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NDC Singapore 30-08-2012

3D technology in clinical practice: evidence and future Anne Marie Kuijpers-Jagtman Thomas Maal Department of Orthodontics and Craniofacial Biology Radboud University Nijmegen Medical Centre, The Netherlands


Bony Cone structures Beam CT


4


Multi slice CT (MSCT)

Many rotations High radiation dose


Cone-beam CT (CBCT)

One rotation Less radiation More noise


Reconstruction


Voxel Based Image Registration


Voxels (Volume elements)

≈ 100 million voxels for scanning the head


Hyrax

n = 21

TPD

n = 14 Nada et al. J Cranio-maxillofac Surg, 2012 in press


Construction and superimposition of 3D models

Pre-treatment

Superimposition

Post-treatment


Superimposed 3D models and distance maps

- 5 mm

0

0

+ 5 mm


Alveolar changes Anterior flattening

- 5 mm

TPD

1.9 (±1) mm

Hyrax 1.8 (± 0.8) mm

Lateral expansion

+ 5 mm

0

TPD

-1.2 (± 1.2) mm

Hyrax -1.3 (±1.2) mm

TPD

1.7 (±0.8) mm

Hyrax 1.3 (±1) mm

N=35 Adult patients


Hugo De Clerck

Lucia Cevidanes

Am J Orthod Dentofac Orthop 2009;136:94-99


Superior view

Inferior view

anterior wall of sella, anterior clinoid processes, planum sphenoidale, lesser wings of the sphenoid, superior aspect of ethmoid and cribriform plate, cortical ridges on the medial and superior surfaces of the orbital roofs, inner cortical layer of the frontal bones


pretreatment model [white] and posttreatment [semitransparent red];

pretreatment [red] and posttreatment [triangular mesh]


Hugo De Clerck

J Oral Maxillofac Surg 2009; 67: 2123-2129


Skeletal anchorage with miniplates Hugo De Clerck

De Clerck H, Geerinckx V, Siciliano S. The zygoma anchorage system J Clin Orthod 2002; 36: 455-459


Hugo De Clerck

 Ideal age about 10.5 yr: Earlier not enough maxillary alveolar bone height Lower canines should have erupted

 4 Bollards placement under general anesthesia  Initial loading 2-3 weeks after surgery. Initial loading should not exceed 100-150 grams Over the first 10 weeks gradual increase to 250 grams  24 hours a day

 Instruct patient not to play with the elastics J Oral Maxillofac Surg 2009; 67: 2123-2129


SNA + 5º SNB 0º

SNA + 4º SNB -1.5º

SNA +10º SNB + 3º


Hugo De Clerck

Lucia Cevidanes

Am J Orthod Dentofac Orthop 2010;137:274-284


Am J Orthod Dentofac Orthop 2010;137:274-284


Am J Orthod Dentofac Orthop 2010;137:274-284


Am J Orthod Dentofac Orthop 2010;137:274-284


It looks promising, but ……… De Clerck has never tried it in CLP patients This has to be investigated further


Oef, My experience: NO GROWTH


3D and 4D Soft tissues surface imaging


3D and 4D surface imaging

Soft tissues

 Radiation based  Laser scanning  Structured light techniques  Stereophotogrammetry  Video motion analysis  MRI and ultrasound


Before treatment

After SARME and BSSO


Pre-operative

Post-operative


Soft tissue landmarks on Di3D

Fourie et al. Evaluation of anthropometric accuracy and reliability using different three-dimensional scanning systems Forensic Sci Int 2011; 207: 127-134


Soft tissue landmarks on Di3D Only one measurement t-sn left had a mean Absolute Error of more than 1.5 mm Measurements recorded by a CBCT system are accurate and reliable for research and clinical use. Fourie et al. Evaluation of anthropometric accuracy and reliability using different three-dimensional scanning systems Forensic Sci Int 2011; 207: 127-134


Soft tissue landmarks on CBCT

Fourie et al. Evaluation of anthropometric accuracy and reliability using different three-dimensional scanning systems Forensic Sci Int 2011; 207: 127-134


Soft tissue landmarks on CBCT Only one measurement t-g had a mean Absolute Error of more than 1.5 mm Measurements recorded by a CBCT system are accurate and reliable for research and clinical use. Fourie et al. Evaluation of anthropometric accuracy and reliability using different three-dimensional scanning systems Forensic Sci Int 2011; 207: 127-134


Voxel Based Image Registration Automated registration technique in which grey values of corresponding voxels in a defined region of interest are used to align and superimpose CBCT images.


Voxel Based Image Registration Automated registration technique in which grey values of corresponding voxels in a defined region of interest are used to align and superimpose CBCT images.


Surface rendered soft-tissue representation after voxel based superimpositioning on the cranial base

before and 3 months after bimaxillary surgery


Disadvantages

Deflection of soft tissues during scanning Not photorealistic High radiation dose


This is different from the use of facial templates


University of Cardiff group

The ALSPAC study


Alspac study iets toevoegen


A three‐dimensional look for facial differences between males and females in a British‐Caucasian sample aged 15½ years old

Toma et al. EJO 2008


Females tend to have more prominent eyes and cheeks, whereas males tend to have more prominent noses and mouths.

Toma et al. EJO 2008


3D and 4D surface imaging

Soft tissues

 Radiation based  Laser scanning  Structured light techniques  Stereophotogrammetry  Video motion analysis  MRI and ultrasound


Dynamic facial image acquisition

Stereo videogrammetry 3 cameras set at various angles

4D

Acquisition time 10 s 30 frames per second 51


Dynamic facial image acquisition

3D video imaging

Project Arntz Kho


Three JAI cameras (two monochrome and one color) to capture the 3D surface

Lighting Kino Flo Diva-Lite


Neutral facial expression female

Point tracking Vector lines

Happy facial expression female


Positional changes between two video’s


Correction of transposition Use landmarks that hardly move in a 3D-video, f.e. endoand exocanthions Now it is possible to compare T1 and T2 with each other in a distancemap


T1 87 frames

T2 80 frames


Solution: Coupling sound to 4D Frame selection by analyzing sound fragments


Solution: Coupling sound to 4D First the signal of both audio files are filtered:

T1 audio

T2 audio


Solution: Coupling sound to 4D Find minima and maxima of both audio signals:

T1 audio T2 audio


Solution: Coupling sound to 4D Difference between every maximum and minimum are found (differences between each star) Pre-OP audio

Post-OP audio


Solution: Coupling sound to 4D

• When in this time period more frames are found in one of the 3D-video’s a selection of frames is made • This is done for the whole audio file

1

2

1

3 4

2

5 frames

3 4 frames


Solution: Coupling sound to 4D

• The frames of the minima and maxima are coupeled • The 2 frames in the middle are coupeled to the most closest frames

7

8

9 10 11 framenr

8 9 10 11 framenr.


What does it bring us?

  

No radiation Dynamic soft tissue analysis Motion analysis

 

High costs Technique needs to be developed furher


Teeth Digital models 66


Orthod Craniofac Res 2011;14:1-16


Identification

Additional records identified through other sources (n = 3)

Eligibility

Screening

Records after duplicates removed (n = 283 )

Records screened (n = 40 )

Records excluded (n = 11)

Full-text articles assessed for eligibility (n = 29)

Full-text articles excluded (n = 12)

Studies included in qualitative synthesis (n = 17 )

Included

PRISMA flow chart

Records identified through database searching (n = 347)

Studies included in quantitative synthesis (meta-analysis) (n = 0 )


Results  Absolute mean differences between measurements on plaster and digital models are in the range of 0.01 to 0.3 mm and clinically insignificant

 Measurements like ALD, TSD, ICON, PAR on plaster and digital models are comparable

 Digital models as an alternative to plaster models may be recommended, although the evidence identified in this review is of variable quality Fleming et al. Orthod Craniofac Res 2011;14:1-16


Why do we still take impressions ?


Types of intra-oral scanners

 Direct contact scanners  Non-contact active scanners


Digital impression system Touchscreen display

Scanning device

CPU Powder sprayer

3M Lava COS Chairside Oral Scanner


Dentition must be powdered


Wand (scanning device) contains multiple lenses and LED cells


Accuracy

Impression scanned e-model

Intra-oral scan e-model


Accuracy Intra-oral scan

Alginate impression

Pharasyn, Roelofs, Maal, van Diermen, Breuning


Difficulties

 Learning curve  Intra-oral scanning device is   

big, heavy and not very ergonomic to use Time consuming Software for orthodontic or surgical purposes not yet adequate Image on the monitor is still 2D


Buy now?

Quality

costs

Time


Production of a fully customized lingual appliance

        

Impression taking Set-up 3D-scanning of the set-up Generating individualized bracket bases CAD/Cam design of the bracket body Positioning of the bracket body Rapid prototyping of the virtual bracket series Bonding tray fabrication Wire manufacturing with wire bending robot


Production of a fully customized lingual appliance

  

Impression taking Set-up 3D-scanning of the set-up


Production of a fully customized lingual appliance

  

Generating individualized bracket bases CAD/Cam design of the bracket body Positioning of the bracket body


Generating individualized bracket bases


CAD/Cam design of the bracket body


Production of a fully customized lingual appliance

 

Rapid prototyping of the virtual bracket series Bonding tray fabrication


Production of a fully customized lingual appliance

 

Rapid prototyping of the virtual bracket series Bonding tray fabrication


Production of a fully customized lingual appliance



Wire manufacturing with wire bending robot


Am J Orthod Dentofacial Orthop 2011; 140: 433-443


94 consecutive patients

Initial

Set-up

Final

Am J Orthod Dentofacial Orthop 2011; 140: 433-443


Orange = planned position in set-up Blue = final tooth positions Am J Orthod Dentofacial Orthop 2011; 140: 433-443


3D and 4D Soft tissues surface imaging

Bony Cone structures Beam CT

Teeth Digital models 93


Soft tissues Image fusion 2 Bony structures


Bony structures Image fusion 3 Teeth


Rangel et al. 2011


3D reconstruction of the dental cast

Normal reconstruction

3D-reconstruction with markers extracted


Soft tissues

Image fusion 4

Teeth


Normal 3D-image

3D-image with cheek retractor

Digital dental cast

Rangel et al. Am J Orthod Dentofac Orthop 2008;134:820-826


Int J Oral Maxillofacial Surg 2011;40:341-352


Three-Dimensional Imaging for Orthodontics and Maxillofacial Surgery Chung How Kau (Editor), Stephen Richmond (Editor)

ISBN: 978-1-4051-6240-1 Hardcover, 320 pages December 2010, Wiley-Blackwell ÂŁ95.00 / â‚Ź114.00


The future …..  Plaster casts disappear  Emphasis on 3D-analysis 

of soft tissues Virtual individualized treatment planning


Malocclusion

Set-up


The future …..  Plaster casts disappear  Emphasis on 3D-analysis  

of soft tissues Virtual individualized treatment planning The orthodontist and the surgeon go digital


orthodontics@dent.umcn.nl

Department of Orthodontics and Craniofacial Biology Department of Maxillofacial Surgery 3D-Facial Imaging Research Group Nijmegen - Bruges Radboud University Nijmegen Medical Centre


11 ak evidence3d handout (2)