Orthodontic digital workflow: devices and clinical applications.

INTRODUCTION: The digital technology has contributed to improve and simplify diagnosis, treatment planning and execution in Orthodontics. Among CAD/CAM system (Computer-Aided Design / Computer-Aided Manufacturing) applications in Orthodontics, we highlight the installation and removal of fixed appliance, clear aligners, customized appliances, and retainers fabricated in digital environment. This approach has several advantages for practitioner and patient, as it enhances appliances precision, directly interferes in treatment time and predictability. Even with all the benefits arising from the digital workflow, few orthodontists have adopted this technique in their clinical practice, most due to high cost and lack of technical preparation for proper execution. OBJECTIVES: Thus, given the importance of digital technology to improve specialty performance and the still incipient incorporation of digital flow in Orthodontics, the purpose of this article is to describe the available resources and clinical applications of the CAD/CAM technology in Orthodontics.

Linear measurement accuracy of CBCT panoramic reconstructions: experimental study with dry human mandibles.

INTRODUCTION: Studies on software accuracy of reformatted panoramic computed tomography (CT) images are scarce. OBJECTIVES: The aim of this study was to evaluate the software accuracy of reformatted panoramic views from cone-beam computed tomography (CBCT). METHODS: Ten dry mandibles were scanned using CBCT with different voxel sizes. Following the reconstruction of panoramic views with three different software, horizontal and vertical linear measurements were performed using the electronic rules of each software. Measurements of the corresponding dry mandibles were taken with a digital caliper and defined as the gold standard. RESULTS: There were no statistically significant differences in linear distances among the dry mandibles and reformatted panoramic CT views. The relative error ranged from 1.3 to 8.0%, depending on the software and voxel size. CONCLUSIONS: The linear measurements on reformatted panoramic views are reliable.

Accuracy of the measurements from multiplanar and sagittal reconstructions of CBCT.

OBJECTIVES: The purpose of this study was to assess the accuracy of linear measurements performed in multiplanar reconstructions (MPR) and sagittal reconstructions (SR) of the left hemiface obtained from cone-beam computed tomography (CBCT) with 3D® Dolphin Imaging software by comparing them with the same measurements made on lateral cephalograms and on dry skulls. SETTING AND SAMPLE POPULATION: Lateral cephalograms and CBCT (with voxels of 0.25, 0.3 and 0.4 mm) were taken of 10 dry skulls. MATERIALS AND METHODS: Linear distances were measured using the software's electronic rulers. Measurements performed on dry skulls using a digital caliper were considered the gold standard. The measurements were performed twice by two evaluators. RESULTS: No significant difference was found in the measurements performed with the different imaging modalities and on the dry skulls. The highest mean error was observed in the lateral cephalograms, followed by MPR and SR. CONCLUSIONS: Cephalometric measurements performed on multiplanar and sagittal reconstructions from CBCT, with different spatial resolutions, are accurate when compared with the measurements obtained in lateral cephalograms.

Evaluation of the maxillomandibular positioning in subjects with sickle-cell disease through 2- and 3-dimensional cephalometric analyses: A retrospective study.

Sickle-cell disease (SCD), which involves morphological changes to the red blood cells, is the most common hemoglobinopathy worldwide. This conformational change in erythrocytes affects multiple organs and systems, including the hard and soft tissues of the stomatognathic system. The objective of this study was to provide a description of the maxillomandibular positioning of patients using computed tomography in a case series of 40 patients with SCD. To define the facial profile of patients, 2-dimensional (2D) and 3-dimensional (3D) McNamara and Steiner cephalometric tracings were performed. The results showed that there is a tendency to maxillary protrusion in 2D and 3D analyses. There was no statistical difference between the 2D and 3D evaluations; additionally, sex affected the maxillomandibular positioning of patients, but only in McNamara evaluations.

Pharyngeal airspace of asthmatic individuals and those suffering from obstructive sleep apnea syndrome: Study by CBCT.

PURPOSE: The objective of the present study was to comparatively evaluate the oropharyngeal space of patients with obstructive sleep apnea syndrome (OSA) and asthma by means of Cone Beam Computed Tomography (CBCT) images. MATERIAL AND METHODS: The study included individuals with OSA and asthma (n=10), with OSA and without asthma (n=6), asthmatics without OSA (n=6) and healthy individuals (n=25). All patients were evaluated by a pneumologist and submitted to a nocturnal polysomnogram. Participants underwent CBCT examinations using an I-CAT® device (Imaging Sciences International, Hatfield, PA, U.S.A.) and all images were exported to Dolphin Image 3D® software. Cephalometric measurements were taken, as well as measurements of length (C), volume (VOL), sagittal area (SA) and minimum cross-sectional area (MCA); an evaluation was made of the format and contour of the upper airway in three dimensions, with p<0.05 considered significant. RESULTS: In the results of the present study, a statistically significant difference was found between VOL, SA and MCA (p=0.011; p=0.009; p=0.010) with reduced elevated values among the OSA+Asthma, OSA, Asthma and Control groups. Significant differences were seen between the linear (AP), cross-sectional (TR) and mean transverse area (TA) measurements in the group of patients with OSA and asthma as compared to the control group. In the control group, the greatest narrowing of the airway was observed either in the retroglossal or retropalatal area, while more patients in the experimental groups showed narrowing in the retropalatal area. CONCLUSION: The condition of OSA+asthma was associated with a substantial reduction in upper airway measurements in comparison to controls.

Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography.

INTRODUCTION: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. MATERIAL AND METHODS: The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin Imaging™ software version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. RESULTS: No statistically significant differences were found in any measurements evaluated. CONCLUSIONS: No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography

Introduction: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. Material and Methods: The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin ImagingTMsoftware version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. Results: No statistically significant differences were found in any measurements evaluated. Conclusions: No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

Introdução: tem sido sugerido que a cirurgia de recuo mandibular - que é uma das alternativas de tratamento para pacientes com prognatismo mandibular -, associada ou não ao avanço maxilar, pode promover alterações no espaço das vias aéreas superiores. Por esse motivo, o presente estudo teve como objetivo avaliar o comportamento das vias aéreas superiores, na região da orofaringe, em pacientes com padrão esquelético de classe III submetidos à cirurgia ortognática bimaxilar (avanço maxilar e recuo mandibular) e mentoplastia. Métodos: a amostra foi composta por 26 tomografias computadorizadas de feixe cônico de 13 pacientes, tomadas antes e após o procedimento cirúrgico. Usando o programa Dolphin Imaging(r) versão 11.5 Premium, foram mensurados o volume do espaço orofaringeano; sua área (em um corte sagital); a mínima secção transversal dessa região, com sua largura, profundidade e localização; além de seu comprimento. Os dados obtidos foram tratados estatisticamente, tendo-se utilizado os testes Shapiro-Wilk e T-student pareado, considerando-se significativos os resultados com p < 0,05. Resultados: não foram encontradas diferenças estatisticamente significativas em qualquer uma das medidas avaliadas. Conclusão: não foram observadas modificações significativas na orofaringe após a realização da cirurgia ortognática bimaxilar e mentoplastia.