Occlusal plane, Maxilla, Mandible, Lower face height, Growth type, Skeletal profile, Maxillo-mandibular position.	graphic analysis for growth type
Incisal pin table
This table allows the exact conversion of planned modifications of the vertical position in the articulator. For example, with the index, modifications of cephalometric values planned in the VTO can be calculated to the height of the incisal pin. This means that you can exactly convert the planning on the X-Ray through the modified height of the articulator.
Overlay and comparison
Overlays and comparisons are useful in various areas. For instance, orthopedic or dental modifications directly planned on the screen can be displayed with overlays of the original situation. Of course, comparisons of findings are also possible, before, between, during and after treatment.	overlay: planned modification of mandible position with recalculated soft tissue profile
Diagnostic evaluations using lateral far X-ray
Providing optical displays of the skull, uncovering dynamic interrelationships and offering the possibility of recognizing compensatory processes, X-Ray diagnostics often set a decisive copurse to treatment planning. However, placing too much emphasis on only one or several points should be avoided. When used in connection with the other findings, X-Ray diagnostics can make a meaningful contribution towards the final diagnosis. Basically, cephalograms are analyzed according to the following aspects: Skeletal evaluation · Vertical evaluation · Occlusal plane evaluation · Dental analysis · Aesthetic evaluation · Dynamic analysis · Compensation mechanisms · VTO
Skeletal evaluation
Mandibula and maxilla are evaluated separately, as skeletal units. After this basic classification, the principle of the architecture will be reclassified to an appropriate sub-group of facial patterns, based on the values at hand. A significant aspect of skeletal diagnostics involves the position of the jaw, relative to the reference structures of the skull, as well as the relative relation of the lower jaw to the upper jaw. This individual preparation is so important, because all of the further analytical results can then be compared to the individualized values which correspond to the patient’s skeletal pattern.	the “uniform face” does not exist; the variations in skeletal relations are manifold
Vertical evaluation
During growth, an individual distance develops between the upper and lower jaw: in individual cases, this vertical can be necessary as compensation for skeletal discrepancies. Therefore, this vertical assumes a special significance in diagnostics and treatment planning. This system classifies patients according to their skeletal principles. This is followed by the calculation of an individual vertical and a comparison with the current situation. This can supply valuable information for planning therapy. However, the “norm”, as a principle of classification, should not be dogmatically set as the goal.	the individual lower face height as an important parameter for planning therapy
Dental analysis and occlusal plane evaluation
The anterior tooth situation and the occlusal plane, important for many functions, are decisive elements of the dental analysis. Here, it is very important to take into consideration the morphology of the lingual functional surfaces of the anterior teeth. First, the occlusal plane is evaluated statically. It is defined relative to the mandible and evaluated.	magnified display of the anterior tooth situation
Aesthetic evaluation
In the lateral X-Rays, the soft tissues are displayed well, using soft-filtering. This allows you to evaluate the facial aesthetics, and also to make a quality evaluation of the circumoral structures. The tooth position within and relative to the lip structures is important for diagnosis and planning. The position of the upper- and lower lips in the facial profile can be evaluated in relation to aesthetic planes of reference.
Dynamic analyses
A significant element of lateral X-Ray analysis is the dynamic examination of mandibular movement. This is achieved by transferring the recordings of hinge axis movement. With this supplement, it is possible to identify the functional determinants in their interrelationships and make a diagnostic evaluation. The dynamic is defined through the relation of the sagittal condylar track inclination (SCI) to the occlusal plane and its inclination (OPI) as the relative condylar track inclination (RCI): RCI = SCI – OPI From this simple formula, an optimal inclination of the occlusal plane, adhering to functional aspects, can be planned easily, as a whole or for individual teeth.	schematic illustration of relative condylar track inclination and relative anterior guidance
Case planning with CADIAS^® – VTO
The program offers planning possibilities on the X-Ray display, which allow you to simulate important parameters and treatment steps on the computer screen. The following actions can be displayed: · Modification of the vertical situation · Orthopedic tooth movements (rotation and shifting) · Orthopedic TMJ movements of the maxilla and mandibula · Surgical treatment simulation · Soft tissue simulation · Mandibular positioning, using condylography data (CADIAX®) While using the application, you can make use of all static and dynamic analyses and call up a comparison of the planned situation with the original situation in index form or graphic. Using the incisal table chart, you can transfer various planned parameters back to the articulator. You can save as many plans as you like for each case. The program notes every planning step simultaneously, so you can create a detailed planning list and/or retract every step.