1
|
Ntovas P, Marchand L, Finkelman M, Revilla-León M, Att W. Accuracy of manual and artificial intelligence-based superimposition of cone-beam computed tomography with digital scan data, utilizing an implant planning software: A randomized clinical study. Clin Oral Implants Res 2024. [PMID: 38858787 DOI: 10.1111/clr.14313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/17/2024] [Accepted: 05/26/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES To investigate the accuracy of conventional and automatic artificial intelligence (AI)-based registration of cone-beam computed tomography (CBCT) with intraoral scans and to evaluate the impact of user's experience, restoration artifact, number of missing teeth, and free-ended edentulous area. MATERIALS AND METHODS Three initial registrations were performed for each of the 150 randomly selected patients, in an implant planning software: one from an experienced user, one from an inexperienced operator, and one from a randomly selected post-graduate student of implant dentistry. Six more registrations were performed for each dataset by the experienced clinician: implementing a manual or an automatic refinement, selecting 3 small or 3 large in-diameter surface areas and using multiple small or multiple large in-diameter surface areas. Finally, an automatic AI-driven registration was performed, using the AI tools that were integrated into the utilized implant planning software. The accuracy between each type of registration was measured using linear measurements between anatomical landmarks in metrology software. RESULTS Fully automatic-based AI registration was not significantly different from the conventional methods tested for patients without restorations. In the presence of multiple restoration artifacts, user's experience was important for an accurate registration. Registrations' accuracy was affected by the number of free-ended edentulous areas, but not by the absolute number of missing teeth (p < .0083). CONCLUSIONS In the absence of imaging artifacts, automated AI-based registration of CBCT data and model scan data can be as accurate as conventional superimposition methods. The number and size of selected superimposition areas should be individually chosen depending on each clinical situation.
Collapse
Affiliation(s)
- Panagiotis Ntovas
- Department of Prosthodontics, School of Dental Medicine, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Laurent Marchand
- Department of Prosthodontics, School of Dental Medicine, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Matthew Finkelman
- Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Marta Revilla-León
- Department of Prosthodontics, School of Dental Medicine, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Faculty and Director of Research and Digital Dentistry, Kois Center, Seattle, Washington, USA
| | - Wael Att
- Center for Dental Medicine, Department of Prosthetic Dentistry, ,Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Private Practice, The Face Dental Group, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Mahmood RS, Hamandi SJA, Al-Mahdi AH. Create virtual dentoskeletal model by superimposing digital dental cast into cone-beam computed tomography scan. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03111-4. [PMID: 38600410 DOI: 10.1007/s11548-024-03111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Many artifacts and obstacles associated with cone-beam computed tomography (CBCT) scan can obscure or distort the details of the teeth and occlusal surface, like distorted teeth, streak artifacts, noise, and some malocclusion cases with excessive overlapping between jaws cause decrease the interocclusal space, which can impact diagnosis and treatment planning, and the 3D reconstruction accuracy. Optimizing dental precision by Integrating CBCT scans with other imaging modalities, supply more information to enhance CBCT accuracy, mainly in dental areas with limited clarity. METHODS Performing the Structure-from-Motion (SfM) photogrammetry method, using phone camera and photograph studio setup using simple hardware, to digitize the dental casts and obtain an accurate digital dental model. Using this digital dental model to enhance dental precision in the CBCT data by performing the superimposition process, using a surface-based registration method and integration process to create a virtual dentoskeletal model. Evaluate the accuracy and quality of the superimposition results using qualitative (visual inspection) and quantitative measures. RESULTS The differences between the virtual dentoskeletal model and the reference CBCT model are calculating by the 3D Euclidean distance, the mean ± SD are 0.212 ± 0.169 mm and 0.26 ± 0.149 mm for the maxilla and mandible, respectively. The color-coded map shows that the two surfaces are similar, but the extremist values are concentrated in the dental region due to the presence of the noise in the reference model and the gingiva in the virtual dentoskeletal model. CONCLUSIONS The resulting virtual dentoskeletal model can be viewed and manipulated on a computer screen, allowing for a detailed analysis of the teeth and supporting structures. The 3D model generated by the SfM photogrammetry technique did well during the superimposition process, representing a reliable method for virtual-based processing such as orthognathic surgery planning and splint design.
Collapse
Affiliation(s)
- Reem Shakir Mahmood
- Biomedical Engineering Department, College of Engineering, Al-Nahrain University, Baghdad, Iraq.
| | | | - Akmam Hamdy Al-Mahdi
- Medical City - Oral and Maxillofacial Surgery Department BDS, FICMS, HiDLM, MFDSRCPS (Glas.), FDCRCS (Eng), Baghdad, Iraq
| |
Collapse
|
3
|
Carrico C, Skrjanc L, Kanduti D, Deeb G, Deeb JG. Effect of guided implant placement learning experiences on freehand skills: A pilot study. Clin Exp Dent Res 2024; 10:e878. [PMID: 38506282 PMCID: PMC10952114 DOI: 10.1002/cre2.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Guided implant systems can be used as a training approach for placing implants. This in vitro prospective randomized pilot study evaluated the learning progression and skill development in freehand placement of two implants supporting a three-unit fixed prosthesis on a simulation model among novice operators. MATERIAL AND METHODS Four senior dental students with no prior implant placement experience participated in the study. As a baseline, each student placed two mandibular and two maxillary implants by freehand technique on a simulation model. Sixteen consecutive guided placements using a static guide, dynamic navigation, and template-based guide followed totaling 32 guided implant placements into maxillary and mandibular models. Freehand implant placements before and after the various guided navigation attempts were compared to assess their impact on freehand skill. Metrics compared included surgical time, horizontal, vertical, and angulation discrepancies between the planned and placed implant positions measured on superimposed CBCT scans and analyzed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = .05). RESULTS Before training with guided techniques, the average baseline freehand implant placement took 10.2 min and decreased to 8.2 after training but this difference was not statistically significant (p = .1670) There was marginal evidence of a significant difference in the 3D apex deviation with an average improvement of 0.89 mm (95% CI: -0.38, 2.16, p = .1120); and marginal evidence of a significant improvement in the overall angle with an average improvement of 3.74° (95% CI: -1.00, 8.48, p = .0869) between baseline and final freehand placement attempts. CONCLUSIONS Within the limitations of this pilot study, guided implant placement experiences did not significantly benefit or hinder freehand placement skills. Dental students should be exposed to various placement techniques to prepare them for clinical practice and allow them to make informed decisions on the best technique based on their skills and a given clinical scenario.
Collapse
Affiliation(s)
- Caroline Carrico
- Dental Public Health and Policy, School of DentistryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | | | - Domen Kanduti
- Department for Oral Diseases and Periodontology, Division for Dental Medicine, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - George Deeb
- Department of Oral and Maxillofacial Surgery, School of DentistryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Janina Golob Deeb
- Department of Periodontics, School of DentistryVirginia Commonwealth UniversityRichmondVirginiaUSA
| |
Collapse
|
4
|
Ho CT, Denadai R, Lo LJ, Lin HH. Average Three-Dimensional Skeletofacial Model as a Template for Bone Repositioning during Virtual Orthognathic Surgery. Plast Reconstr Surg 2024; 153:435-444. [PMID: 36940142 DOI: 10.1097/prs.0000000000010449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Virtual planning has revolutionized orthognathic surgery. This study presents a computer-assisted method for constructing average three-dimensional skeletofacial models that can be applied as templates for surgical planning for maxillomandibular repositioning. METHODS The authors used the images of 60 individuals (30 women and 30 men) who had never undergone orthognathic surgery to construct an average three-dimensional skeletofacial model for male participants and one for female participants. The authors validated the accuracy of the newly developed skeletofacial models by comparing their images with 30 surgical simulation images (ie, skulls) that had been created using three-dimensional cephalometric normative data. The comparison was conducted by superimposing surgical simulation images created using the authors' models with the previously created images to analyze their differences, particularly differences in the jawbone position. RESULTS For all participants, the authors compared the jaw position in the surgical simulation images created using the authors' average three-dimensional skeletofacial models with that in the images created using three-dimensional cephalometric normative data. The results revealed that the planned maxillary and mandibular positions were similar in both images and that the differences between all facial landmarks were less than 1 mm, except for one dental position. Most studies have reported less than 2 mm to be the success criterion for the distance difference between planned and outcome images; thus, the authors' data indicate high consistency between the images in terms of jawbone position. CONCLUSION The authors' average three-dimensional skeletofacial models provide an innovative template-assisted orthognathic surgery planning modality that can enhance the fully digital workflow for virtual orthognathic surgical planning. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
Collapse
Affiliation(s)
- Cheng Ting Ho
- From the Division of Craniofacial Orthodontics, Department of Dentistry
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital
| |
Collapse
|
5
|
Wu J, Wu Q, Yu H. Virtual Implant Treatment Planning Using the Existing Denture With Metal Frameworks as a Radiographic Guide: A Technique Note. J ORAL IMPLANTOL 2023; 49:573-577. [PMID: 38279642 DOI: 10.1563/aaid-joi-d-23-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- Jiacheng Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Dental Technology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Qin Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Haiyang Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| |
Collapse
|
6
|
Biun J, Dudhia R, Arora H. The in-vitro accuracy of fiducial marker-based versus markerless registration of an intraoral scan with a cone-beam computed tomography scan in the presence of restoration artifact. Clin Oral Implants Res 2023; 34:1257-1266. [PMID: 37602506 DOI: 10.1111/clr.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES To determine the effect of restoration artifact ('metal artifact') on registration accuracy of an intraoral scan and cone-beam computed tomography (CBCT) scan, comparing fiducial marker-based registration with markerless registration. MATERIALS AND METHODS A maxillary model was fitted with multiple configurations of zirconia crowns to simulate various states of oral rehabilitation. Intraoral scans and CBCT scans (half and full rotation) were acquired. Registration was performed using markerless (point-based registration with surface-based refinement) and fiducial marker-based registration. Each experimental condition was repeated 10 times (n = 320). The absolute deviation was measured at the canines and first molars, and the average and maximum values were analysed using multiple linear regression. RESULTS R2 was 0.874 for average error and 0.858 for maximum error. For markerless registration, there were 0.041 mm (p < .001) and 0.045 mm (p < .001) increases in average and maximum error per crown, respectively. For fiducial marker-based registration, the effect of additional crowns was not statistically significant for average (p = .067) or maximum (p = .438) error. For a full arch of crowns, the regression model predicted average and maximum errors of 0.581 and 0.697 mm for the markerless technique, and 0.185 and 0.210 mm for the fiducial marker-based technique. Overall, the fiducial marker-based technique was more accurate for four or more crowns. The half rotation scan increased average error by 0.021 mm (p = .001) and maximum error by 0.029 mm (p < .001). CONCLUSIONS Under the present study's experimental conditions, the fiducial marker-based technique should be considered if four or more full-coverage highly radiopaque restorations are present.
Collapse
Affiliation(s)
- John Biun
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Raahib Dudhia
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Himanshu Arora
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
Li B, Xu YM, Shi RY, Hu YR, Liu SY, Gu ZX. A retrospective study of the accuracy of Invisalign Progress Assessment with clear aligners. Sci Rep 2023; 13:9000. [PMID: 37268700 DOI: 10.1038/s41598-023-36085-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/29/2023] [Indexed: 06/04/2023] Open
Abstract
The objective of this study was to detective the accuracy of model superimposition and automatic analysis for upper and lower dentition width in Invisalign Progress Assessment during the process of clear aligners. 19 cases were included in this study. Pre-treatment dental cast (T0) and post-treatment dental cast after staged treatment (T1) were available for three-dimensional model superimposition. Subsequently, movements of maxillary teeth in the horizontal plane (cross-section) after staged treatment and width of upper and lower dentition were measured by three-dimensional model superimposition in the real world and Invisalign Progress Assessment separately. Consequently, the data collected from these two methods were compared. In Invisalign Progress Assessment, movements of maxillary teeth in the horizontal plane after staged treatment was 2.31 (1.59,3.22) [median (upper quartile, lower quartile)] millimeter (mm), while in three-dimensional model superimposition, the result was 1.79 (1.21,3.03) mm. The difference between the two groups is significant (P < 0.05). Intercanine width upper, intermolar width upper, intercanine width lower, and intermolar width lower were 36.55 ± 2.76 mm, 56.98 ± 2.62 mm, 28.16 ± 1.85 mm, 53.21 ± 2.72 mm separately in Invisalign Progress Assessment and were 36.48 ± 2.78 mm, 56.89 ± 2.58 mm, 28.05 ± 1.85 mm, 53.16 ± 2.64 mm separately in three-dimensional model analysis, which was no significant difference among these groups (P > 0.05). The data from Invisalign Progress Assessment was not in parallel with what was achieved from model superimposition with palate as a reference completely. The accuracy of model superimposition in Invisalign Progress Assessment needs further investigation, whereas the accuracy of model analysis in Invisalign Progress Assessment was accurate. Thereby, results from Invisalign Progress Assessment should be interpreted with caution by the orthodontist in the clinic.
Collapse
Affiliation(s)
- Bo Li
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi Clinical Research Center for Oral Diseases, Xi'an, 710032, China
| | - Yi-Meng Xu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi Clinical Research Center for Oral Diseases, Xi'an, 710032, China
| | - Rui-Ying Shi
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi Clinical Research Center for Oral Diseases, Xi'an, 710032, China
| | - Yi-Rong Hu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi Clinical Research Center for Oral Diseases, Xi'an, 710032, China
| | - Si-Ying Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi Clinical Research Center for Oral Diseases, Xi'an, 710032, China
| | - Ze-Xu Gu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, The Fourth Military Medical University, Shaanxi Clinical Research Center for Oral Diseases, Xi'an, 710032, China.
| |
Collapse
|
8
|
Wu Q, Wu J, Tan Y, Sun J, Yu H. A chairside digital radiographic guide for registering digital casts to cone beam computed tomography scans with strong metallic artifacts. J Prosthet Dent 2023:S0022-3913(22)00758-2. [PMID: 36610844 DOI: 10.1016/j.prosdent.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 01/06/2023]
Abstract
Accurate registration of digital casts and cone beam computed tomography (CBCT) scans with strong metallic artifacts is essential for the accuracy of guided implant surgery. This article describes a procedure for mapping digital casts onto CBCT scans containing significant scatter artifacts in the virtual implant planning stage. The technique uses a chairside segmented occlusal wing-like radiographic guide, which is constructed of digital splints fabricated using a desktop 3-dimensional printer and composite resin spheres as markers to accurately superimpose the bimaxillary digital scans onto the CBCT scans in a single procedure. This cost-effective technique is timesaving for clinicians and patients, and the digital information for implant planning can be collected in a single visit.
Collapse
Affiliation(s)
- Qin Wu
- Doctoral candidate, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Jiacheng Wu
- Graduate student, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Ying Tan
- Graduate student, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Jikui Sun
- Graduate student, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Haiyang Yu
- Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
| |
Collapse
|
9
|
Zou B, Kim JH, Kim SH, Choi TH, Shin Y, Kook YA, Lee NK. Accuracy of a surface-based fusion method when integrating digital models and the cone beam computed tomography scans with metal artifacts. Sci Rep 2022; 12:8034. [PMID: 35577911 PMCID: PMC9110746 DOI: 10.1038/s41598-022-11677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this study was to evaluate the intra- and inter-observer reliability of maxillary digital dental model integration into cone-beam computed tomography (CBCT) scans to reconstruct three-dimensional (3D) skeletodental models for orthognathic patients. This retrospective study consisted of CBCT and digital maxillary dentition images of 20 Class III orthognathic patients. After two repeated fusions of digital cast images with reconstructed CBCT images by a digital engineer and an orthodontist respectively, the 3D coordinate values of the canines, first molars, and central incisors were evaluated. The intra- and inter-observer reliability of 3D positions of maxillary teeth were compared using intraclass correlation coefficients (ICCs). Intra-observer reliability of x-, y-, and z-coordinate values of maxillary teeth showed significant and excellent agreement in an engineer (0.946 ≤ ICC ≤ 1.000) and an orthodontist (0.876 ≤ ICC ≤ 1.000). The inter-observer reliability of the y- and z-coordinates of each tooth was significantly excellent or good, but that of the x-coordinates showed insignificantly poor to moderate agreement. This study showed that the integration of maxillary digital models into CBCT scans was clinically reliable. However, considering the low inter-observer reliability on the x-coordinates of dentition, clinical experience and repeated learning are needed for accurate application of digital skeletodental model in orthognathic patients.
Collapse
|
10
|
Shujaat S, Bornstein MM, Price JB, Jacobs R. Integration of imaging modalities in digital dental workflows - possibilities, limitations, and potential future developments. Dentomaxillofac Radiol 2021; 50:20210268. [PMID: 34520239 PMCID: PMC8474138 DOI: 10.1259/dmfr.20210268] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The digital workflow process follows different steps for all dental specialties. However, the main ingredient for the diagnosis, treatment planning and follow-up workflow recipes is the imaging chain. The steps in the imaging chain usually include all or at least some of the following modalities: cone-beam computed tomographic data acquisition, segmentation of the cone-beam computed tomography image, intraoral scanning, facial three-dimensional soft tissue capture and superimposition of all the images for the creation of a virtual augmented model. As a relevant clinical problem, the accumulation of error at each step of the chain might negatively influence the final outcome. For an efficient digital workflow, it is important to be aware of the existing challenges within the imaging chain. Furthermore, artificial intelligence-based strategies need to be integrated in the future to make the workflow more simplified, accurate and efficient.
Collapse
Affiliation(s)
- Sohaib Shujaat
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland, USA
| | - Reinhilde Jacobs
- Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Ho CT, Lai HC, Lin HH, Denadai R, Lo LJ. Outcome of full digital workflow for orthognathic surgery planning in the treatment of asymmetric skeletal class III deformity. J Formos Med Assoc 2021; 120:2100-2112. [PMID: 34092467 DOI: 10.1016/j.jfma.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/25/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/PURPOSE Studies have reported the advantages of digital imaging-assisted orthognathic surgery planning, but there is scarce information about a full digital planning modality. This study evaluated the 3D cephalometric-based and patient-reported outcomes of a full digital workflow for orthognathic surgery planning in the treatment of asymmetric maxillomandibular disharmony. METHODS A postoperative 3D image dataset of 30 Taiwanese Chinese patients with asymmetric skeletal Class III deformities who underwent full digital planning for two-jaw surgery were retrieved from the authors' database. The 3D cephalometric data (dental, skeletal, and soft tissue evaluations) were compared to the ethnicity-matched 3D cephalometric normative values. Patient-reported outcome measure tools regarding postoperative overall appearance and satisfaction with facial areas (ranging from 0 to 100 and 0 to 10, respectively) were administered. The number of needed or requested revisionary surgery was collected. RESULTS No difference (all p > 0.05) was observed between the orthognathic-surgery-treated patients and the normative value for most of the tested 3D cephalometric parameters, with the exception (p < 0.05) of three mandible and occlusal-plane-related parameters. Both patient-reported outcome measure tools showed that patients' satisfaction with their postoperative appearance was high for overall face (89.7 ± 4.5) and specific facial regions (nose, 7.1 ± 1.3; lip, 8.3 ± 1.6; upper gum, 8.5 ± 1.2; cheek, 8.8 ± 1.1; chin, 9.2 ± 1.2; and teeth, 9.3 ± 0.8), with no need for revisionary surgery. CONCLUSION The patients treated with a full 3D digital planning-assisted two-jaw surgery had a similar 3D dental relation, facial convexity, and symmetry compared to healthy ethnicity-matched individuals, and they reported higher satisfaction levels with their postoperative facial appearance results.
Collapse
Affiliation(s)
- Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chih Lai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Rafael Denadai
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Lun-Jou Lo
- Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
12
|
Digital Occlusion Setup Is Quantitatively Comparable With the Conventional Dental Model Approach: Characteristics and Guidelines for Orthognathic Surgery in Patients With Unilateral Cleft Lip and Palate. Ann Plast Surg 2021; 85:171-179. [PMID: 31800561 DOI: 10.1097/sap.0000000000002079] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The evolving 3-dimensional computer-based technology revolutionized the field of orthognathic surgery (OGS). Digital occlusion setup for OGS may provide advantages in the planning comparing with the conventional approach based on the manual setup using dental casts, but we are not aware of any study focusing on digital occlusion setup for cleft OGS. The purposes of this study were to compare the conventional and digital occlusion setup approaches and to propose a protocol for digital occlusion setup in unilateral cleft OGS. METHODS Thirty consecutive patients with unilateral cleft lip/palate who underwent orthodontic treatment by a single orthodontist and 2-jaw OGS by a single surgeon using 3-dimensional surgical simulation were adopted for analysis. Quantitative data were collected from the dental cast occlusion setup approach (conventional group). A multidisciplinary team combined this quantitative data and established a protocol for digital occlusion setup in cleft OGS. Digital occlusions were set according to this protocol using the images of the 30 patients, and quantitative data were collected accordingly (digital group). The results of 2 groups were compared. All information was reviewed to refine the protocol and define the final guidelines. RESULTS There were no significant differences (all P > 0.05) for all parameters, except midline discrepancy (conventional group > digital group, P < 0.001). The root-mean-square deviation (0.46 ± 0.26 mm) indicated acceptable relationship between the conventional and digital groups. A 6-step protocol for digital occlusion setup in cleft OGS was established: dental midline, overjet/overbite, yaw rotation, pitch rotation, roll rotation, and overall facial skeletal appearance. CONCLUSIONS This study shows that digital occlusion setup is quantitatively comparable with the conventional dental model approach and contributes for cleft OGS by establishing a protocol for surgical occlusion setup using digital approach.
Collapse
|
13
|
A dual scan approach to creating an accurate dental surface for virtual implant planning: A dental technique. J Prosthet Dent 2020; 126:464-470. [PMID: 32972712 DOI: 10.1016/j.prosdent.2020.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022]
Abstract
Artifacts from metal restorations can make it challenging or impossible to accurately orient a digital dental cast to cone beam computed tomography (CBCT) scan data for virtual implant planning. A dual scan technique is described that uses an alginate impression with fiducial markers in a stock tray to create a digital dental cast that is precisely oriented to the scan in the same patient coordinate system for surgical guide design.
Collapse
|
14
|
Seo HJ, Denadai R, Pai BCJ, Lo LJ. Modern Surgery-First Approach Concept in Cleft-Orthognathic Surgery: A Comparative Cohort Study with 3D Quantitative Analysis of Surgical-Occlusion Setup. J Clin Med 2019; 8:E2116. [PMID: 31810279 PMCID: PMC6947614 DOI: 10.3390/jcm8122116] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 02/05/2023] Open
Abstract
Despite the evident benefits of the modern surgery-first orthognathic surgery approach (reduced treatment time, efficient tooth decompensation, and early improvement in facial esthetics), the challenge of the surgical-occlusion setup acts as a hindering factor for the widespread and global adoption of this therapeutic modality, especially for the management of cleft-skeletofacial deformity. This is the first study to assess three-dimensional (3D) quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery. This comparative retrospective study was performed on 3D image datasets from consecutive patients with skeletal Class III deformity who had a unilateral cleft lip/palate (cleft cohort, n = 44) or a noncleft dentofacial deformity (noncleft cohort, n = 22) and underwent 3D computer-assisted single-splint two-jaw surgery by a single multidisciplinary team between 2014 and 2018. They received conventional orthodontics-first or surgery-first approaches. 3D quantitative characterization (linear, angular, and positional measurements) of the final surgical-occlusion setup was performed and adopted for comparative analyses. In the cleft cohort, the occlusion setup in the surgery-first approach had a significantly (all p < 0.05) smaller number of anterior teeth contacts and larger incisor overjet compared to the conventional approach. Considering the surgery-first approach, the cleft cohort presented significantly (all p < 0.05) larger (canine lateral overjet parameter) and smaller (incisor overjet, maxillary intercanine distance, maxillary intermolar distance, ratio of intercanine distance, and ratio of intermolar distance parameters) values than the noncleft cohort. This study contributes to the literature by providing 3D quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery, and delivers information that may assist multidisciplinary teams to adopt the surgery-first concept to optimize cleft care.
Collapse
Affiliation(s)
- Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 33302, Taiwan; (H.J.S.); (R.D.)
- Department of Plastic and Reconstructive Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan City 49241, Korea
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 33302, Taiwan; (H.J.S.); (R.D.)
| | - Betty Chien-Jung Pai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan City 33302, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 33302, Taiwan; (H.J.S.); (R.D.)
| |
Collapse
|
15
|
Elnagar MH, Aronovich S, Kusnoto B. Digital Workflow for Combined Orthodontics and Orthognathic Surgery. Oral Maxillofac Surg Clin North Am 2019; 32:1-14. [PMID: 31699582 DOI: 10.1016/j.coms.2019.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an overview of the digital workflow process for Combined orthodontics and Orthognathic surgery treatment starting from data acquisition (3-dimensional scanning, cone-beam computed tomography), data preparation, processing and Creation of a three-dimensional virtual augmented model of the head. Establishing a Proper Diagnosis and Quantification of the Dentofacial Deformity using 3D diagnostic model. Furthermore, performance of 3-dimensional Virtual orthognathic surgical treatment, and the construction of a surgical splint (via 3-dimensional printing) to allow transfer of the treatment plan to the actual patient during surgery.
Collapse
Affiliation(s)
- Mohammed H Elnagar
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Room 131, Chicago, IL 60612-7211, USA.
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Budi Kusnoto
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Room 131, Chicago, IL 60612-7211, USA
| |
Collapse
|
16
|
Tsuchida Y, Takahashi H, Watanabe H, Oki M, Shiozawa M, Kurabayashi T, Suzuki T. Effects of number of metal restorations and mandibular position during computed tomography imaging on accuracy of maxillofacial models. J Prosthodont Res 2019; 63:239-244. [DOI: 10.1016/j.jpor.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
|
17
|
Replacement of the Distorted Dentition of the Cone-Beam Computed Tomography Scans for Orthognathic Surgery Planning. J Oral Maxillofac Surg 2018; 76:1561.e1-1561.e8. [PMID: 29572134 DOI: 10.1016/j.joms.2018.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Cone-beam computed tomography (CBCT) does not record dental morphology accurately because of the scattering produced by metallic restorations and the reported magnification of the dentition. The aim of this study was the development and evaluation of a new method for the replacement of the distorted dentition of CBCT scans with a 3-dimensional (3D) dental image captured by a digital intraoral camera. MATERIALS AND METHODS Six dried skulls with orthodontic brackets fixed on the teeth were used in this study. Three intraoral markers made of dental stone were constructed and attached to orthodontic brackets. The skulls were scanned by CBCT and the occlusal surfaces were captured using the TRIOS 3D intraoral scanner. The digital intraoral scan (IOS) was fused into the CBCT models. This produced a new composite digital model of the skull and the dentition. The skulls were scanned again using the commercially accurate Faro laser arm to produce the 3D model the skull and teeth gold standard for the assessment of the accuracy of the developed method. This was assessed by measuring the distance between the occlusal surfaces of the new composite model and the gold standard 3D laser produced model. RESULTS The results showed the errors related to the superimposition of the intraoral image on the CBCT to replace the distorted dentition were 0.11 to 0.20 mm. CONCLUSION The results of this novel method suggest that the dentition on the CBCT scan can be accurately replaced with the digital IOS image captured by an intraoral scanner to create a composite model that will improve the accuracy of digital orthognathic surgical planning and the fabrication of the guiding occlusal wafer.
Collapse
|
18
|
Rangel FA, Maal TJJ, de Koning MJJ, Bronkhorst EM, Bergé SJ, Kuijpers-Jagtman AM. Integration of digital dental casts in cone beam computed tomography scans-a clinical validation study. Clin Oral Investig 2017; 22:1215-1222. [PMID: 28932947 PMCID: PMC5866842 DOI: 10.1007/s00784-017-2203-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/04/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Images derived from cone beam computed tomography (CBCT) scans lack detailed information on the dentition and interocclusal relationships needed for proper surgical planning and production of surgical splints. To get a proper representation of the dentition, integration of a digital dental model into the CBCT scan is necessary. The aim of this study was to validate a simplified protocol to integrate digital dental models into CBCT scans using only one scan. MATERIALS AND METHODS Conventional protocol A used one combined upper and lower impression and two CBCT scans. The new protocol B included placement of ten markers on the gingiva, one CBCT scan, and two separate impressions of the upper and lower dentition. Twenty consecutive patients, scheduled for mandibular advancement surgery, were included. To validate protocol B, 3-dimensional reconstructions were made, which were compared by calculating the mean intersurface distances obtained with both protocols. RESULTS The mean distance for all patients for the upper jaw is 0.39 mm and for the lower jaw is 0.30 mm. For ten out of 20 patients, all distances were less than 1 mm. For the other ten patients, all distances were less than 2 mm. CONCLUSIONS Mean distances of 0.39 and 0.30 mm are clinically acceptable and comparable to other studies; therefore, this new protocol is clinically accurate. CLINICAL RELEVANCE This new protocol seems to be clinically accurate. It is less time consuming, gives less radiation exposure for the patient, and has a lower risk for positional errors of the impressions compared to other integration protocols.
Collapse
Affiliation(s)
- Frits A Rangel
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martien J J de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Preventive and Restorative Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, 309 Dentistry, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|