3 d facial imaging /certified fixed orthodontic courses


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  • 3 d facial imaging /certified fixed orthodontic courses

    1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. RECENT ADVANCES IN DIAGNOSTIC AIDS www.indiandentalacademy.com
    3. 3. 3 D FACIAL IMAGING THE CUTTING EDGE www.indiandentalacademy.com
    4. 4. • Principles of 3d imaging • Over view of different techniques Stereophotogrammetry 3d laser scanning 3d cephalometry 3D facial morphometry Moire topography 3d cone beam ct scanning • Applications of 3d imaging www.indiandentalacademy.com
    5. 5. 3D FACIAL IMAGING www.indiandentalacademy.com
    6. 6. 3 D DENTAL IMAGING www.indiandentalacademy.com
    7. 7. PROCESS OF ACQUIRING 3 D IMAGE • In 3D medical imaging set of anatomical data is collected using diagnostic imaging equipment. www.indiandentalacademy.com
    8. 8. PROCESS OF ACQUIRING 3 D IMAGE • Then processed by a computer and then displayed on a 2D monitor to give an illusion of depth. www.indiandentalacademy.com
    9. 9. PROCESS OF ACQUIRING 3 D IMAGE • Depth perception causes the image to appear in 3D. www.indiandentalacademy.com
    10. 10. Applications of 3D imaging • Pre post orthodontic assessment of dento-skeletal and facial relationships. • Auditing orthodontic outcomes in regard to soft and hard tissue. • 3D treatment planning • 3D soft and hard tissue simulation • 3D customized arch wires • Archiving 3D facial,skeletal and dental planning for in treatment records. • Research and medico legal purpose are also benefits of 3D imaging. www.indiandentalacademy.com
    11. 11. Historical background • Singh and Savara ( angle orthodontist 1966) 3D analysis of maxillary growth changes in girls. • Thalmann and degan ( 1944) reported the use of stereophotogrammetry. www.indiandentalacademy.com
    12. 12. PRINCIPLES www.indiandentalacademy.com
    13. 13. STEPS IN 3D IMAGING www.indiandentalacademy.com
    14. 14. MODELLING www.indiandentalacademy.com
    15. 15. TEXTURE MAPPING www.indiandentalacademy.com
    16. 16. Shading and lighting www.indiandentalacademy.com
    17. 17. RENDERING www.indiandentalacademy.com
    18. 18. www.indiandentalacademy.com
    19. 19. www.indiandentalacademy.com
    20. 20. APPROACHES TO 3D IMAGING • Udupa and Herman ( 3d imaging in medicine 1991). www.indiandentalacademy.com
    21. 21. SLICE IMAGING www.indiandentalacademy.com
    22. 22. VOLUME IMAGING www.indiandentalacademy.com
    23. 23. PROJECTIVE IMAGING www.indiandentalacademy.com
    24. 24. MEASURING SCANNED OBJECTS • Orthogonal measurement • Measurement by triangulation www.indiandentalacademy.com
    25. 25. ORTHOGONAL MEASUREMENT Y Z X www.indiandentalacademy.com
    26. 26. MEASUREMENT BY TRIANGULATION www.indiandentalacademy.com
    27. 27. VARIOUS TECHNIQUES • • • • • • 3D Cephalometry 3D CT scanning 3D laser scanning Moire topography Structured light technique Stereophotogrammetry www.indiandentalacademy.com
    28. 28. 3D CEPHALOMETRY • Drawbacks – Time consuming – Exposes the patients to radiation – Does not define soft tissue and there are difficulty in relating accurately the same landmarks in two radiographs ,especially in biplanar technique. www.indiandentalacademy.com
    29. 29. 3D LASER SCANNING Advantages – Less invasive technique for capturing face for planning or for evaluation outcomes of treatment. www.indiandentalacademy.com
    30. 30. Disadvantages – - slowness of method, making distortion of scanned image likely. - safety issues of exposing eyes to laser beam, especially in growing children. - inability to capture soft tissue texture, which results in difficulties in identification of landmarks that are dependant of surface color. www.indiandentalacademy.com
    31. 31. Moire topography • Defines 3D information based on the contour fringes and fringe intervals. • Difficulties are encountered if the surface has sharp features. • Care to be taken about positioning of the head. www.indiandentalacademy.com
    32. 32. • Motoyoshi et al ( AJO 1992) described the system and concluded that it does not capture facial texture and subsequent landmark identification is difficult. www.indiandentalacademy.com
    33. 33. STRUCTURED LIGHT TECHNIQUE • Light is used to illuminate the scene and only one image is required. • The position of the illuminated points in the captured image compared to their position on the light projection plane provides the information to extract the 3D co-ordinates of the imaged object. www.indiandentalacademy.com
    34. 34. DRAWBACKS • To obtain high density image the face needs to be illuminated several times with light.this is time consuming and may alter the position of the head. • Also the camera does not provide a 1800 ear to ear facial model. www.indiandentalacademy.com
    35. 35. • Techaletpaisarn and Kuroda (Int J Adult Orthod Orthog surg 1998) Used two Lcd projectors and Ccd ,and computer to produce a 3D image. www.indiandentalacademy.com
    36. 36. • Curry et al ( seminar in orthodontics 2001) their system consists of 2 cameras and a projector. • Texture mapping www.indiandentalacademy.com
    37. 37. STEREOPHOTOGRAMMETRY • Two cameras configured as a stereo pair are used to recover 3D distances of features on the surface of face by triangulation. www.indiandentalacademy.com
    38. 38. www.indiandentalacademy.com
    39. 39. • Uses a portable stereometric camera along with a plotting instrument . • Recent advances have enabled conversion of simple photographs into 3D images. www.indiandentalacademy.com
    40. 40. • Ras et al ( journal of dentistry 1996 ) demonstrated a stereophotogrametric system that gives 3D co ordinates of any chosen facial landmarks that can be measured • Consists of 2 synchronized semi metric cameras mounted on a frame with a difference of 50 cm and a position convergently with an angle of 15 degrees. www.indiandentalacademy.com
    41. 41. C3D IMAGING SYSTEM • This is based on use of special digital cameras and with a special textured illumination ,with a capture time of 50 milli seconds and is sufficiently cost effective to be used in daily practice. www.indiandentalacademy.com
    42. 42. • It captures the natural surface appearance of patients skin and drapes this texture on the captured 3D model of the face. • It offers a life like3D model that can be rotated tilted and angulated like a patients head. www.indiandentalacademy.com
    43. 43. www.indiandentalacademy.com
    44. 44. 3D FACIAL MORPHOMETRY • Uses 2 CCD cameras that capture the subject • real time hardware for recognition of markers • software for 3D reconstruction of landmarks. www.indiandentalacademy.com
    45. 45. • Landmarks are located with a 2mm hemisphere reflective markers. • An infra red streptoscope is used to light up the reflective markers. • Two side acquisiton is required to capture the whole face. www.indiandentalacademy.com
    46. 46. DRAWBACKS • Placement of landmarks on the face is time and labour consuming • Reproducibility of landmark is questionable. • No life like models are produced to show natural soft tissue appearance of the face. www.indiandentalacademy.com
    47. 47. APPLICATIONS OF 3D FACIAL IMAGING • Assessment of facial deformity and outcome of surgical and/or orthodontic correction. www.indiandentalacademy.com
    48. 48. APPLICATIONS OF 3D FACIAL IMAGING • Subjective outcome of deformities, 3D models are a valuable media for locating the source of deformity and its magnitude. www.indiandentalacademy.com
    49. 49. APPLICATIONS OF 3D FACIAL IMAGING • Assessment of outcome can also be performed easily by visual comparison of pre and post treatment models placed side by side. www.indiandentalacademy.com
    50. 50. LAND MARK BASED SUPERIMPOSITION www.indiandentalacademy.com
    51. 51. 3D CT SCANNING • Surgical outcome and soft to hard tissue ratio following orthognathic surgery (Mccance et al BJO 1992) www.indiandentalacademy.com
    52. 52. OPTICAL LASER SCANNING • Used to assess soft tissue changes following functional treatment (Morris et al EJO 1998) • Following extraction and non extraction treatment (MORRIS et al AJO DO 2002) • Following orthognathic surgery (Moss et al AJO DO 1994) • Cleft lip and palate (Mccance et al Cleft Craniofac J 1997) www.indiandentalacademy.com
    53. 53. STEREOPHOTOGRAMMETRY • Assess the outcome of twin block treatment (Bourne et al Clin Orthod 2001) • Combined orthodontic surgical treatment of class II or class III (Hajeer et al Int J Adult Orthod Orthognath 2002) www.indiandentalacademy.com
    54. 54. 3D FACIAL MORPHOMETRY • Application in orthodontics and allied fields (Ferrario et al Plast Reconstr Surg 1999) www.indiandentalacademy.com
    55. 55. RESULTS OF FACIAL CHANGES • • • • Landmark identification Inter landmark distance and angles Color millimetric maps Volumetric changes www.indiandentalacademy.com
    56. 56. 3D Dental Imaging www.indiandentalacademy.com
    57. 57. 3D LASER SCANNING • Difficult procedure • Safety issues www.indiandentalacademy.com
    58. 58. 3D LASER SCANNING OF STUDY CASTS www.indiandentalacademy.com
    59. 59. APPLICATIONS OF 3D IMAGING OF THE TEETH Archiving study models (Orthocad) www.indiandentalacademy.com
    60. 60. VIRTUAL ORTHODONTIC PATIENT www.indiandentalacademy.com
    61. 61. • Combining 3D skeletal ct scan with vision or laser scanning techniques. www.indiandentalacademy.com
    62. 62. XIA TECHNIQUE (IJO 2000) • Reconstructing 3D soft and hard tissue models for sequential CT slices using a surface rendering technique • Three colouerd potraits (different colours) were texture mapped onto the 3D mesh • Validity of construction was not evaluated nor was the importance of head postioning www.indiandentalacademy.com
    63. 63. 3D CT SKELETAL MAPS AND 3D LASER MODELS • Nishi et al and Terraai et al (JOMS 1997) www.indiandentalacademy.com
    64. 64. 3D SKELETAL DATA WITH 3D LASER SCANNING • Okumura et al (AJO DO 1999) • This cannot be used for prediction of soft tissue changes following treatment. www.indiandentalacademy.com
    65. 65. 3D CEPH DATA WITH 3D LASER SCANNING • Chen and chen (Int J Adult Orthod Orthognat Surg 1999) • 3D computer aided simulation system to plan surgical procedures an to predict post operative changes in orthognathic surgery patients www.indiandentalacademy.com
    66. 66. 3D SPIRAL CT SCAN AND STEREOPHPTOGRAMMETRY • Khanay et al (Int J Adult Orthod Orthognat Surg 2002) www.indiandentalacademy.com
    67. 67. CRANIOFACIAL RESEARCH • Tie points( landmarks placed on speific areas of the face prior to imgaing). • Anatomic areas marked on the x ray act as refrence points. www.indiandentalacademy.com
    68. 68. Teleradiology • Teleradiology is the electronic transmission of radiological images from one location to another for the purposes of interpretation and/or consultation www.indiandentalacademy.com
    69. 69. • When a teleradiology system is used to produce the official authenticated written interpretation,- there should not be a significant loss of spatial or contrast resolution from image acquisition through transmission to final image display. www.indiandentalacademy.com
    70. 70. 3 D FACIAL IMAGING THE CUTTING EDGE www.indiandentalacademy.com
    71. 71. RECENT ADVANCES IN DIAGNOSTIC AIDS Dr. Sathwik. B. S. www.indiandentalacademy.com
    72. 72. 3D cone beam c t scan www.indiandentalacademy.com
    73. 73. Conventional c t scan • Developed by Godfrey hounsfeld (1967) • Different generations based on organization of the individual parts of the device and physical motion of the beam of capturing the data. www.indiandentalacademy.com
    74. 74. First generation • Single radiation source and a single detector. The information obtained by slice and slice. www.indiandentalacademy.com
    75. 75. Second generation • Multiple detectors within the plane of scan. • These were not continuous nor did they scan the diameter of the object. www.indiandentalacademy.com
    76. 76. Third generation • Advancement in data acquisition and detector • Fan beam ct. • Ring artifacts were seen on the image often distorting the 3D image and obscuring certain landmarks. www.indiandentalacademy.com
    77. 77. www.indiandentalacademy.com
    78. 78. Fourth generation • A moving radiation dose and a fixed detector ring were introduced. • More scattered radiation were seen. www.indiandentalacademy.com
    79. 79. Fifth generation • To reduce motion or scatter artifacts. • The detector is stationary and electron beam is swept along a semi circular tungsten strip anode. • The radiation is produced where the electron beam hits the anode and this results In an x ray that rotates about the patient without any translation or scatter. • 4D motion picture www.indiandentalacademy.com
    80. 80. limitations • Considerable physical space. www.indiandentalacademy.com
    81. 81. limitations • Much more expensive. www.indiandentalacademy.com
    82. 82. limitations • Stacking procedure (time consuming and expensive). • Radiation exposure was primarily responsible for limiting its usage. www.indiandentalacademy.com
    83. 83. CBCT (cone beam CT scan) www.indiandentalacademy.com
    84. 84. • Developed to overcome some of the limitations of conventional ct scanning. www.indiandentalacademy.com
    85. 85. Procedure • Object is captured by a 2 d detector so that a single rotation can capture the area of interest • Cone beam also produces less scattering of radiation. • Radiation exposure is 20% of conventional c t ( equal to full mouth IOPA) www.indiandentalacademy.com
    86. 86. www.indiandentalacademy.com
    87. 87. Advantages of CBCT • Reduction in the cost www.indiandentalacademy.com
    88. 88. Advantages of CBCT • Smaller in size • Exposure chamber (head) is custom built and reduces the amount of radiation www.indiandentalacademy.com
    89. 89. Advantages of CBCT • Images are comparable to conventional c t and are displayed as full head view or regional components. www.indiandentalacademy.com
    90. 90. • CBCT machines are available for different size,possible settings,area of image capture and field of view. www.indiandentalacademy.com
    91. 91. Acquisition systems • • • • New tom 3 g (quantitative radiology Italy) I cat ( imaging sciences international USA ) C b mercury ( Hitachi medical corp., japan) 3 d acuitomo ( J morita mfg corp. ). www.indiandentalacademy.com
    92. 92. New tom 3 g • Image capture is done in 36 sec. • Voxel resolution of .125mm. • They can be incorporated into dicom 3 d software for analysis. www.indiandentalacademy.com
    93. 93. I cat • 20 – 40 sec image capture time • Field view of 20 x 25 cms can be obtained . • Amorphous silicon flat panel detector produces no distortion. www.indiandentalacademy.com
    94. 94. Cb mercury ray • Image intensifier and a solid state ccd. • Gives 288 views in 10 sec . www.indiandentalacademy.com
    95. 95. 3 d accuitomo • Field of view 30x40 mm focuses on regional and anatomical investigations • Small size ( 1.6 times an OPG unit ). www.indiandentalacademy.com
    96. 96. Clinical applications www.indiandentalacademy.com
    97. 97. Impacted teeth www.indiandentalacademy.com
    98. 98. Airway analysis • Aboudara et al (orthod craniofac 2003) • Showed variability in the upper airway space compared with lateral ceph. www.indiandentalacademy.com
    99. 99. www.indiandentalacademy.com
    100. 100. Assessment of alveolar bone height and volume • Hatcher et al ( 2003) site for implant placement. www.indiandentalacademy.com
    101. 101. Lateral and frontal cephalometric views www.indiandentalacademy.com
    102. 102. Advantages over other cephalograms • True 1:1 representation of the structure being imaged. • Avoiding superimposition of irrelevant structures. www.indiandentalacademy.com
    103. 103. 3 d skeletal views www.indiandentalacademy.com
    104. 104. 3 d facial analysis www.indiandentalacademy.com
    105. 105. www.indiandentalacademy.com
    106. 106. Alveolar ridge shape and volume www.indiandentalacademy.com
    107. 107. 3 d review of dentition www.indiandentalacademy.com
    108. 108. www.indiandentalacademy.com
    109. 109. TMJ analysis www.indiandentalacademy.com
    110. 110. Radiation exposure • Depends on the kvp and ma. www.indiandentalacademy.com
    111. 111. Alara principle • Radiographs on the patient needs • Using the fastest film compatible with the diagnostic task • Collimating the size of the beam to as close o film size. • Using lead aprons and thyroid shields. www.indiandentalacademy.com
    112. 112. www.indiandentalacademy.com
    113. 113. Drawbacks • Map out the muscle structures and their attachments • True colour texture of the skin cannot be captured • Long capture time of the full view of a subject ( 30 –40 sec). • High costs www.indiandentalacademy.com
    114. 114. Resorption of incisors after ectopic eruption of maxillary canines: a CT study • Angle orthodontist 2000 (Sune Ericson and Kurol) www.indiandentalacademy.com
    115. 115. Superimposition of 3D cone beam CT models of orthognathic surgery patients • British journal of radiology 2005 (Bailey et al) www.indiandentalacademy.com
    116. 116. MRI scan www.indiandentalacademy.com
    117. 117. • Formerly called as NMR ( nuclear magnetic resonance ) • Primarily used to demonstrate the physiological or pathological alterations in living tissues. www.indiandentalacademy.com
    118. 118. History of MRI • Developed by Dr. Raymond Damadian and a group of graduate students at downtown medical centre. • First performed in July 1997. • Paul Lauterbur and sir Peter Mansfield were awarded the Nobel prize in 2003. www.indiandentalacademy.com
    119. 119. • • • • • • What is an MRI scan How does a MRI scanner work What does a MRI scan show When are MRI scans done How is an MRI scan done Difference between an MRI and CT scan • Risks and safety issues concerning an MRI scan www.indiandentalacademy.com
    120. 120. What is a MRI scan? • Is a radiological technique that uses magnetism, radio waves and a computer to produce images of body waves. www.indiandentalacademy.com
    121. 121. How does a MRI scanner work • Radio waves 10,000 – 30,000 times stronger than the magnetic field of earth are sent through the body. • Body produces radio waves of its own. • Scanner picks up these signals and a computer turns them into an image. www.indiandentalacademy.com
    122. 122. www.indiandentalacademy.com
    123. 123. What does an MRI scanner show • It is possible to make pictures of all body structures. • Less hydrogen atoms (darker). • More hydrogen atoms (brighter). www.indiandentalacademy.com
    124. 124. • It is possible to get clear pictures of body that are surrounded by bone tissue (brain and spinal cord). • Best technique to find out tumors especially of the brain . • MULTIPLE SCLEROSIS (BLEEDING) and lack of oxygen or stroke. www.indiandentalacademy.com
    125. 125. When are MRI scans used • • • • Brain tumors Integrity of spinal cord after trauma. Structure of the heart and aorta. Accurate information of the joints, soft joints and bones inside the body. • Surgeries can be accurately directed after MRI. www.indiandentalacademy.com
    126. 126. Dental applications • Relation of orthodontics and TMD (Temperomandibular disorders). • Post treatment • Results of orthognathic surgeries. • Effects of mandibular advancements in obstructive sleep apnea. www.indiandentalacademy.com
    127. 127. How is an MRI scan performed? • Out patient procedure • Patient needs to relax. • All metallic objects need to be removed before the scan • Remove all hearing aids or pace makers. www.indiandentalacademy.com
    128. 128. • Loud clicking noises are heard which may be uncomfortable for the patient. • Iv injections are necessary to enhance the images www.indiandentalacademy.com
    129. 129. • Water • Paramagnetic contrast compound (gandolium compound) • Super-magnetic contrast agents (iron oxide nano particles) • Diamagnetic agents (barium sulphate) www.indiandentalacademy.com
    130. 130. Safety procedure • Implants and foreign objects www.indiandentalacademy.com
    131. 131. Ferromagnetic foreign bodies • Shell fragments • Metallic implants www.indiandentalacademy.com
    132. 132. Reactions • Trauma due to movement of objects in magnetic field • Thermal injury • Failure of an implanted device www.indiandentalacademy.com
    133. 133. Projectiles • Missile effect accidents ( attractions of ferromagnetic objects towards Center of magnet) www.indiandentalacademy.com
    134. 134. Radiofrequency energy • Hyperthermia in children. www.indiandentalacademy.com
    135. 135. Acoustic noise • 130 db ( jet engine take off) • Appropriate use of ear protection www.indiandentalacademy.com
    136. 136. Cryogens • Emergency shut down of superconducting magnet leads to an operation called quenching. • Release of helium and risk of asphyxiation. • Recommissioning of magnet is extremely expensive www.indiandentalacademy.com
    137. 137. Is MRI scan dangerous • There are no known side effects. • Within first 12 weeks of pregnancy. • Because of large cylinder the procedure may be claustrophobic. www.indiandentalacademy.com
    138. 138. Specialized MRI scans • Diffusion MRI scanning - diffusion tensor imaging - diffusion weighted imaging • Magnetic resonance angiography • Magnetic resonance spectroscopy • Interventional MRI • Radiation therapy stimulation • Current density imaging www.indiandentalacademy.com
    139. 139. Applications of MRI scanning www.indiandentalacademy.com
    140. 140. MRI of pharynx and treatment efficiency of mandibular advancement in OSPS • Eur resp j 2002 (Sanner et al ) www.indiandentalacademy.com
    141. 141. Orthodontics and TMD • AJO DO 2002 (Grabber et al ) www.indiandentalacademy.com
    142. 142. Frankel appliance therapy and TMD • AJO DO 2002 (Franco et al ) www.indiandentalacademy.com
    143. 143. Rigid versus wire fixation for mandibular advancement • AJO DO 2002 (Dolce et al ) www.indiandentalacademy.com
    144. 144. Changes in condylar disc position and tm after disc repositioning therapy • Angle orthodontist feb 2000 (Hatice and Turkharmann) www.indiandentalacademy.com
    145. 145. RECENT ADVANCES IN DIAGNOSTIC AIDS Dr. Sathwik. B. S. www.indiandentalacademy.com
    146. 146. www.indiandentalacademy.com
    147. 147. Thank You For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com