3 D imaging for Orthodontics

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A simple and a bit dated presentation on imaging in rothodntics.

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3 D imaging for Orthodontics

  1. 1. Dr Jean Marc Retrouvey
  2. 2. A new way to look at our patients
  3. 3. Historical perspectiveImages and animations from the Stanford University project Dr Paul Brown
  4. 4. Two dimensional radiographicImaging for Orthodontic Diagnosis  Historical perspective  What is in use today  2D conventional versus 2D digital  Digital 2D is now the standard of care in Orthodontics
  5. 5. 1. Cephalostat: Ceph Analysis Popularized by Dr Broadbent in the 1930s with his landmark study “The face of Normal Child” Angle Orthodontist 1937 He studied the growth pattern of children with the help of cephalometric radiographs. Still the norm in 2008
  6. 6.  Cephalometric analyses › Used since the 1950 › Well recognized diagnostic tool in Orthodontic Diagnosis › Multitude of analyses to analyze the information provided by the radiograph › Great to analyze AP projection of the dentition
  7. 7.  2D image of a 3D object Measure of a plane not a volume Misses the z coordinate Problems of superimpositions of structure Difficulty in picking up the asymmetries Dentition is not clearly visible.
  8. 8.  Single image Rarely used or reported in the literature Harder to trace Useful to study the transverse dimension No real norms have been developed for this type of radiograph.
  9. 9.  Actually, few norms exist to quantify the data obtained from these 3D imaging systems In the future, 3D norms will be established to analyze the facial structures in 3D Systems will become more affordable and user friendly.
  10. 10.  No commercial analyses of the data provided by 3D imaging is currently available to the practicing orthodontist (to my knowledge) 3D imaging system are getting used in orthodontic departments in Canada
  11. 11. Panoramic radiograph Proven method The whole dentition and the lower facial structures are clearly visible Fairly affordable system
  12. 12.  2D image Inaccurate Gives only an idea of the problem Mainly a screening tool Digital system as now are much better than the standard ones
  13. 13. Example: Impacted canines Usually diagnosed with the help of a panoramic radiograph. Off angle radiographs are taken to help position the impacted tooth as accurately as possible
  14. 14. Routine radiograph taken at 9 years of age
  15. 15. In this case, the panoramic radiograph was usefulin detecting a potential canine impaction problem 11 years old
  16. 16. Ct Scan usage in OrthodonticsVery limited use in dentistry due to cost and high radiation dosage
  17. 17.  Good 3D visualization of the jaws Position of the teeth is clearly visible Costly High radiation dose for the child Offered only in an hospital environment Should never be used as routine procedure
  18. 18. In the dental discipline, CtScans will be replaced byConebeam technology inthe near future
  19. 19.  B: 15 year old patient afflicted by multiple impactions Followed by an orthodontist for several years Surgery to expose the impacted upper anterior teeth done a year ago. Surgeon recomanded to extract anterior teeth The orthodontist then refers to the Montreal Children Hopsital for treatment
  20. 20. 3D folderViewerStartInteleViewerCD.exe
  21. 21.  We decided to keep the lateral incisors for now and slowly position to the occlusal plane Probable extraction of the upper central incisors for lack of bone Micro implants to expose the lower lateral incisors and bring these on the arch
  22. 22.  Valid procedure for impacted teeth as a real visualization of the position of the tooth in relation to the alveolar bone is possible Avoid bad surprises with impacted teeth and root resorption Useful for complex eruption sequences
  23. 23.  Allows for vision in the 3 planes of space Soft tissues as well as hard tissues are visible Tooth anatomy and position are visible Great TMJ visualization (hard tissues for now) Asymmetries
  24. 24.  You can observe the structures in 3D from the lateral to the frontal. Multiple images The occlusion can be observed in relation to the osseous structures (advantage over the study casts) Much better visualization of the roots in their real position (advantage over 2D radiographs)
  25. 25.  Great for complex adult cases TMJ cases with a potentially significant physical component “mandatory?” for orthognathic cases › See Dr Chehade for that. In my practice, all orthognathic surgery cases will go through a Conebeam (machine is actually being tested on site)
  26. 26. When not to use Cone Beam Marketing.. Standard radiographic techniques give sufficient information. Do not irradiate growing kids for the sake of imaging normal structures These tools are there to make our treatment planning and observations easier and more precise. Use them appropriately
  27. 27.  1. Severely impacted teeth 2. TMJ visualization 3.Airway analysis 4.Complex restorative cases 5. Orthognathic surgery (to come)
  28. 28.  This “new” technology has re-opened my eyes on TMJ pains and pathologies and their possible relationship to occlusion and or malfunction. Removing the guessing in severe Cl II malocclusion
  29. 29.  ANB 7 Retrognathic mandible Severe crowding Very acceptable esthetics 14 year old: Camouflage treatment?
  30. 30.  TMJ pains are reported (despite the age) Mandibular deviation to the right on opening These pains are supposed to be transitory according to several head and neck pain experts and mainly of psychosomatic origins. Anyway…we order imaging of the joints
  31. 31. The head of the left condyle is getting smaller. Thecortical bone has disappeared
  32. 32.  Great for sleep apnea patients
  33. 33.  Root angulation Root torque Root length Pathologies are clearly visible and seen in their real position
  34. 34.  Patient occlusion is visible in 3D from all planes of space Transverse cuts will be obtained to analyze torque and interdigitation. Relation to the articular condyle is clearly visible
  35. 35.  Conebeam technology should not replace study casts routinely. Study casts (plaster or 3D representation) remain the standard of care in orthodontics. However in some cases, such as orthognathic surgery and complex rehabilitation, virtual models may be indicated
  36. 36.  Now we can incorporate STL files from dental scanners ( intra or extra orals with files obtained from cone beam CTs. We also have a virtual articulator to mimic rotational motions of the condyles. Nothing yet for the translation motions though
  37. 37. Old way to incorporate modeldata into a ceph radiograph
  38. 38. Diagnostic Wax Up will be replaced byvirtual ones
  39. 39.  Huge advantage over any conventional system Better diagnosis Better planning (multiple possibilities) Superimposition in 3 D Possibility to get transfer splints from the radiograph information with a 3D printer
  40. 40.  Planification of case is much better and multiple options may be explored You can transfer the DICOM files to an STL for a virtual model or order a transfer splint (using CD-CAM technology)
  41. 41.  New user friendlier software for easy manipulation of images We will be able to finish our cases before we start Example: Anatomage or Dolphin 3D › www.anatomage.com

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