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Thomas Maal Martien de Koning


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Introduction

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Introduction

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Before 2009 • • • • •

Clinical judgement Articulator/facebow 2D-analysis Prediction-tracing Model surgery on plaster models

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Before 2009 • • • • •

Clinical judgement Articulator/facebow 2D-analysis Prediction-tracing Model surgery on plaster models

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Clinical judgement • • • • •

Mono-, vs bimax. osteotomy Asymmetry/midlines Dental-show Occlusal plane Simulation end-to-end

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Before 2009 • • • • •

Clinical judgement Articulator/facebow 2D-analysis Prediction-tracing Model surgery on plaster models

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Articulator/face-bow • Techniques takes a lot of time • Wax bite prone to errors • Often discussion after model surgery

Result: facebow-registration is not used….

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Before 2009 • • • • •

Clinical judgement Articulator/facebow 2D-analysis Prediction-tracing Model surgery on plaster models

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

2D-analysis/prediction-tracing • • • •

X-OPG, X-RSP Cephalometry Judge of the bony chin Cut and paste

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Before 2009 • • • • •

Clinical judgement Articulator/facebow 2D-analysis Prediction-tracing Model surgery on plaster models

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Model surgery • • • •

Measuring distances on plaster casts Maxilla first Intermediate wafer made of Palavit Final wafer -> dental laboratorium

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Since 2009 • 2005: Prof. Stefaan Bergé 3D • 2006: Technical support 3D Lab • 2008: Dr. De Koning Cursus Arnett

Result: implementing 3D-planning…

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Requirements • • • • •

CBCT (i-CAT®) met Extended Height Stereophotogrammetry (3dMD®) Triple-scan Software-program (Maxilim®) ‘3D-lab’

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Concept planning • Soft tissue planning – Natural Head Position – True Vertical Line

• Maxilim®

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Natural Head Position •

Broca (1862): ‘when a man is standing and when his visual axis is horizontal, he [his head] is in the natural position’

Schmidt (1876): ‘the horizontal positioning of the head is a physiologic concept,……,that is to say which anatomical plane within the skull corresponds closest to the physiologic horizontal’

Moorrees, AJPA 1958 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Natural Head Position •

Broca (1862): ‘when a man is standing and when his visual axis is horizontal, he [his head] is in the natural position’

Schmidt (1876): ‘the horizontal positioning of the head is a physiologic concept,……,that is to say which anatomical plane within the skull corresponds closest to the physiologic horizontal’

Downs, AO 1956 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Natural Head Position •

Broca (1862): ‘when a man is standing and when his visual axis is horizontal, he [his head] is in the natural position’

Schmidt (1876): ‘the horizontal positioning of the head is a physiologic concept,……,that is to say which anatomical plane within the skull corresponds closest to the physiologic horizontal’

Björk, AO 1951 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Natural Head Position •

Broca (1862): ‘when a man is standing and when his visual axis is horizontal, he [his head] is in the natural position’

Schmidt (1876): ‘the horizontal positioning of the head is a physiologic concept,……,that is to say which anatomical plane within the skull corresponds closest to the physiologic horizontal’

McNamara, AO 1981 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Natural Head Position •

Broca (1862): ‘when a man is standing and when his visual axis is horizontal, he [his head] is in the natural position’

Schmidt (1876): ‘the horizontal positioning of the head is a physiologic concept,……,that is to say which anatomical plane within the skull corresponds closest to the physiologic horizontal’

Sella-Nasion Basion-Nasion Porion-Orbitale (FH) NHP

5.3 (sd) 4.7 (sd) 5.0 (sd) 1.8 (sd)

Lundström, EJO 1995 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Concept of planning • Weke delen planning – Natural Head Position – True Vertical Line

• Maxilim®

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

True Vertical Line

Arnett & McLaughlin 2004, ISBN 0723433208 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Concept planning • Soft tissue planning – Natural Head Position – True Vertical Line

• Maxilim®

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Maxilim

www.medicim.com

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Maxilim

• Accurate dental data - Augmented Model scan • Cephalometry

• Osteotomies • Orthognathic Surgery

• Soft tissue simulation

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Augmented Model To enable 3D orthognathic surgery planning: “Accurate visualization of the interocclusal relationship

A Cone-Beam CT triple scan procedure to obtain a three-dimensional augmented virtual skull model appropriate for orthognatic surgery planning Dr. R.J.Swennen, Dr. W. Mollemans et al.J. Cranio. Surgery,

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Introduction • Aim: Accurate 3-D model of Skull and Dental models, without the use of plaster dental models

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

History • Cadaver Study – –

Robust visualization of the dental occlusion by a double scan procedure. Schutyser et al. The use of a new 3D splint and a double CT scan procedure to obtain an accurate anatomic 3D virtual augmented model of the skull. Swennen et al.

• Clinical pilot study –

– –

The use of a wax bite wafer and a double CT scan procedure to obtain a 3D augmented virtual skull model, Swennen et al. A cone-beam CT based technique to augment the 3D virtual skull model with a detailed dental surface, Swennen et al. The use of a double cone-beam CT procedure and a 4-layer wax bite wafer to augment the 3D virtual skull model with detailed occlusal and intercuspidation data. Swennen et al.

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods • 10 orthognatic patients - Conventional bite registration - Delar Registration Wax (Delar Corp, Lake Oswego, USA)

- All in one impression of upper, lower dental arches Alfa™ Tripple tray® (Premier® , Plymouth Meeting, USA) AlgiNot™, Kerr, USA, Tomulus, USA)

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods • Normal patient scan (CBCT)

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods • Normal Patient Scan – Detailed Settings - ICAT Classic • • • • •

kV mAs Height Scan time Reconstruction

120 48 22 cm 2x20 sec 0.4 mm

– Remarks • The facial soft tissues should be in a relaxed position • The patient is not allowed to move during the acquisition time • Tip of the nose and Porion should be visible on the DICOM images

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods • Low Dose Dental Scan

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods • Low Dose Dental Scan – Detailed Settings - ICAT Classic • • • • •

kV mAs Height Scan time Reconstruction

120 12 8 cm 1x10 sec 0.4 mm

– Remarks • Impression must be central in the FOV • Part of the mandible and maxilla have to be visible • Impression must be well in place. Any air gaps result in errors in the augmented model. 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods • High resolution scan

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods • Impression scan – Detailed Settings - ICAT Classic • • • • •

kV mAs Height Scan time Reconstruction

120 47 8 cm 40 sec 0.2 mm

– Remarks • Position the impression horizontally • The upper dentition side must be at the top

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods – Triple scan procedure Normal patient scan

Low dose dental scan

Impression scan

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods Scan impression

Low Dose Patient Impression scan

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Material and Methods

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Validation • Accuracy – Synthetic skull model – Dental Landmarks

• Robustness – Rigid transformations compared to original, translation (+/- 10mm combined with rotation +/- 10 degrees) total of 7290 registrations (10 x 33 x 33 = 729 )

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Results • Accuracy – 98,1% Overlap between synthetic skull and scanned impression after voxel based registration – Euclidean distance between landmarks is 0.08 mm ± 0.03 mm

• Robustness – 72,3 % Succesfull – If succesfull, accuracy very high (< 0.2 mm) 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Conclusion •Detailed occlusal surface • No streak artifacts • No plaster casts used • Relaxed facial soft tissues • Required for orthognathic planning and digital splin design.

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Maxilim

• Accurate dental date - Augmented Model scan • Cephalometry

• Osteotomies • Orthognathic Surgery

• Soft tissue simulation

3-D Facial Imaging Research Group Nijmegen / Bruges


KIO Cursus Oktober 2008, Nijmegen

Surgical planning – computer aided • Maxilim Software – Cephalometry – Osteotomy – Soft Tissue Simulation

KIO Cursus – Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Planning - Cephalometry

KIO Cursus â&#x20AC;&#x201C; Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Maxilim

• Accurate dental date - Augmented Model scan • Cephalometry

• Osteotomies • Orthognathic Surgery

• Soft tissue simulation

KIO Cursus – Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Planning - Osteotomy Le Fort I

SARME

BSSO

Zygoma

KIO Cursus â&#x20AC;&#x201C; Oktober 2008, Nijmegen

Genioplasty

Le Fort III


KIO Cursus Oktober 2008, Nijmegen

Planning - Le Fort I

KIO Cursus â&#x20AC;&#x201C; Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Planning - BSSO

KIO Cursus â&#x20AC;&#x201C; Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Planning – Genioplasty

KIO Cursus – Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Maxilim

• Accurate dental date - Augmented Model scan • Cephalometry

• Osteotomies • Orthognathic Surgery

• Soft tissue simulation

KIO Cursus – Oktober 2008, Nijmegen


3-D Facial Imaging Research Group

Maxilim® • three translations and three rotations

Ackerman, AJODO 2007 3-D Facial Imaging Research Group Nijmegen / Bruges


KIO Cursus Oktober 2008, Nijmegen

Orhtognathic Surgery

KIO Cursus â&#x20AC;&#x201C; Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Maxilim

• Accurate dental date - Augmented Model scan • Cephalometry

• Osteotomies • Orthognathic Surgery

• Soft tissue simulation

KIO Cursus – Oktober 2008, Nijmegen


KIO Cursus Oktober 2008, Nijmegen

Simulation – Le fort I + BSSO

KIO Cursus – Oktober 2008, Nijmegen


Facial Modelling for Surgery Systems Wouter Mollemans


Outline • Introduction • Biomechanical models • 3D soft tissue simulator

• Validation • Conclusion


Outline Outline • Introduction • Biomechanical models • 3D soft tissue simulator

• Validation • Conclusion


Soft Tissue Simulation â&#x20AC;˘ Can we predict the new facial outlook of the patient in 3D based on this bone related planning? â&#x20AC;˘ Why predicting the new facial outlook? - Adjust the bone related planning in function of the new facial outlook - Better communication between surgeon and patient


Computer Aided Maxillofacial Planning Systems • History: – 1980: 2D Bone related • Lateral RX Data • Cephalometric analysis • Planning (cut lines and move the different patches)

– 1990: + Soft tissue profile • Statistical ratio’s of bone/soft tissue movement

– 1995: + Video overlay • Photo realistic results • Dentofacial planner, Dolphin Imaging, Onyxceph, …

– 2000: 3D bone related • Schutyser et. al.


Computer Aided Maxillofacial Planning Systems • 3D Bone related planning systems – CT data – 3D skull and skin surface representations – Planning • Osteotomy planes • Translate and rotate bone segments in 3D

• Advantages of the 3D CAS: – Data integration – Full 3D inspection of the skull anatomy – Definition of realistic osteotomy planes and of the full 3D movement of each bone segment


Outline Outline • Introduction • Biomechanical models • 3D soft tissue simulator

• Validation • Conclusion


Biomechanical models • How to predict the new facial outlook? – Build a mathematical model that is able to imitate the elastic deformation behaviour of facial tissues = biomechanical soft tissue model • Properties: • Patient specific • Accurate • Fast (simulation environment)

• The usage of different biomechanical models was studied


Biomechanical models • Finite Element Model (FEM) – Definition: • Discretization of the object into a number of volumetric elements (tetrahedral elements) • Deformation of the object = sum of the deformations of each element

– Properties + + -

Strong biomechanical relevance Accurate Large memory usage Slow simulations

F


Biomechanical models • Mass Spring Model (MSM) – Definition • Discretization of the object into a number of mass nodes, interconnected by a set of elastic springs • When a set of the mass nodes are moved, springs will be elongated and elastic forces arise  object deforms

– Properties (Courtesy of L. Roose) + Easy implementation + Less memory usage + Fast simulations - Less biomechanical relevance - Unphysical solutions - Bad convergence of the optimization function, If a very fine discretization is used


Biomechanical models • Mass Tensor Model (MTM) – Definition • Discretization of the object into a number of volumetric elements (tetrahedral elements) • Condensation of the FEM equations in the model points • Locality in the optimization strategy – Increase simulation speed

– Properties • Strong biomechanical relevance • Less memory usage • Faster simulations


Outline Outline • Introduction • Biomechanical models

• 3D soft tissue simulator • Validation • Conclusion


3D Soft Tissue Simulator • 3D Maxillofacial Soft Tissue Planning system

• What will be the post-operative outlook of this patient?


3D Soft Tissue Simulator - Acquisition

• Step 1: Data acquisition and pre-processing – Pre-operative CT scan – Dense skin and skull surface models


3D Soft Tissue Simulator – Model Building

• Step 2: Model building – Segment (select) facial soft tissues (Courtesy of M. Loubele) • Semi-automatic levelset algorithm

– Build a volumetric model • Commercial packages – (Amira, Netgen, …)


3D Soft Tissue Simulator - Planning

• Step 3: Planning – Computer aided 3D bone-related planning • Define osteotomy planes • Derive necessary displacement of each bone fragment – Maxilim (Medicim)


3D Soft Tissue Simulator - Simulation

â&#x20AC;˘ Step 4: Simulation â&#x20AC;&#x201C; Calculate the soft tissue deformations caused by the displacement of the bone fragments


3D Soft Tissue Simulator - Simulation

– The displacement of some of the tissues points is defined – With a biomechanical model we calculate the position of all other points • FEM, MSM, MTM


3D Soft Tissue Simulator - Simulation

Bone-related planning

Mapping

Simulation result


3D Soft Tissue Simulator - Visualisation

• Step 5: Visualisation – Present calculated deformations to the surgeon • Volume/surface mapping method • 3D texture addition • 2D post-operative photographs


3D Soft Tissue Simulator - Visualisation • Volume/surface mapping – For fast simulations: • A sparse volumetric model • Include only the soft tissue parts that will deform during surgery

 Bad for visual inspection – Generate from the CT data highly detailed skin surfaces – Map the calculated deformations to these surfaces • Combination fast calculations and highly detailed visualisations


3D Soft Tissue Simulator - Visualisation • 3D Texture addition: – Add patient specific tissue colours to the skin surface

• Method 1: 3D Camera (Courtesy of P. De Groeve)

• Eyetronics, 3DMD,… • Combine 3D textured surface with the deformable skin surface

3D camera


3D Soft Tissue Simulator - Visualisation • 3D Texture addition • Method 1: 3D camera • Method 2: 2D photo mapping (Courtesy of K. Suetens)

– Highly detailed skin surface + “normal” 2D photographs  3D textured skin surface

+


3D Soft Tissue Simulator - Visualisation


3D Soft Tissue Simulator - Visualisation • 2D post-operative pictures (Courtesy D. Loeckx)

– Calculate deformations in 3D – 2D pre-operative photographs – Apply the 3D deformations to the 2D photographs


Outline Outline • Introduction • Biomechanical models

• 3D soft tissue simulator • Validation • Conclusion


Validation Study • Goal : – Before a soft tissue simulator can be used in clinical practice, it is necessary to study and determine the accuracy of the predictions of the post-operative outlook • Validation should include a comparison between postoperative and predicted data: – Quantitative validation – Qualitative validation


Validation Study: Conclusion • Quantitative study – MTM and FEM most accurate • T50% < 0.6 mm, T90% < 1.5 mm

– Tsim < 10 sec • Qualitative study – Most predictions were perceived as being “good” • General conclusion – This soft tissue simulator can be used in clinical practice to help the surgeon during planning of the surgery and to improve the communication between surgeon and patient


Outline Outline • Introduction (6) • Biomechanical models • 3D soft tissue simulator

• Validation • Conclusion


Conclusion • Implemented a complete soft tissue simulation environment • • • • •

Acquisition Model Building (Semi-Automatic levelset) Planning Simulation (FEM, MSM, MTM) Visualisation (volume/surface, texturing, 2D photographs)

• Implemented and studied the usage severeal different biomechanical models

• A quantitative and a qualitative validation study – Results showed usability of the presented soft tissue simulator in clinical practice


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

SARME + 35/45/18/28 3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Patient Case

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Natural Head Position â&#x20AC;˘ Natural Head Position in 3D software

3-D Facial Imaging Research Group Nijmegen / Bruges


Roll


Roll


Yaw


Yaw


Yaw


Yaw


Pitch (CCW)


Pitch (CCW)


3-D Facial Imaging Research Group

Digital Wafers

3-D Facial Imaging Research Group Nijmegen / Bruges


Digitale wafers


3-D Facial Imaging Research Group

Digital wafers

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Measuring

3-D Facial Imaging Research Group Nijmegen / Bruges


Meten


3-D Facial Imaging Research Group

Matching

3-D Facial Imaging Research Group Nijmegen / Bruges


Matchen


3-D Facial Imaging Research Group

Asymmetry

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Short face

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Anterior Open Bite

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

Ectodermal displasia

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

3-D Facial Imaging Research Group Nijmegen / Bruges


3-D Facial Imaging Research Group

• • • • • • • •

Introduction Before 2009 Since 2009 Requirements Concept of planning Patient Cases Possibilities / Limitations Conclusion

3-D Facial Imaging Research Group Nijmegen / Bruges


Thomas Maal 3D Planning Orthognathic Surgery