Computers in ortodontics /certified fixed orthodontic courses by Indian dental academy

COMPUTERS IN ORTHODONTICS

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INDIAN DENTAL ACADEMY
Leader in continuing dental education


Contents
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Introduction
History of Computer Technology and Systems
Use of computers in dental practice
Classification of appliance
a)Administrative
b)Clinical
c)miscellaneous
Computed Tomography
Digigraph
VTO
Computerised tooth width analysis
Cephalometric applications
Dento facial planner plus
Vistadent image management system
Video imaging
MRI
Invisalign

Application of computers in orthodontics – Contents


sem1/sb/09-04

INTRODUCTION
When the word "technology" is mentioned, most people think about
computers. Virtually every facet of our lives has some
computerized component.
A few years ago, it was considered a specialized component,
which has now been converted to an everyday appliance. The
computer is basically an automatic
electronic machine that performs calculations or
derives results based on the data fed into it and the software/
program it is designed for. A computer is capable of accepting
data, performing operations according to instructions and
providing the results of these operations in comparatively shorter
duration of time and with greater accuracy as compared to
Manual labor. It is built to perform routine calculations with
speed, www.indiandentalacademy.com ease.
reliability and

. A computer can be described as an automatic
electronic device capable of accepting information
(data), perform operations and calculations
according to the instructions given and supply the
results of the operations.
Dentistry, being that branch of medicine which
relies heavily on technology and which embraces
new techniques with great gusto, was quick to
hitch onto the P.c. bandwagon and employ
computers to enhance not only record keeping,
but practice management, patient education and
motivation.

History of Information Technology and Systems

Four Basic Periods of Information Technology

1.
2.
3.
4.

Pre mechanical
Mechanical
Electromechanical
Electronic


The Premechanical Age: 3000 B.C. 1450 A.D. The
First Calculators: The Abacus
The First Information Processor


The Electromechanical Age: 1840
- 1940.
•The discovery of ways to harness electricity by
Benjamin Franklin was the key advance made
during this period.
•Information could now be converted into electrical
impulses.


Alan Mathison Turing
Father of Modern Computer
Science

Concept of algorithm and
computation: the Turing
machine

British mathematician
and cryptographer

Designed one of the
FIRST electronic
programmable digital
computers
THE COLOSSUS

1854 1912


The Electronic Age: 1940 Present
The Four Generations of Digital Computing
 The First Generation

(1951-1958) Punch Cards
 The Second Generation (1959-1963) Transistors
 The Third Generation (1964-1979) Integrated
Circuits
 The Fourth Generation (1979-Present)

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Uses of computers in dental
practice

classification of applications:
1) Administrative applications
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Patient case records
Recall appointments
Patient scheduling
Accounts
Patient correspondence
Billing
Inventory lists
Prescription formats
Post-treatment instructions
Insurance claims
Referral information
Missed appointment www.indiandentalacademy.com
follow up.

2) Clinical applications
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Patient photographs-analysis and storage
Patient radiographs-analysis and storage
Inter- specialty referral and opinion
Patient motivation
Appliance design using CAD CAMs
Growth predictions
Visual treatment objectives
Generation of pre- and post-treatment photographs · Patient
interaction and information on the internet Miscellaneous
applications
Survey information/epidemiological data
Presentations
Continuing dental/ medical education
Literature reviews
Entertainment


3) Miscellaneous application
 Survey information/epidemiological data
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Presentations
Continuing dental/ medical education
Literature reviews
Entertainment


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Orthodontists with their love for technology and
miniaturization have not remained untouched. Computers
are practically used in all the facets of any dental
practice today .Computers have become especially useful
to orthodontists for:

Digital photography
Digital radiography
Digital cephalometrics
Video cephalometrics
3-D imaging
Digital study models


Applications of Computers in Clinics
Conventional
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Computerised

Case Paper
Impression & Diagnostic
Casts
Radiographs
Manual Tracing
Cephalometric Analysis
Diagnostic Set-up
Treatment-Preformed
System
Mid Term Evaluation

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Data Sheet
3D Photography
RVG, Digital Radiography
Digitised Tracing
Advanced software's
VTO / VTP
Treatment-Customised
Continuous Monitoring


Computed Tomography
Invented by Sir Godfrey Hounsfield
who was awarded a Nobel prize in
1979
 CT is an image display of the
anatomy of a thin slice of the body
developed from multiple x- ray
absorption measurements made
around the body’s periphery.
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Parts of the Equipment;
1. Scanner ( movable
x ray table + gantry)
2. Computer system
3. A display console


Principle;
A x ray source and array of detectors
mounted within the gantry rotate
around the patient during each scan.
Detectors record the attenuation values
of the beam emerging from the
patient
Information from each traverse is a
Profile


The tube and detectors
are further angled
and another
traverse is made.
A series of Profiles is
built up.
The computer analyses
the data and an
image is produced.

Early scanners
system.

translate and rotate

Recently developed scanners
stationary
detectors and x ray tube rotates around the
patient
both the
detectors and x ray tube rotate in synchrony


Radiation dosage
for
single section

1.536 rad
a

1.8432 rad for
multiple sections

Estimated dose to the centre of the condyl
with CT is 180mR

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Useful in determining changes
in bone density
Primary imaging method when
internal derangement or
arthrosis is suspected – clinical
diagnosis is not always
sufficient.
Has advantages when planning
treatment or operations on jaws
and TMJ diseases and
deformities.

Microcomputed Tomography
Principally the same as CT, except that
the reconstructed cross sections are
confined to a much smaller area.
Significantly reduces radiation dosage.
Used to measure bone connectivity in all
3 dimensions.


Cephalometric Applications
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DIGIGRAPH
Introduced by Dolphin imaging systems
Non-radiographic system
‘Digigraph workstation’
Video images also possible
VTO
Reduces time required for records.

System design:
The DigiGraph Work Station
is about 5 feet long, 3 feet
wide and 7 feet high.
The main cabinet contains
the electronic circuitry, and
the patient sits next to the
cabinet in an adjustable chair
similar to those used with
cephalometers.


The head holder is suspended from a
beam, supported by a vertical column
attached to the cabinet.
more comfortable than cephalometer head
holders, allowing the patient to remain in
the holder for several minutes.
Ear rods and forehead and posterior head
pieces are used to minimize patient
movement.
The ear rods can be removed so that facial
and intraoral images can also be recorded
while the patient is sitting in the adjustable
chair.

A model board can be inserted into the
head holder, and images of various
views can be recorded .


A light box can also be attached to the
head holder for imaging headfilms,
wristfilms, laminagraphic films, and
panoramic x-rays.


The video monitor is attached that
can be rotated as the operator
moves.
Images are as sharp as those on a
standard color television.
The images, text, and numerical data
can be displayed, stored, and
modified using either a light pen or a
standard computer keyboard.

Any image appearing on the screen can be
reproduced instantaneously with one of three
"hard copy" output devices:
• Sony video imager— makes 5 " x 7 " color
prints in 60 seconds
• Polaroid freeze-frame camera— produces
Polaroid prints in 10 seconds;
• Hewlett Packard Paintjet printer— makes 8
" x 10 " paper color copies in 4 to 8 minutes.


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

Three-dimensional digital
modeling and setup
Aldo Macchi,S Gianpaolo Carrafiello,b Vittorio
Cacciafesta,C and Antonio Norcinic Varese, Italy
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Obtaining accurate images of the craniofacial
region is critical when developing an
orthodontic diagnosis and treatment plan.
It is a new imaging method that provides
complete 3-dimensional views of the maxilla
and the mandible, and the model setup with
individual anatomic roots. The method uses
computed tomography technology and laser
scanning using computers.

Am J Ortho Dentofacial Orthop, MAY 2005


3D Digital modeling and setup
A

C

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B

D

E

3D superimposition of the anatomic teeth, before treatment [A &
B] and after [C & D] the setup to visualize the amount of teeth
movement before and after treatment [ E ] by making use of 3D
setup using computers.
By making use of this set up we can analyse a degree of
correction achieved in malocclusion and discrepensies like
fenestrations.


Airway volume assessment in pt. with mouth
breathing, adenoid hypertrophy, or sleep
apnoea, by application of transfer function to

3D CT scan

Bone rendering with transparent soft
tissues by application of transfer
function ,which render soft tissue
invisible on 3D CT scan.
Visualization of internal anatomic
structures by removal of cranium by
box cut to peek inside a 3D volume by
use of transfer function.


3D Cone-Beam CT virtual models

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A. Can be Used In case of Surgical patients and those
with developmental anomalies like hemi facial
microsomia where in case ,if the working condyle is
missing, it can be replaced with costocondral graft by
proper planning of surgery using 3D cone beam CT
virtual models .

B. can be used to evaluate significant facial asymmetry
Am J and missing articular fossa.
Ortho Dentofacial Orthop, MAY 2006
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3D Cone-Beam CT models

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Can render bone transparent which allows visualization
of developing permanent teeth & It can also be used to
determine the position of the surgical pins or implants in
bone, that might be impairing tooth eruption .


Rapid prototyping as a tool for diagnosis
and treatment planning for maxillary
canine impaction
Jorge Faber,S Patricia Medeiros Berto,b and Marcelo Quaresmas
Treating an impacted maxillary canine requires identifying its
exact position.
 a new method for diagnosis and treatment planning of maxillary
canine impaction is done by using computed tomography
combined with rapid prototyping. .
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CT image files of a patient with tooth impaction were edited
to produce, by means of rapid prototyping. An anatomic model
of the maxillary teeth and a single attachment model that was
later used to fabricate a metal attachment to be bonded to the
impacted tooth can be designed using computers. The dental
model was used in the diagnosis and orthodontic treatment
planning. The model will show the exact anatomical relationship
between the impacted tooth and the other teeth; it was the main
aid in intraoperative navigation during surgery to expose the
tooth. The metal attachment built from the prototype will be
bonded to tooth during surgery. Prototyping has become a new
tool for fabricating brackets and other precision accessories for
specific needs.
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3D reconstruction from CT files.
A) CT images placed one on top of another for volume rendring .
B) 3D reconstruction of face using CT files.
C) Lower-density tissues (Hounsfield units) will be eliminated for visualization of part
of soft and hard tissues by making use of transfer function.
D) Hard tissues on CT can be separated from all soft tissues.
E) Only maxillary teeth can be visualized after images of mandibular teeth and lowerdensity tissues are deleted for accurate diagnosis of impacted canine position.

Trays


Rapid prototyping: A new method of
preparing trays for indirect bonding
Fabio Ciuffolo,a Ettore Epifania,b Gionni Duranti,C Valentina
De Luca,d Daniele Raviglia,d Silvia Rezza,d
Computer-aided technology is used to
design the individualized trays, which are then
produced with a rapid prototyping procedure.
The advantages of application includes time
saving and accurate bracket placement .


Clinical application of RPT:
A) Bracket in RPT virtual tray with adhesive paste;
B) RPT placed on tooth;
C) RPT removal;
D)and E) RPT placement on adjacent teeth (full arch
bonding can undertaken);
F) Light-curing.

Design process of virtual
tray:
A) scanned malocclusion
model;
B) virtual bracket
placement;
C) and D)
creation of virtual tray.

Computerized tooth width
analysis

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Introduced by Christopher T.C. Ho and Terrence
Freer

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Named as Ho-Freer Graphical analysis of tooth
width Discrepancy (GATWD)

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Base line data obtained from pre treatment
orthodontic casts.


 Direct input using digital calipers

or manual

input using visual basic 3.0
 Upto 24 tooth width measurements can be
done
 Caliper used is a Mitutoyo 6”/ 150mm , with
tapered beaks
 Connected to a Mitutoyo digimatic mini
processor IBM compatible
computer

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Advantages:
Less time consuming
Use of digital calipers reduces errors
during transfer of measurements
Mathematical calculations done by the
computer
Eliminates reference to standard value
tables


Classification of Software
•SOFTWARE FOR REGULAR USAGE

 Microsoft Word
 Microsoft Power

 MS DOS
 Microsoft Outlook

point
 Microsoft Access
 Microsoft Excel

 Microsoft Frontpage
 Net Meeting


Classification of Software
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ADVANCED USAGE

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Adobe Acrobat Reader
Flash
Corel draw
MS Photo editor
Adobe Photoshop
Microsoft publisher
Anti Virus Norton,
Sophos…

 3d smax
 Maya
 AutoCAD
 WinZip
 Digicam Software
 Nero Express
 MSC Nastran, Patran
 Ortho cad


Digitalizing study models using OrthoCAD

 OrthoCAD -

It is a digital study model capture,
assessment and storage system.
 It provides a 3D record of the original malocclusion,
any stages during treatment and the outcome of the
treatment.

VISTADENT Image management
system
VISTADENT COMPLETE™
ability to modify an image that is stored in the program,
as well as the ability to do Visual Treatment Objective
(VTO).
Images can easily be manipulated to show treatment
objectives by using standard editing features such as cut
and paste or more advanced features like the Smile
Library.

Ideal system requirements;
 win 98 operating system or above
 pentium processor II
64 MB RAM
Other attachments:
• digital camera or scanner
• RGB camera
• Printer ( color)
• CD ROM drive


Easy to calculate cephalometric analysis.
The Ceph program allows one to trace and
identify your points directly from a
scanned X-RAY.
After points and tracings are entered they can
easily be edited for accuracy purposes. Then
Tracings, Analysis and Measurements can all
be printed on one page with the image.


The VTO feature automatically illustrates
soft tissue changes based on measurements for
most orthodontic treatment as well as many
surgeries.


Dentofacial Planner Plus is a powerful treatment
visualization software system.
DFP Plus links digitized lateral cephalograms to digital
facial images - move the skeletal and dental components
of the cephalometric tracing - the cephalometric profile
and the facial image are automatically transformed to
represent the predicted facial form.

Cephalometrics
DFP Plus contains all of the cephalometric functionality of
Dentofacial Planner,
A digitized radiograph is used as the starting point for a
wide variety of cephalometric analyses and
superimpositions, growth estimation, orthodontic
treatment planning and surgical prediction.
Soft tissue profile changes are automatically computed and
displayed during treatment planning manipulations.


Flexible Cephalometric Analysis
Dento Facial Planner and DFP Plus share the unique
functionality of Tools(tm), that provides flexibility in
customizing the work.
Tools - mix and match measurements from several
different analyses into one or more personalized
cephalometric analyses.
They easily add new landmarks, measurements and
graphical reference lines.


Image Review:
• simultaneously showing pretreatment and predicted
images:
Other functions;
•Ceph superimposition and narrow review
•Overlay ceph tracing on image
•Semi-transparent image superimposition


Specifications
Recommended hardware:
Pentium computer, Windows 95, MS-DOS 5.0 or
higher


Video Imaging.
With the integration of
computers and
cephalometric technology in
the 1970s, complex
statistical analyses of growth
patterns and dentoskeletal
relations were established.
The speed of computerized
cephalometric programs has
helped streamline the
laborious manual
measurement of patient
cephalograms and the
creation of the visualization
treatment objective (VTO).

In the VTO of an
orthognathic surgery
case, the clinician
classically has used
acetate templates of the
teeth and jaws to predict
orthodontic and surgical
movements and the final
profile is determined by
the reaction of the soft
tissue to the hard tissue
movements.

Video imaging technology
allows the orthodontist to
gather frontal and profile
images and modify them to
project overall esthetic
treatment goals
The video image is much
more realistic than
photograph simulation and it
is much easier for the patient
to comprehend than just the
soft tissue profile of a
cephalometric tracing.


Tracing Display
Tracings - displayed immediately;
include planes relevant to the selected
cephalometric analysis;
An advantage - is that the nonlinear
distortion associated with radiographs is
eliminated.
- all points are recorded in a direct, oneto-one manner, allowing precise
superimposition of patient tracings over
video images .

Visual Treatment Objective
• To move part of the picture, simply touch
the light pen to two points on the screen, at
opposite extremes of the area to be moved.
• The computer draws a box with the two
points at opposite corners.
• Then, by touching the light pen to another
spot on the screen, the boxed image is
moved to that spot .
• Boxes can be moved vertically,
horizontally, or diagonally, or they can be
rotated about any point.

The software automatically blends
skin tones and smoothes profile
lines so they are consistent with the
surrounding tissue.
"before and after" format.
The light pen can also be used for
freehand drawing over any video
image.

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Coordinating images and cephalogram:
Digitizing the ceph and then matching the
size of the video image to it
Digitizing the ceph and then sizing the
ceph to an existing video image (loss of
calibration)
Gathering the video image of a ceph
through a calibrated video camera and
matching it to an existing video image
Simultaneous image gathering and ceph.
radiography.

Cephalometric Applications
•Ricketts lateral
• Ricketts frontal
• Vari-Simplex
• Holdaway
• Alabama
• Jarabak
• Steiner

 Downs

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Burstone
McNamara
Tweed
Grummons frontal
Standard lateral
Standard frontal


What is Invisalign®?
•Invisalign® is the invisible
way to straighten teeth
without braces.
• uses a series of clear
removable aligners to
straighten teeth without metal
wires or brackets.

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co-founded by Zia Chishti and Kelsey Wirth in
1997
Based in Sunnyvale, California.*
Align Technology
the treatment procedure is handled by the
computer technicians in Pakistan - process
takes 3 weeks to a month.
After approval from the orthodontist,
specifications are transmitted to the
manufacturing plant in Mexico


Procedure

Impressions
are made
using
Polyvinyl
Siloxane

After wearing all of
the aligners in the
series,

Impression and
bite send along
with a detailed
treatment plan.

advanced imaging
technology
transforms plaster
models into a
highly accurate 3-D
digital image.

customized set of
aligners are made from
From the approved file,
these models, sent to the
laser scanning to build a
doctor, and given to the
set Invisalign® uses of
patient. Pt to www.indiandentalacademy.commodels that reflect
wear each
actual
aligner for about two
each stage of the
weeks.
treatment plan.

A computerized movie called ClinCheck® depicting the movement
of teeth from the
beginning to the final
position is created.

Using the Internet, the
doctor reviews the
ClinCheck file - if
necessary, adjustments
to the depicted plan are
made.

 Patient gets the first aligner 6 weeks after

the 1st visit
 Most treatments require 20 – 60 aligners
 worn for 2 weeks each
 Should be taken off only for eating and
brushing


Contraindications;
 patients with severe malocclusions
 All children – growing jaws and erupting
teeth too complicated for the computer to
model


Magnetic Resonance Imaging
Principles:
Magnetism is a dynamic
invisible phenomenon
consisting of discrete
fields of forces.
Magnetic fields are caused
by moving electrical
charges or rotating
electric charges.
Images generated from
protons of the hydrogen
nuclei.
Essentially imaging of the
water in the tissue.www.indiandentalacademy.com

Equipment;
1. The Gantry ;houses the
patient. Patient is
surrounded by magnetic
coils
2. Operating console ; where
the operator controls the
computer and scanning
procedure
3. Computer room network.


The technique is based on the presence of
specific magnetic properties found within
atomic nuclei containing protons and
neutrons.
Inherent property of rotating about their axis
Causes a small magnetic field to be generated
around the electrically charged nuclei.

The dipoles exposed within a strong electric
field
Cause Orientation in response to the field
Depending on density and spatial relation
Signal is interpreted and image produced

When images are displayed; intense signals
show as white and weak ones as black .
Intermediate as shades of gray.
Cortical bone and teeth with low presence of
hydrogen are poorly imaged and appear
black.


The objectives of MRI imaging of the TMJ are;

Determine relationship between the disc and
Temporal and mandibular components of the TMJ

Detect inflammation, hematoma and effusion for the
soft tissue components.

MRI clearly differentiates the soft tissue components .
Short and long echo imaging of the TMJ enables
identification of the positional relationships between
the disc and the condyl.


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Indications
Assessing diseases of the TMJ
Cleft lip and palate
Tonsillitis and adenoiditis
Cysts and infections
Tumors


Contraindications;
 Patients with cardiac pacemakers.
 Patients with cerebral metallic
aneurysm clips. Slight movement of
the clip could produce bleeding
 Stainless steel and other metals
produce artifacts ; obliterate image
details of the facial area.*



Short comings;
 Inability to identify ligament tears or
perforations
 Dynamics of tissue joint not possible
 Cannot be used in patients suffering
from claustrophobia.
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BIBLIOGRAPHY
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•
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C urrent

principles and techniques in
orthodontics- by
Thomas.M.Graber & Robert.L.Vanarsdall.
Contemporory Orthodontics – by William.R.Proffit
Gurukeerat Singh, Text Book of Orthodontics, First
Edition, 2004 – Jaypee Brothers, New Delhi
AJODO 2006; August ,volume130 ,no 2 : 257-65
AJODO 2006: may, volume 129 ,no 5; 605-617
AJODO 2005volume 128: 157-60
AJODO 2006 volume 127: 627-637
AJODO 2005 volume 127 no 5
World journal of orthodontics December 2006
OrthoCAD Bracket Placement Solution W. R. Redmond et al,
AJO/DO, May 2004
Comparison of measurements made on digital and plaster models
M. Santoro et al, AJO/DO July 2003


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