LIVE Recording from Spear Facially Generated Treatment Planning Workshop

LIVE Recording from Spear Facially Generated Treatment Planning Workshop

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Alright, well we are here in Facially Generated
Treatment Planning, and part of that course is looking at how we can use digital templates
to do treatment planning. We’re here with a live class and I am presenting
this and I’m going to play a little bit in PowerPoint and in Keynote. First thing I’d like to get somebody to
do, Kevin, if you could push number two back there to shut off some lights. I’d like first to touch a little bit on
image management. Gregg touched on this a little bit for you. But one of the things you want to think about
in image management is, even if you don’t have a place or a program to put things in,
it can be as simple as putting them in folders. One of the most important things is don’t
store them in your practice management software. It takes up lots and lots of memory and actually
will make things run more slowly. So we recommend is that you just put a patient
folder like he said, I’m going to add one thing that can actually get you started in
organizing. Then I have names for the patients and then
a dated folder for each time with any photos that were taken and I put things like “IX”
which means “initial exam,” those are the first photos for that person. If I do a search for a folder, it’ll look
up every folder that has that. And as I go down it will show me what patient
that is, OK. Good. And then inside there I would have a number
of images specific to that time, that visit, that I could always go back and use. Specifically, initially I’m going to use
the pictures we took at the initial exam. Do you save them flipped or un-flipped? Doesn’t really matter. If you’re taking mirror shots, just have
a protocol. My protocol is always to save them in my database
the way they were taken. So all of my occlusal shots will be upside
down and all of my side shots are going to be flipped and need to be flipped horizontally. So, although, that looks like a nice picture,
that’s actually what the patient is. I know that because I know I always store
them that way. Okay? If you are going to use templates on a Mac,
I would recommend that you would use Keynote. You could use PowerPoint for Mac but PowerPoint
for Mac is not PowerPoint, it is different and it won’t do all of the same things. The instructions that I’ve put in to the
PowerPoint folder are for using PowerPoint on a PC because it is different than it is
on a Mac. Okay. So if you’re going to use a PC, get PowerPoint. The beauty here is, in many offices what I
hear is “Well, I personally like my Mac but my office runs on PowerPoint. And so if I want to use it at the office,
it has to be on PowerPoint.” Excellent! All Keynotes can be exported as a PowerPoint,
they will work perfectly in PowerPoint and you can have it in both formats. Can’t do that on a PC it will not open or
run a Keynote. You’d have to export it as a PowerPoint. Okay? Excellent! So, I’m going to switch gears here and pull
up some things on the screen. Switch to my auxiliary video and go 16:9 and
we’ll hope everything comes up real nicely. Okay, there we go. You are now looking at the screen of my Mac. That’s what you’re seeing up here. In the middle is a folder and I know it’s
little but it says ‘Keynote’ underneath it. On your disk that you were given, that disk
there are some folders in there. One of them says ‘Keynote’ one of them
says ‘PowerPoint’. If you use Keynote then I would already just
open it up and drag that whole folder in. if you open the folder, there’s going to
be some stuff in the folder there is an EFSB Master Keynote 16:9 that’s the one we’re
going to use. There’s also one from 2009. I actually have two 2009 ones and that’s
because some models of Macs will not run the newer software. We are going to use this one which is the
Master Keynote, and I’m going to open that up. So, in this what you’ll notice is, if you
look at this … And by the way for those on Facebook, these are available to you. We can send you a Dropbox link. You guys have them on a disk but if you ever
want them not on the disk you just email me and I’ll connect you with a Dropbox link
that has all this stuff in it. I want you to notice that this one has been
created with 18 images in it. And those are the 18 images that we recommended
that you take as a full series of imagining on a patient. You’ll notice, as I said, I store all of
mine upside down so these are upside down. When you flip them, you may do your collection
a little bit differently. That would be your protocol. Those are the 18 pictures. The beauty of this is that, now that you know
the 18 pictures, anyone on your team can look at this and know the 18 pictures. Which means that they could actually put them
into this and create a file for you if you wanted to do that. And, in fact, in many offices the protocol
is that the team takes a lot of the images and they just put together a file and that’s
what you get with all of the images in it. To do that in Keynote, what we’re going
to do is we’re first going to duplicate our master. To do that we have to go to file, duplicate. And, by the way, for those of you who are
here and for those of you listening on Facebook on your disk and in the Dropbox, is a PDF
with full written step by step instructions for everything I’m going to show you. And the reason I did that is that most of
you don’t operate a two screen system. If you had two screens, it’s really easy
to put up a PDF and then do something. I don’t know about you but I have had the
experience of going on to the computer and its giving me directions to do something on
the computer… yeah how do you do that? You have to go back and forth between the
different screens and move things off, it’s really hard, and so I printed it. If you do work two screens or have a giant
screen, you can actually put up the PDF, it’s the same thing you have printed. However, for your convenience, we printed
it. In the Dropbox it’s the whole PDF and that
is also on your disk. Once this is duplicated, I now have two of
these, this one says “copy” right up here. I’m going to close the previous one because
I’m going to keep that as my master and I’m going to label this one. I’m going to save it. When I hit ‘save’ it will say ‘what
do you want to call it’. I’m just going to call it ‘test’ and
will let it save in the Keynote file. If it was a patient one that I was really
doing I would like to go look for the file folder with the patient’s name on it. That’s where I always store these I just
pop it in there so that it is in there. In my system, I keep all of my patient images
on a separate hard drive that is then backed up in two different places. But I carry around a drive with me, a one
terabyte drive that has patient images on it. I’m running out of space, I need a two terabyte
drive, pretty soon. The reason for that, again, is that it takes
up tons of space. So I find it easier not to have it on my regular
computer because I have lots of other stuff on there. But you may have plenty of room to have them
and if you have a system in the practice what you’re going to want to have is probably
a place where you set aside a partition or an area on the hard drive where you’re backing
up all of that imaging. So I’ll save it. And now, although it is pretty nice to look
at pictures of Janina, that’s not the patient that we’re doing right now. By the way, somebody asked me one time, “Why
do you have pictures of Janina in here?” When I made this file, this is a true story,
when I made this file I had two folders with patients one of those folders was of me as
a patient, the other one was Janina. So you should all thank me. Okay, now, as pleasant as they are to look
at, that’s not what I need right now. I need pictures of my patient. So in Keynote, the way that I would load the
images in, is, did you notice this morning when Gregg was loading in his images that
when you load a file into a Keynote or a PowerPoint a lot of times the picture is bigger? Or smaller? Do you know why that is? It’s because of the resolution of the image
and the resolution of the program. Because you can set up the program to be any
resolution you want. When you do that, those two have to jive. If you’ve ever loaded them in, you know
what a pain that can be. So what I’ve done is that all of these images
are designed as media place holders. What that means is if you drag another picture
into this picture, it doesn’t matter if its five mega pixels or five megabytes, it
will always exactly fill that frame. Which makes it way easier and way less hassle. So it doesn’t matter where you got the image
it will fill that frame. Here’s what I’m going to do, I’m going
to go to a folder over here on my desk top that says patient photos. And as I told you I have a folder, I just
have folders by name. Let’s go down and look at I think probably
Craig. I’ve used this before but right there it
says “initial exam photos.” It’s this little folder here, if I open
it up I’m going to see a whole list of images. This is what it looks like under list mode. And under list mode, what I’m going to have
is a whole bunch of numbers. Because the camera assigns a number to each
file. Okay? That’s not helping me. In Keynote, if I come over here at the top,
there’s a little thing that says “view.” The first thing in “view” is icons. If I click that it’s going to show me the
pictures. Now I can pick the image that is his full
face smile. I think you can see that right here. If I left click, or click on my pad, and hold
it and drag it over, the blue line around it tells me it’s a media place holder. As soon as I let go, it will replace that
image with that image and it will exactly fill the file, fill that frame. It makes it real easy to drag these in. So the next one I would do the same thing. If I know that I want his smile. Oops, should have gone down one, excuse me. And then actually what I could do, I could
get this out of the way and make it a little more convenient because I don’t need a big
picture there. If I now know I want this one here, you can
see how easy it is to drag these in. I would drag all of those in. As soon as I was done I would now have all
18 of my images, I’m not going to drag every one of these in, because you get the idea
of what I’m doing. I will drag one of his front teeth in there. Let’s do this one. Alright for him, because I know it’s up
here. Let’s come up to this, put this in here. Alright, because sometimes I would still want
to crop so I’m going to show you how I would do that in Keynote. Let’s close this because now, let’s imagine
we have them all in there. I would tell you that my personal protocol,
once I’ve loaded them all in, is to leave them up there and drag them down, copy them,
and then drag them down to work on them so I always have originals available to me. That’s not necessary and a lot of people
don’t do that. It does take up a bit more disk space because
I have lots of multiple images in there. So that would be a personal decision. The only reason I do it is that it leaves
me with all 18 and I know that I still have originals in case want to go back and look
at how I took that picture. If I decided that I wanted to do something
here to crop this, in Keynote, if I click the image and select it and I’m on format
I can go to image and it will say ‘edit mask’ and that’s what cropping is in this. And now I can begin to crop things, move things
up, just like in any other program in lots of places you can crop whatever it is you’d
like out of the image. Then you can move that image once you’ve
cropped it. If you can make it bigger, you just click
off but have it still be selected. Now I can make it bigger if I want to. Let’s go back here and look at one other
thing, because one of the things I often have to do, one of the things I try to do with
my new patients as I meet them is I try to decide, do I think their pupils are parallel
with the floor. If their pupils are parallel with the floor,
by the way to do that, you have to meet them standing. And it’s really convenient if you can get
them to walk towards you. Because when you walk, you level your head. If their level with the floor, what do I know
about this picture? It’s canted. So, I can correct that. I can go and grab a line or an arrow down
here, I’ll show you all those in a moment. There’s a slide here that has lines and
stuff, in fact, we’ll do that. We’ll copy a line. Command-C to copy the line. I can go to the picture I want to put it on
and command V. I can grab an end and stretch it out. What I could have done is gone up to a shape. There is a … let’s see if it’s a parallel
line. Let’s go to zero. I think this might be, the line is goofed,
and that’s angled. So actually, there is a glitch in Keynote. And the glitch in Keynote, I’ve already
told Apple and they know about the glitch, I’m going to get rid of this line. That line, because it was drawn in before,
actually will give you one degree off if you believe Keynote. I know, isn’t that interesting. I contacted them and they said “yeah we
know, it’s a glitch.” If you come here and you want to do a line,
you click here and it will let you draw a line. And this one usually, actually works, that’s
zero. That’s telling me it’s zero and that’s
a horizontal line. That’s following. So, that’s the glitch. If you have an existing shape, some of those
shapes will give you some wrong numbers. So this one is at zero. At zero, what do I know? Where should both pupils be? So I’ll kind of go in the middle, I’ll
come over here to arrange, I’ll hit the picture, arrange, and down here I have a thing
called angle. It’s going to let me angle the image. So I just can tip it. Now, what do I know? That’s how he is in space. If I want to use imaging to diagnose and do
esthetic stuff and then plan, I’d like to know where his face is in space. I want to know where the teeth are. So the way you find out, the way you deal
with where the teeth are. I’m going to copy this, now, you see that
I’ve selected the image, no I’m sorry, the slide, up top. If I hit copy, Command-C, Command-V, I’ll
make a duplicate slide. Now what I can do with a duplicate slide,
is I’m going to view it as much smaller. I’ll make it a 25-percent view, so I’ll
click on this picture and make it huge, put his teeth in the middle of the slide, now
go back to fill my window, fit my window. Now what I can do is I can pick any two spots
on this image, so I’ll start with the canine on the patient’s left, I’ll take the right
side and I’m going to come up until I’m on the canine on the patient’s right. And now that line will allow me to go to any
close up image of those two teeth and correct that image. So I know I have that corrected in a place
where I couldn’t see his eyes. When would that be? Retracted? Teeth apart, which is the most common image
that I will draw on. Remember that image needs to be taken at the
level of the occlusal plane so that we can use it. Okay? But that’s how I would correct the image. If I wanted to draw. So, actually, let’s draw around Janina’s
lips. If I wanted to draw, what I’d do on this
one is I’d go shape, draw with pen, and what I can actually do now is pick something
to follow. In this case I’m actually going to go control,
Command-X and change that, I’m going to escape because I went down too far. I go right to where the lip meets lip. Now what I can do is I can just draw along
the lip. So I’m clicking as I go and I just create
a shape. If I wanted to draw all the way around, if
I double click it will end. If I go Command-Z it will go back one but
I probably can’t add to it. I would have to start over. Do you get the idea? Once it’s done, if you click off of it ok
if I double click I can now go in and select it and now I can pick what color I want it
to be. If I hit style it will let me pick a color
over here. So I can make it yellow. If I wanted to do that I could draw along
the occlusal plane, which I can show you in a little bit and then I can move that line
up and down. If I wanted to put an arrow in so I could
point out a chip in a tooth, so let’s take this out. Let’s get rid of that. I can come up here to shape, and I can get
shape and put it in. Or I could go down to my slide that has those
things on them and I can just pick an arrow. Command-C, that’s to copy it. Bring it back up and paste it in. And then I can put an arrow here that could
talk about the chipping. So I can put things in that will allow me
to point things out to the patient if I wanted to by having the slide as a back drop to our
discussion. So kind of see where front teeth should be. So I am actually going to correct this image
without, although I have my line don’t I. Let’s correct that image. Come back to this, put it in here. To correct this image I need to go to the
canines so I’ll go a little bit kind-of between where I think that is, click on that. Hit arrange, and now what I can do is I can
come right here. And actually that’s going to be pretty close. So I’m going to go one more. I’ll usually leave my work so I’ll just
duplicate the slide and then I’ll get rid of this. Now if I want to put in where I think I’d
like teeth to be, let me tell you that if I look at gingival margins for Craig it looks
pretty good. He wants his teeth to be longer, his front
teeth. And if you look at the buckle cusps of his
premolars, we can see that these, the incisal edges are apical to that. Aren’t they? Again, one of the rules is, you know where
the least length you want on maxillary central incisors? Buckle cusp tips of the maxillary premolars. If they’re shorter than that it looks like
a reverse or a flat smile to us and we notice it. So, let’s say that I want to figure out
where teeth should be, let’s go get some teeth. If we look at these, I’m going to go over
these in a bit with everybody, for those watching on Facebook let’s just say there’s a number
of different slides that have different shapes and different things. These are all the teeth. These are the originals. We use to use those six teeth. I drew this probably about eight years ago. We’ve been using it ever since. And then several years ago what I learned
was that with these if you’re clicking on the shape you have to click the line, and
it can be kind-of a pain trying to move things. So I actually put together a set that is partly
filled. So these you can click anywhere. Include a couple implants. Because that’s part of the process, you
might pop an implant in. I think I want an implant there. Remember this isn’t about precision. This is about thought. So let’s change Craig’s six front teeth. I am going to hold down the click. It’s a left click. Anything I touch with a rectangle as I drag
in Keynote will be selected. I’m going to copy those. Command-C. I could have gone to edit, copy. I’ll go back to the picture that is corrected
and I’ll paste them. Command-V, there they are. I can now take this and do whatever I want
with them. So I usually center and put where I think
I would like to have incisal edges. So I’m going to go about there. Is that okay with everybody? Okay? Off camera: We have a question on Facebook. Dr. Gary DeWood: We have a Facebook question. Off camera: They want to know if you’re
going to talk about PowerPoint. Dr. Gary DeWood: Am I going to talk about
PowerPoint? It is right here, I am getting there. I’m going to show you how to do things in
PowerPoint. Actually, most of the things I am doing in
Keynote work exactly the same way in PowerPoint. I will show you the differences. That’s going to be how I will end my demo. So what I would do now is, I would put the
incisal edge where I’d like. If I click off of these I can now individually
size them if I grab a corner it will let me move like this. By the way, exactly the same in both formats. I put the gingival margin where the gingiva
is. So in this case I was pretty close to where
the teeth are, gingival margins are right kind-of here. I can move one out, come here. You all get the idea? This is not about precision. It’s actually about getting an idea. Now I just did something I didn’t want to
do. You see what I did? Dang it. Don’t you hate when you do that? There’s a neat little thing it’s called
Command-Z. Or Control-Z in PowerPoint. And what you wind up doing is you undo whatever
you just did. It always happens if I click and I didn’t
really grab what I thought I was grabbing. You all get the idea of sizing those? Because here’s what I can do next. I’m going to leave these undone. I’m going to duplicate that slide and I’m
going to get rid of the picture. So, Command-X. Now I am not distracted and I can set proportion. And I would tell you just believe what you
like. I like long teeth so I’m going to make his
teeth a little longer. I kind-of like those. Keynote will actually tell you the ratio,
but I will tell you I never even look, ever. My technician is going to measure it. I just want to see, “What would that look
like.” I want to get an idea and what would I have
to change. So I suggest to illustrate the change, I’ll
show you. Let’s say I really wanted to have some big
prominent central incisors. I will come up here to do this just so it
looks better. And all I’m doing is dragging. So let’s say that I decided this really
is what I think I would like so it looks better in his face. The next thing I would do now is duplicate
the slide. Let’s put the teeth back. To find that I would go to the picture of
the teeth, select it, copy, Command-C. I’m going to paste it in, Command-V. I just pasted
it over the slide. Any time you paste anything into a slide it
will go to the top. Let’s move it to the back. When it’s selected, if I am on arrange I
have choices here; back, front, backward, forward. Back sends it all the way back. Backward sends it one step back. I want to go all the way to the back so those
are on there. It now illustrates for me all the soft tissue
difference I want and the hard tissue difference I want. What does it not tell me? How I can do it. But it tells me what I want. Now, the ways to do it though can become just
as you see them. What I are my choices for moving free gingival
margins? Ortho, perio. Right, those are my choices. How do you decide? You look and you see where is the papilla
going to wind up? What’s the papilla look like? How would this look with a nicely proportioned
tooth with a 50/50 papilla split? Which is usually a number we kind of aim at. That’s what you would do. If I took a picture that was not flipped,
to flip it in Keynote you select the image at arrange there is flip. This is vertical, there’s my vertical flip
so I just corrected my picture. Let me do that once more for the lower. Because they’re a vertical flip. If I was a retracted buckle mirror shot, then
it’s going to be a horizontal flip. Okay? Let’s switch to PowerPoint and I’ll show
you some differences. What you see now is my PowerPoint screen. You see a folder called PowerPoint. If I open that up you’re going to see the
same thing, although there’s only one version. I have two versions of Keynote, again because
some people can’t run both, or can’t run the newer one because of their operating system. That’s going to change soon because Mac
will stop supporting it. Let’s open up that same file in PowerPoint. Off camera: We have another question on Facebook
from Mansi. “So when do you actually do this? During comp exam or do you bring the patient
back? How long does it actually take you? …”
Dr. Gary DeWood: Ok, I would actually not do this during a comprehensive evaluation. This is going to be done later. Now what could be done at an initial exam
is I’d pick the photos that I might want to talk about. I wouldn’t do all this. I’d pick some images that I could use to
print and show them. This is going to be about treatment planning. I’m putting things in here so I can actually
create a treatment plan. That’s why I’m doing that. In PowerPoint it’s a little bit different. First of all in PowerPoint if I want to duplicate
the file I’m going to go to file, save as. How many of you are in PowerPoint? Okay, so everything I did in Keynote works
almost exactly the same. I’ll show you the things that are different. When you save your new file in PowerPoint
you have to go to “save as.” When you go to “save as,” it’s going
to ask you where you want to save it. So I’m going to do the current folder but
I could do anywhere. You could go find a place, you could find
Craig’s chart and put it in their folder and put it in there. In this case I’m going to put it in PowerPoint
because it’s a test. It’s going to say, “What do you want to
name it?” I’m going to call it “test.” And one of the nice things about PowerPoint
as soon as I hit save it’s going to ask if you want to replace it. I am going to replace it because I did one
earlier. It’s going to go in and it’s going to
park that master back in the folder it came from unchanged. Beautiful. This new one says “test.” You can see that at the top. If I want to load images in PowerPoint the
way to do that is to right click on the image. And one of your choices will be “change
picture.” If I hit change picture, it’s going to say,
“OK, where do you want me to go find a picture?” So it’s going to go and find where I should
look for pictures. In this case I’m going to tell you it’s
from a file. Let’s browse, there’s my patient photos. It’ll go to any files where you have photos
in them. Patient photos let’s go pick Craig again. Here’s his initial exam. And now I can pick his smiling face, double
click. Now if you do it this way you will do the
same thing a media place holder did in Keynote. It will put any size image into that frame. If you drag it in or you just click insert
and go to an image it will do whatever size is relative to the resolution of that file. Okay? Good. So again let me just show you, because there’s
one thing to show you more about this. If I go to my next slide PowerPoint does know
that I was looking to change pictures. So if I go change picture again, it’ll say,
“OK, do you still want to browse?” Yes. If you’re going to browse, I bet you’re
going to browse the same place. And it always takes you back to the folder
you were in. Which actually makes this go very quickly
I’ll double click and I’ll put it in. That’s one of the differences. Audience Question: Do you leave that window
open so you don’t have to keep going back to browse? Dr. Gary DeWood: I cannot, not if I do it
this way. And I’m going to recommend this way because
you never have to resize images. If you don’t mind resizing images or you
always know the size you shoot them at and they fit in your slides because you created
a PowerPoint for that resolution, then yes, you can actually drag them in and then position
them. Kind of like we did in Keynote. I was trying to create something that would
make it really easy for any image from a different camera to still fill those and have it be
the same thing. That’s why I created this, this way. If you want to flip your images, in PowerPoint,
what you would do is select the image, find arrange, and it means you have to look across
the top because if you’re in any of these other things, you’re not going to find arrange
it’s in home and then arrange. When you click arrange there’s a little
down arrow, click down. One of your choices is align. Align has a whole bunch of things you can
do, one of them is rotate. Find align. If you find align you will always find rotate. The new version they split them, it used to
be under align. You find rotate. Go to flip vertical. There it is. The neat thing about PowerPoint, I want you
to watch what happens. When I click and select it and go down here,
the neat thing about PowerPoint that Keynote does not do, it shows you what you’re going
to do if you push the button. It does it as you get there. To say, “That’s what’s going to happen. Is that what you want?” As soon as you click it, it will close and
it’s changed. Same thing with a horizontal change. I would arrange that. And rotate, now why isn’t it lighting up? What did I forget to do? I did not select the image. If I select the image all of a sudden it … horizontally. We’ll use this picture if I want to put
some drawings some teeth drawings in there, let’s go do the same thing. There is one little difference. It is a left click and you must totally surround
whatever you want to select. If you don’t, I want you to notice that
I’m touching lots of teeth here. But the only ones I’m surrounding are the
six anteriors. They are the only ones that will select. When they select, I can then copy them, control
c, because there is no command key on a PC. I’ll use this one to put them in, it will
be too small, but control v pastes them in. And we can do the same things exactly that
we did before. Now, that’s an esthetic treatment plan. What it does is give me ideas about things
that I could do with teeth. I am going to show you just on the screen
that all of the four areas, appearance, esthetics, function, structure and biology are here in
those slides. So that as you’re treatment planning, you
can add slides and make notes for yourself. So I can put a new blank slide in go in and
put a text box in and start typing notes for myself. The idea of this is that you could use this
to sit down and actually treatment plan what would be a good therapy for that patient based
on your evaluation, examination and your photography. I’m going to talk about how to use these. I’m going to be leaving the demo for those
of you on Facebook, we’re going to be saying “good-bye.” If you go to our website, actually can you
go through the Facebook link? There’s a link on Facebook where you can
actually go in and you can get a link so that you can actually watch me do this. I have two videos, one for PowerPoint, one
for Keynote that would be completely accessible to you. At those videos, you can actually find a way
to link up with me and ask me to send you a Dropbox link that would allow you to download
everything you’ve seen today in Keynote, PowerPoint or both. Thanks for being here, Facebook people.

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