Your SlideShare is downloading. ×
  • Like
×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

3 D imaging for Orthodontics

  • 585 views
Published

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

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

Published in Education
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
585
On SlideShare
0
From Embeds
0
Number of Embeds
3

Actions

Shares
Downloads
56
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Dr Jean Marc Retrouvey
  • 2. A new way to look at our patients
  • 3. Historical perspectiveImages and animations from the Stanford University project Dr Paul Brown
  • 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. 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.  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.  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.  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.  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.  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. Panoramic radiograph Proven method The whole dentition and the lower facial structures are clearly visible Fairly affordable system
  • 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. 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. Routine radiograph taken at 9 years of age
  • 15. In this case, the panoramic radiograph was usefulin detecting a potential canine impaction problem 11 years old
  • 16. Ct Scan usage in OrthodonticsVery limited use in dentistry due to cost and high radiation dosage
  • 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. In the dental discipline, CtScans will be replaced byConebeam technology inthe near future
  • 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. 3D folderViewerStartInteleViewerCD.exe
  • 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.  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.  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.  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.  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. 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.  1. Severely impacted teeth 2. TMJ visualization 3.Airway analysis 4.Complex restorative cases 5. Orthognathic surgery (to come)
  • 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.  ANB 7 Retrognathic mandible Severe crowding Very acceptable esthetics 14 year old: Camouflage treatment?
  • 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. The head of the left condyle is getting smaller. Thecortical bone has disappeared
  • 32.  Great for sleep apnea patients
  • 33.  Root angulation Root torque Root length Pathologies are clearly visible and seen in their real position
  • 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.  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.  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. Old way to incorporate modeldata into a ceph radiograph
  • 38. Diagnostic Wax Up will be replaced byvirtual ones
  • 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.  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.  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