3-D DIAGNOSIS & TREATMENT PLANNING IN ORTHODONTICS / fixed orthodontics courses in india

DIAGNOSIS & TREATMENT PLANNING IN
ORTHODONTICS www.indiandentalacademy.com

CONTENTS
• INTRODUCTION
• HISTORICAL BACKGROUND
• LIMITATIONS OF 2D ANALYSIS
• 3D CLINICAL DIAGNOSIS
• 3D IMAGING OF THE FACE
 3D CEPHALOMETRY
 3D CONE BEAM COMPUTED TOMOGRAPHY
 MAGNETIC RESONANCE IMAGINGwww.indiandentalacademy.com

 STRUCTURED LIGHT TECHNIQUE
 STREOPHOTOGRAMMETRY
 LASER HOLOGRAPHY
• 3D IMAGING OF THE TEETH
 3D LASER SCANNING
 INTRA-ORAL DIRECT SCANNING
 INDIRECT METHOD
www.indiandentalacademy.com

• APPLICATION OF 3D IMAGING
 ORTHO CAD TECHNOLOGY
 ALIGN TECHNOLOGIES
 AQUARIUM
 VIRTUAL ORTHODONTIC PATIENT
• MISCELLENEOUS
 STEREOLITHOGRAPHY
• CONCLUSION

INTRODUCTION
• Three-dimensional (3D) imaging has evolved greatly in
the last two decades and has found applications in
orthodontics, as well as in oral and maxillofacial surgery.
• In 3D imaging, a set of anatomical data is collected using
diagnostic imaging equipment, processed by a computer
and then displayed on a 2D monitor to give the illusion
of depth. Depth perception causes the image to appear
in 3D.
• The applications of 3D imaging in orthodontics include
pre- and post-orthodontic assessment of dentoskeletal
relationships and facial aesthetics

• Auditing orthodontic outcomes with regard to soft
and hard tissues
• 3D treatment planning, and 3D soft and hard tissue
prediction (simulation).
• Three-dimensionally fabricated custommade
archwires, archiving 3D facial, skeletal and dental
records for treatment planning.
• research and medicolegal purposes are also among
the benefits of using 3D models in orthodontics.

• Initial Part of this seminar focuses on the techniques
that record the external craniofacial morphology and
their applications (i.e. 3D imaging of the face), whereas
later Part will evaluate the applications of direct or
indirect recording of dental morphology (i.e. 3D
imaging of the teeth).

HISTORICAL BACKGROUND
• From the introduction of the cephalostat, Broadbent
stressed the importance of coordinating the lateral and
postero anterior cephalometric films to arrive at a
distortion-free definition of skeletal craniofacial form.
• The earliest clinical use of stereophotogrammetry was
reported by Thalmann-Degan in 1944 who recorded
change in facial morphology produced by orthodontic
treatment.

• In 1969 godfrey hounsfield, a researcher working for EMI limited
in England, developed a prototype CTscanner based on the
principle of image reconstruction for which he and allen cormack
received a Nobel prize in 1979.
• The first commercial Computerized Tomography (CT) scanner
appeared in 1972. Soon after, it was apparent that a stack of CT
sectional images could be used to generate 3D information
• In the early 1980s, researchers began investigating 3D imaging of
craniofacial deformities. The first simulation software was
developed for craniofacial surgery in 1986. Shortly after the first
textbooks on 3D imaging in medicine appeared with a
concentration on the principles and applications of 3D CT- and
MRI-based imaging.

•Three-dimensional imaging has evolved into a discipline
of its own, ‘dealing with various forms of visualization,
manipulation and analysis of multi-dimensional medical
structures’

LIMITATIONS OF 2D ANALYSIS
• There are several reasons for the limited validity of
two dimensional cephalometry’s scientific method
and thus its application as outlined.
• First, and perhaps the most significance, is the fact
that a conventional head film is a two-dimensional
representation of a three-dimensional object. When a
three dimensional object is represented in two
dimensions, structures are displaced vertically and
horizontally in proportion to their distance from the
film or recording plane.

• Second, cephalometric analysis are based on the
assumption of a perfect superimposition of the right
and left sides about the mid sagittal plane, but this is
observed infrequently because facial symmetry is rare
and because of the relative image displacement of the
right and the left sides. The resultant discrepancies
between the right and left sides do not lend
themselves to an accurate assessment of the
craniofacial anomalies and facial asymmetries.
• Third a significant amount of external error,
acquisition. These errors includes size magnification
and distortion, errors in patient positioning, and
projective distortion inherent to the film/ patient/
focus geometric relationships.

• Fourth, manual data collection and processing in
cephalometric analysis has been shown to have low
accuracy and precision.
• Finally, large errors are associated with ambiguity in
locating anatomical landmarks due to the lack of well-
defined outlines, hard tissues edges, and shadows, as
well as variations in patient position. Such landmark,
identification errors are considered a major source of
cephalometric error.

3D CLINICAL DIAGNOSIS
• The functional line of occlusion illustrates arch form,
arch width, and symmetry. It does not describe the
position of the anterior teeth relative to the facial
soft tissues, that is, anterior tooth display and smile
arc.
• In order to describe the dental and soft-tissue
contributions to anterior tooth display, another line
must be used. This line, the esthetic line of the
dentition, follows the facial surfaces of the maxillary
anterior and posterior teeth .The orientation of both
the functional line of occlusion and the esthetic line of
the dentition should be described using an x, y, z
coordinate system in combination with pitch, roll, and
yaw.

3D cephalometry ( Digigraph)
• It was developed by Dr. Mark Lemschen and Mr. Gary
Engel.
• The digigraph work station is a unique device that allows
the clinician to perform non radiographic cephalometric
tracing and analyzes, videoimaging, and treatment
planning including manipulation of the patients tracing
overlaid on the videoimage.
• It also takes facial, intraoral and model photographs. Has
the ability to record, evaluate and store facial, intraoral
and model photos, to manipulate an image on the
monitor screen, simulating possible patient changes as a
result of treatment or growth. This also has the ability to
use sonic digitizing instead of radiography as the basis for
cephalometric tracing and measurements.

• System design:-
• Digigraph work station is about 5 feet long, 3 feet wide
and 7 feet high. A working area of 25 square feet is
suggested.

• Head holder:-
• It is suspended from a beam, supported by a vertical
column attached to the cabinet. It is designed to be
sturdier and more comfortable than cephalometric
holders, allowing the patient to remain in holder for
several minutes. Ear rods and forehead and posterior
head pieces are used to minimize patient movement.

• 2 video cameras: Permanently aimed and focused are
mounted on the vertical column. Lighting emanates
from sources inside the boom, insuring all images are
properly illuminated.
• Model board: Can be inserted into the head holder, and
images of various views can be recorded.

Video monitor: Is attached to a swivel arm that can be rotated around
the boom as operator moves. Images, text, numerical data can be
displayed, stored and modified using either a light pen or keyboard. The
light pen is a wand that can be pressed against a specific portion of the
screen to initiate an activity or modify images on the screen.

• Digitizing hand piece:
• It is used to record cephalometric data while the patient
is in head holder. The removable, sterilizable tip of hand
piece is placed directly on the patient to record a series
of facial and intraoral landmarks. As each landmark is
located, handpiece button is depressed and location is
recorded in three dimensional coordinates (x,y,z). Each
time handpiece button is depressed; audible sound is
picked by an array of 4 microphones on the boom. The
time it takes the sound to reach each of the
microphones determines the landmark location.

Digitzing handpiece with removable tips

• Record taking procedure:-
• 1. Beginning the session:
After turning on the machine, load 2 blank 3 1/2”
disks and then the monitor will display the format for
entry of basic patient data including name,
identification number, birth date, sex, race, missing
and primary teeth. After this entry, system’s main
menu appears on the monitor.
•

• 2. Video imaging:
Images can include left or right lateral, frontal full face,
standard intraoral or dental casts. These can be
viewed on the monitor singly or in traditional
groupings. The operator locks the head holder in the
appropriate lateral or frontal position. The patient is
seated in the chair and placed in the head holder.
Operator looks at the live image on the monitor and
makes any necessary adjustments to patient’s
position. Then the user strikes a key on the keyboard
or touches the light pen to the proper screen icon and
images are captured.

Patient images in traditional grouping

• 3. Digitizing landmarks:-
• Before digitizing, user selects the cephalometric
analyses to be performed on the patient. The
digigraph then automatically prepares a landmark
list, which appears on the screen. The user need only
digitize those points needed for the selected
analyses.
• Skeletal landmarks are digitized one by one directly
from patients head, using sonic handpiece. As each
point is digitized, its location is shown on the screen,
superimposed on patients previously captured
videoimage.

• Digitizing is done in this order:
• I. Facial land marks
• II. Mouth closed intraoral landmarks.
• III. Intraoral landmarks requiring disposable bite opener
to be inserted.
• IV. Extrapolated landmarks i.e., those that are not
digitized directly. Such frequently used points as sella,
incisor root apices, and anterior nasal spine cannot be
measured directly from the patient. Using digitizer
locations of these points are calculated by digigraph
program based on the locations of other related
landmarks using specific mathematical algorithms.

Adjusting patient’s position in
Head holder
Land marks digitized directly
From patient

As each landmark is digitized,
It is superimposed over video image

• 4. Cephalometric analysis display:-
• Program produces any of 14 cephalometric analyses:
• - Ricketts lateral, ricketts frontal, Vari-simplex, Holdaway,
Alabama, Jarabak, Steiner, Downs, Burstone, McNamara,
Tweed, Grummons frontal, standard lateral and frontal.
• 5. Tracing display:
Tracings based on the digitized landmarks can be
displayed immediately.
• 6. Visual treatment objective (VTO)
The digigraph software automatically blends skin tones
and smoothes profile lines so they are consistent with the
surrounding tissue. Its useful application is to modify an
initial patient image and then display it with the current
facial image in a “before and after” format. The patient
can immediately understand potential treatment benefits.

CONE BEAM COMPUTERIZED TOMOGRPHY(CBCT)
• Cone beam computerized tomography (CBCT) was
developed in the 1990s as an evolutionary process
resulting from the demand for three-dimensional (3D)
information obtained by conventional computerized
tomography (CT) scans.
• Custom built cranio- maxillofacial CBCTs started to
appear in the market over the last decade and a variety
of applications to the facial and dental environments
have been established.

• CBCTs were designed to counter some of the limitations
of the conventional CT scanning devices.
• The object to be evaluated is captured as the radiation
source falls onto a two-dimensional detector. This
simple difference allows a single rotation of the
radiation source to capture an entire region of interest,
as compared to conventional CT devices where multiple
slices are stacked to obtain a complete image .
PRINCIPLE OF CBCT

cone beam acquisition, whole volume with a single rotation

ADVANTAGES OVER CONVENTIONAL CT
• The cone beam produces a more focused beam and
considerably less scatter radiation compared to the
conventional fan-shaped CT devices. This signiﬁcantly
increases the X-ray utilization and reduces the X-ray
tube capacity required for volumetric scanning.
• It has been reported that the total radiation is
approximately 20% of conventional CTs and equivalent
to a full mouth peri-apical radiographic exposure.

• There are currently four main system providers in the
world market:
• NewTom 3G (Quantitative Radiology, Verona, Italy)
• I-CAT (Imaging Sciences International, Hatfield, USA).
• CB MercuRay (Hitachi Medical Corporation, Tokyo,
Japan).
• 3D Accuitomo (J Morita Mfg Corp, Kyoto, Japan).

Clinical applications of orthodontic interest With CBCT
technology
• All possible radiographs can be taken in under 1
minute. The orthodontist now has the diagnostic
quality of periapicals, panoramic, cephalograms and
occlusal radiographs, and TMJ series at their
disposal, along with views that cannot be produced
by regular radiographic machines like axial views, and
separate cephalograms for the right and left sides

• Impacted teeth
clinical reports using three-dimensional 3D CT scans
have shown that the incidence of root resorption to
the adjacent teeth has been larger than previously
thought. A recent report found that the use of CBCT
technology could add value to the management of
patients with such anomalies. This technology can be
used to precisely locate the ectopic cuspids and to
design treatment strategies that allowed for minimally
invasive surgery to be performed and helped to design
effective orthodontic strategies.

• oral abnormalities :
Another interesting use of the CBCT is the location of
incidental oral abnormalities in patients. Some centers in
the USA have begun to adopt CBCT imaging into routine
dental examination procedures. Initial reports have
suggested that there were higher incidences of oral
abnormalities than previously suspected (i.e. oral cysts,
ectopic/buried teeth and supernumeraries). The value of
these ﬁndings must be taken with caution, as the number
of elective treatments that may be carried out may be
limited.

• Airway analysis :
The CBCT technology provides a major improvement in
the airway analysis, allowing for its three-dimensional
and volumetric analysis. Airway analysis has
conventionally been carried out by using lateral
cephalograms. A recent study using lateral cephalograms
and CBCT imaging found that there was moderate
variability in the measurements of upper airway area
and volume. Three-dimensional airway analysis will no
doubt be useful in understanding the clinical conditions
like sleep apnoea and enlarged adenoids and the way
clinicians manage these complex conditions

• Assessment of alveolar bone heights and volume:
Implantologists have long appreciated the third
dimension in their clinical work. Conventional CT scans
are used routinely to assess bone dimensions, bone
quality and alveolar height, especially when multiple
units are proposed. This has improved the clinical
success of these prostheses, and led to more accurate
and aesthetic outcomes in oral rehabilitation. The CBCT
has already been in use in implant therapy and may be
exploited in orthodontics for the clinical assessment of
bone graft quality following alveolar surgery in patients
with cleft lip and palate. The images produced resulted
in greater precision in the evaluation of bone sites and,
therefore, gave the clinician a better chance of restoring
the site with implants.

• Temporomandibular joint (TMJ) morphology
• The quality of the images of the TMJ with CBCT
machines is comparable to conventional CTs, but the
image taking is faster, less expensive, and provide less
radiation exposure. This has opened a new avenue for
imaging the TMJ. Cone beam technology is able to
provide three-dimensional volumetric images with up
to four times less radiation than a conventional CT, the
resulting effective radiation is dependent on the
settings used (kVp and mA).

Stereophotogrammetry
• Stereophotogrammetry refers to the special case
where two cameras, configured as a stereo pair, are
used to recover 3D distances of features on the
surface of the face by means of triangulation.
• The adapted photogrammetrical method consists of
following components.
• At first, for image acquisition and providing of
coordinates for 3D reconstruction by triangulation a
convergent arrangement of two cameras is used.
• For encoding the object shape a special
illumination is adapted which maps a sequence of
about 20 statistically generated patterns onto the
object

• A computer processor with complex mathematical
algorithms to convert the 3d coordinate points into 3d
picture.

• The C3D® imaging system has been developed as the
result of collaboration between Glasgow University
Dental School and the Turing Institute.
• C3D® is based on the use of stereo digital cameras
and special textured illumination, with a capture time
of 50 milliseconds and it is sufficiently cost effective to
be utilized within the daily clinical routine.
• C3D® captures the natural surface appearance of the
patient’s skin and ‘drapes’ this skin texture over the
captured 3D model of the face

• So, C3D® affords the clinician a life-like 3D model of
the patient’s head that can be rotated, enlarged, and
measured in three dimensions as required for
diagnosis, treatment planning and surgical outcome
analysis. The system has been validated and its
accuracy was reported to be within 0.5 mm.19

Structured light techniques
• In the structured light technique, the scene is
illuminated by a light pattern and only one image is
required (compared with two images with
stereophotogrammetry).
• The position of illuminated points in the captured
image compared to their position on the light
projection plane provides the information needed to
extract the 3D coordinates on the imaged object.
• However, to obtain high-density models, the face
needs to be illuminated several times with random
patterns of light. This increases the capture time with
increased possibility of head movements.

• In addition, the use of one camera does not provide a
180° (ear to ear) facial model, which necessitates the
use of several cameras or rotating the subject around
an axis of rotation, which is not practical and has
resulted in reduced applicability of this technique.

MAGNETIC RESONANCE IMAGING
PRINCIPLES
• Magnetic resonance (MR) uses magnetic energy and
radio waves, rather than X-rays to create cross-sectional
images or ‘slices’ of the human body. The MR imager is
built around a large tube-shaped or cylindrical magnet.
• Inside the magnet are coils that transmit and detect
radiofrequency signals. Images are obtained by
manipulating inherently magnetic protons of hydrogen
atoms.
• Protons are most abundant in the hydrogen atoms of
water so that an MR image shows differences in water
content and its distribution in various body tissues.

• During the examination, a radio signal is turned on and
off. The protons are ﬁrst excited and then relaxed,
emitting radio signals that can be computer-processed to
form an image. The time taken for the protons to mix up
is termed T2 relaxation and the time for the protons to
then realign is known as T1 relaxation.
• The MR signal can be made to detect either T1 or the T2
values of the spins. A T1-weighted image produces sharp
and detailed images of the structures. In contrast, the T2
sequence is most useful in differential diagnosis, but it is
more prone to most types of artifact.

• Magnetic Resonance Imaging (MRI) has been applied
to craniofacial imaging for several years; however, its
use in dentistry is limited mostly to evaluation of
• The temporomandibular joint : gold standards for
articular disc disorders, degenerative TMJ diseases.
• airways analysis
• Craniofacial anomalies
• Possible reasons for the lack of wider use of MRI are
cost, access, and orthodontists’ lack of experience in
interpretation.

• MRI does not use ionizing radiation and allows for
dynamic imaging. Those capabilities may give MRI a role
in future craniofacial imaging
• Orthodontists see their patients regularly. Rapidly
developing medical problems can manifest themselves at
any age, even in the young.
• All metals used in orthodontics can produce artifacts on
MRI images to varying degrees;
• Fixed components of orthodontic appliances, such as
brackets and bands, can be left in place unless they lie
in the area of investigation;
• stainless steel archwires, removable orthodontic
appliances, removable palatal bars and lingual arches
should be removed prior to the scans to be taken care if
Patient needing MRI is on orthodontic appliances:www.indiandentalacademy.com

Laser holography
• Holography is a photographic technique for recording
and reconstructing images in such a way that the 3 D
aspects of an object can be obtained . The recorded
image is called a hologram
• Holography is a wave front reconstruction process in
which two coherent beams converge to produce a
constructive and destructive interference pattern
which is recorded on film.

• Orthodontic application of laser holography include:
• Storage of study model images
• Measurement of incisor intrusion
• Tooth position measurement on dental cast.
• To determine the centre of rotation produced by
orthodontic forces.
• To asses facial and dental arch asymmetry.
• To study the effect of maxillary expansion on facial
skeleton.

3D imaging of the teeth•
3D laser scanning
Direct method Indirect method

DIRECT METHOD
• A direct method of producing 3D digital images of the
dentition is made possible by using a scanner to capture
both dental shape and information.
• Orametrix (Orametrix, Inc Dallas - TX, USA) uses a
structured light intraoral scanner to directly produce a
3D image of the dentition.
• After isolating the dentition and application of an
opaquing agent, small images of the dentition are taken
with a video camera while a light pattern is projected
onto the teeth. The images are streamed to a computer
where they are registered. The complete dental arch is
imaged in approximately 90 seconds

• A clear advantage of this method is the elimination of
the impression and pouring/trimming needs.
• Nevertheless, the contact points between teeth do not
image well, and segmenting the teeth can be challenging

STEREOLITHOGRAPHY
• Stereolithography, is the pioneer of Rapid Prototyping
technologies and is probably one of the most widely used.
The parts produced with the Stereolithography
technology have very high accuracy.
• SLA technology uses liquid photopolymer resins that are
solidified by a laser to build parts. The support structures
necessary for the cavities are generated automatically in
the process, using the solid STL file. The support and
model files are sliced for system programming. A
computer controlled laser is used to harden the liquid
epoxy resin drawing the first bottom slice onto the
surface of the liquid. The part is then lowered to a depth
of one single slice thickness and the next slice is drawn on
top of the previous. This procedure is repeated until the
whole part is finished.

INDIRECT METHOD
• The indirect method requires an accurate dental impres-
sion with alginate or polyvinyl siloxane. The 3D digital
dental cast can be produced by scanning the impression,
or scanning the poured cast resulted from the impression.
• The scanning of the dental cast can be either destructive
or non-destructive.
• Destructive methods involve the removal of a thin layer of
material, alternating with image capture to generate a
stack of images that are rendered in 3D.
• Non-destructive methods involve the use of a laser based
system with a multi axis robot to obtain several
perspectives of the plaster model that are combined to
form a complete 3D model.

OrthoCAD™ Technology
• OrthoCAD™ software has been developed by CADENT,
Inc. (Computer Aided DENTistry, Fairview, NJ, USA)
to enable the orthodontist to view, manipulate,
measure and analyze 3D digital study models easily
and quickly
• Alginate impressions of the maxillary and
mandibular dentitions, together with a bite
registration are required for the construction of 3D
digital study models, which are then downloaded
manually or automatically from the worldwide
website using a utility called OrthoCAD Downloader.
The average file size for each 3D model is 3 Mb.www.indiandentalacademy.com

• The operator can browse and view the models
separately and together from any direction and in any
desired magnification on screen (Figure 3).
• The software comes with several diagnostic tools
such as: measurement analyses (e.g. Bolton analysis,
arch width and length analyses);
• midline analysis (the ability to split the model sagittally
or transversely for better comparisons); and overbite
and overjet analyses (Figure 4).
• Any slight inaccuracies in bite registration can be
compensated for by a function in the software, which
enables anteroposterior or transverse shifting of one
jaw.

• One of the interesting features of the program is the
‘Occlusogram’ (Figure 4). It includes color-coded occlusal
views of the upper and lower dental arches, which allow
the orthodontist to visually assess the inter-occlusal
contacts.
• In addition, the operator has the ability to save, print or
send any view on the screen to a colleague (or even to
the patient) as an email attachment.

• Recently, a utility has been added to the software,
• ‘OrthoCAD Virtual Set-up’, which is based on the
straight wire philosophy . The assumption is that all the
teeth are connected to the arch wires and any
manipulation of tooth position is done under the
wire/appliance constraints.
• The orthodontist needs to go through 7 steps to reach the
final plan (virtual treatment; ).
• OrthoCAD™ Bracket Placement System is another addition
to the system, which enables the orthodontist to position
brackets according to their needs.

• The first step in OrthoCAD™ virtual set-up is to choose your
preferred brackets, bands and wires from the available straight
wire systems listed.
• Secondly, incisors need to be positioned, as well as the molars
(if required).
• In the third and fourth steps, the orthodontist should slide
maxillary and mandibular teeth into their proper positions or
correct the positions of the brackets themselves to achieve
better inter- and intra-arch relationships. Extractions can be
simulated at this stage and the resultant space can be
manipulated manually or automatically. In the
• fifth step, the sagittal inter-arch relationships should be
double-checked,
• Followed by evaluating the transverse relationships in step 6.
Finally,
• molar position and jaw closure are adjusted to make sure that
the correct form of treatment is chosen.www.indiandentalacademy.com

Align® Technology
• Align® Technology, Inc. developed the Invisalign appliance
for orthodontic tooth movement in the USA in 1998. It is
an ‘invisible’ way to straighten teeth into a perfect
occlusion using thin, clear, overlay sequential appliances.
• The Invisalign process begins with the orthodontist
making an initial diagnosis and mapping out a course of
treatment.
• Then these are sent to Align® Technology, together with
the patient’s radiographs, impressions of the patient’s
teeth and an occlusal registration.
• In the data acquisition laboratory, models are converted
into 3D data through ‘destructive scanning’ machines. The
destructive scanning machine removes paper-thin slices

• of about 0.003 inch with a digital camera taking a 2D
scan after each slice.
• A computer stacks together around 300 of these digital
images to create a 3D model. These data are then sent
to graphic designers who cut out each tooth and save it
as a separate geometric unit. Once the teeth are
separated and reassembled back into the arches, the
designers create a final set-up of what the patient’s
teeth will look like when the treatment is completed
(Figure 6). The treatment is divided into a series of
stages
• that go from the current condition to the desired end
result. This simulation is then electronically delivered to
the orthodontist for final quality approval, following

• which a series of dental models are constructed from
photosensitive thermoplastic. These are used to fabricate
the finished product: a series of clear Invisalign aligners
• The patient is instructed to wear each aligner for
approximately 1–2 weeks, and then to move forward to the
next stage. The first university-based clinical study reported
successful clinical results of subjects with varying degrees
of mild to moderate malocclusion treated by this means.
• Although, the manufacturing company claims that the
appliance can be used to treat Class II and III sagittal
discrepancies, as well as vertical and transverse
discrepancies, more clinical studies need to be conducted
to prove or disapprove such claims.

• (a) Initial treatment planning with patients’ photographs
and radiographs are sent to Invisalign®laboratories.
• (b) Impressions are converted into positives (plaster
models) and checked for quality.
• (c) In the laboratory, models are first coated with
protective shells, and encased in a mixture of resin and a
hardener.
• (d) After chemical setting, they become blocks of
hardened resin with many plaster models inside. Each
tray is placed in a destructive scanning machine.
• (e) Each 3D model is constructed from about 300 2D
scans. Graphic designers cut out each tooth and save it
as a separate geometric unit.
•

• (f) Once the teeth are separated and re-assembled
back into the arches, the designers create a final set-
up of what the patient’s teeth will look like when the
treatment is completed.
• (g) For each stereolithographic constructed model
(which represents a treatment stage), a clear
Invisalign® aligner is created by heat.
• (h) These aligners are trimmed, polished, cleaned and
finally sent to the prescribing orthodontist.

AQUARIUMTM
• This designed for interactive patient education and case
presentation, Aquarium is a dynamic communication
tool that fully utilizes high quality 3D graphics. It is
designed to demonstrate common and complex topic
including diagnostic finding, corrective procedures and
appliance use.
• Dolphin aquarium uses stunning 3D graphics to
demonstrate the common and complex topics that are
involved in diagnosis and treatment planning.

• Features
• .comprehensive library of topics
• .full-motion video,3D animation,clinical and
before and after photos
• dual monitor support
• full interoperability with dolphin imaging and
dolphin management
• fresh graphical interface

Virtual orthodontic patient
The ultimate dream of 3D imaging and modeling is to
achieve the ‘virtual orthodontic patient’, where we
can see the bone, flesh and teeth in three
dimensions. If this can be achieved in an accurate
way, it will allow considerable data to be collected
and a variety of soft and hard tissue analyses to be
performed. Our knowledge of the masticatory
system will increase, and our understanding of tooth
movement biomechanics, orthopedic and
orthognathic corrections will be enhanced.

CONCLUSION
• The ideal patient record situation would be a complete
3D craniofacial record in which there would be
individual as well as conjunctive access to soft tissue
of the face, craniofacial skeleton, and dentition. The
only way we can have such a record is in a digital
format.
• Several attempts have been made to create a
complete 3D craniofacial record. Most of the attempts
involved the collection of individual digital images for
face, craniofacial skeleton, and dentition, and then
combining them into a single image . The process is
not very accurate because the records are constructed
3D images out of 2Dimages, and the records were
taken at different times with the patient in different
positions. www.indiandentalacademy.com

• The new 3D SYSTEMS show some potential in that
arena, and could develop into the single source of
orthodontic records. If this eventuates, an orthodontic
records appointment could end up taking less than 10
minutes.

REFERENCES
• MY Hajeer, DT Millett, AF Ayub, JP Siebert; Application of
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