Agreement in the determination of preformed wire shape templates on plaster models and customized digital arch form diagrams on digital models.

INTRODUCTION: The aim of this study was to verify the accuracy of preformed wire shape templates on plaster models and those of customized digital arch form diagrams on digital models. METHODS: Twenty pairs of dental plaster models were randomly selected from the archives of the Department of Orthodontics of Federal Fluminense University, Niterói, Rio de Janeiro, Brazil. All plaster model samples were scanned in a plaster model scanner to create the respective digital models. Three examiners defined the arch form on the mandibular arch of these models by selecting the ideal preformed wire shape template on each plaster model or by making a customized digital arch form on the digital models using a digital arch form customization tool. These 2 arch forms were superimposed by the best-fit method. The greatest differences in the 6 regions on the superimposed arches were evaluated. Each examiner presented a descriptive analysis with the means, standard deviation, and minimum and maximum intervals of the differences on the superimpositions. Intraclass correlation coefficient and paired t tests were used to evaluate the accuracy of the superimpositions. RESULTS: Among the 6 regions analyzed in the superimpositions, the largest differences in the anterior and premolar regions were considered clinically insignificant, whereas the largest differences in the right molar region, especially the second molar area, were considered clinically significant by all 3 examiners. The intraclass correlation coefficients showed a weak correlation in the premolar region and moderate correlations in the anterior and molar regions. The paired t test showed statistically significant differences in the left anterior and premolar regions. CONCLUSIONS: The superimpositions between the arch forms on plaster and digital models were considered accurate, and the differences were not clinically significant, with the exception of the second molar area. Despite the favorable results, the requirement of correcting some software problems may hamper the transition from plaster to digital models.

Accuracy of printed dental models made with 2 prototype technologies and different designs of model bases.

INTRODUCTION: The aim of this study was to compare the accuracy of printed models from intraoral scans with different designs of model bases, using 2 types of 3-dimensional printing techniques. METHODS: Three types of model base design were created: regular base, horseshoe-shaped base, and horseshoe-shaped base with a bar connecting the posterior region. The digital models were printed with the 3-dimensional printers using different techniques: stereolithography and triple jetting technology (polyjet). The printed models were then scanned with a computed tomography scanner and a desktop laser scanner to create the respective digital models. Evaluation of the accuracy was done by measuring the dentitions with Ortho Analyzer software (3Shape, Copenhagen, Denmark) and by model superimposition with Geomagic Qualify software (3D Systems, Rock Hill, SC). An observer measured the distances twice, with an interval of 2 weeks. The accuracy of the printed models was statistically evaluated by the mixed-effects regression model approach. RESULTS: The results showed that printed models made by the polyjet printer were accurate, regardless of the design of the model base. Printed models made with the stereolithography technique with the regular model base and the horseshoe-shaped base with a bar were accurate, but the transversal distances measured on the printed models with a horseshoe-shaped base were statistically significantly smaller. CONCLUSIONS: Printed models with a regular base or a horseshoe-shaped base with a bar were accurate regardless of the printing technique used. Printed models with a horseshoe-shaped base made with the stereolithography printer had a statistically significant reduction in the transversal dimension that was not found in the models printed with the polyjet technique.

Are there differences between comparison methods used to evaluate the accuracy and reliability of digital models?

OBJECTIVES: The accuracy and reliability of plaster models and digital models acquired with two different surface laser scanners were tested by means of three methods: measurement with calipers, digital measurement with proper software and superimposition of the digital models. METHODS: Thirty plaster models with permanent dentition that met the inclusion criteria were selected and scanned with two laser scanners (R700 and Xcad). Three examiners measured distances on plaster models with a digital caliper and on digital models using Ortho Analyzer software. The digital models were also compared by means of superimposition of the models using the Geomagic Qualify software. The intra and inter-examiner reliability of the measurements were evaluated using the ICC. Paired t test was used to test the accuracy of the measurements on digital and plaster models. RESULTS: The measurements on plaster and digital models acquired by two different scanners showed high values for the ICC. Although statistically significant differences between the measurements on plaster and digital models have been found, these discrepancies were not considered clinically relevant. The superimposition method with Geomagic Qualify software showed that the two digital models were not significantly different. CONCLUSIONS: Digital models created from scanned plaster models using the R700 or Xcad scanners were clinically accurate according to the two methods of comparison used.

Accuracy of stereolithographically printed digital models compared to plaster models.

OBJECTIVE: This study compared the accuracy of plaster models from alginate impressions and printed models from intraoral scanning. MATERIALS AND METHODS: A total of 28 volunteers were selected and alginate impressions and intraoral scans were used to make plaster models and digital models of their dentition, respectively. The digital models were printed using a stereolithographic (SLA) 3D printer with a horseshoe-shaped design. Two calibrated examiners measured distances on the plaster and printed models with a digital caliper. The paired t test was used to determine intraobserver error and compare the measurements. The Pearson correlation coefficient was used to evaluate the reliability of measurements for each model type. RESULTS: The measurements on plaster models and printed models show some significant differences in tooth dimensions and interarch parameters, but these differences were not clinically relevant, except for the transversal measurements. The upper and lower intermolar distances on the printed models were statistically significant and clinically relevant smaller. CONCLUSIONS: Printed digital models with the SLA 3D printer studied, with a horseshoe-shaped base made from intraoral scans cannot replace conventional plaster models from alginate impressions in orthodontics for diagnosis and treatment planning because of their clinically relevant transversal contraction.

Are there differences between comparison methods used to evaluate the accuracy and reliability of digital models?

ABSTRACT Objectives: The accuracy and reliability of plaster models and digital models acquired with two different surface laser scanners were tested by means of three methods: measurement with calipers, digital measurement with proper software and superimposition of the digital models. Methods: Thirty plaster models with permanent dentition that met the inclusion criteria were selected and scanned with two laser scanners (R700 and Xcad). Three examiners measured distances on plaster models with a digital caliper and on digital models using Ortho Analyzer software. The digital models were also compared by means of superimposition of the models using the Geomagic Qualify software. The intra and inter-examiner reliability of the measurements were evaluated using the ICC. Paired t test was used to test the accuracy of the measurements on digital and plaster models. Results: The measurements on plaster and digital models acquired by two different scanners showed high values for the ICC. Although statistically significant differences between the measurements on plaster and digital models have been found, these discrepancies were not considered clinically relevant. The superimposition method with Geomagic Qualify software showed that the two digital models were not significantly different. Conclusions: Digital models created from scanned plaster models using the R700 or Xcad scanners were clinically accurate according to the two methods of comparison used.

RESUMO Objetivos: a acurácia e a confiabilidade de modelos de gesso e modelos digitais adquiridos por dois diferentes scanners de superfície a laser foram testadas com três métodos: medição com paquímetro, medição com programa específico e sobreposição de modelos digitais. Métodos: trinta modelos de gesso com dentição permanente que preencheram os critérios de inclusão predeterminados foram selecionados e escaneados com dois diferentes scanners a laser (R700 e Xcad). Três examinadores mediram distâncias selecionadas nos modelos de gesso usando um paquímetro digital e, nos modelos digitais, usando o programa Ortho Analyzer. Os modelos digitais também foram comparados por sobreposição de modelos, com o programa Geomagic Qualify. A confiabilidade intra e interexaminadores das medições foi avaliada por meio do coeficiente de correlação intraclasse (ICC). O teste t pareado foi utilizado para avaliar a acurácia das medições nos modelos de gesso e digitais. Resultados: as medições nos modelos de gesso e nos modelos digitais escaneados pelos dois diferentes scanners apresentaram valores elevados para o ICC. As diferenças estatisticamente significativas encontradas entre as medições nos modelos de gesso e nos modelos digitais não foram consideradas clinicamente relevantes. O método de sobreposição de modelos com o programa Geomagic Qualify demonstrou que os dois tipos de modelos digitais não foram significativamente diferentes. Conclusões: os modelos digitais criados a partir do escaneamento dos modelos de gesso com os scanners R700 e Xcad foram clinicamente precisos, de acordo com os dois métodos de comparação utilizados.

Accuracy and reproducibility of measurements on plaster models and digital models created using an intraoral scanner.

AIM: The purpose of the present study was to evaluate the accuracy and reproducibility of measurements made on digital models created using an intraoral color scanner compared to measurements on dental plaster models. METHODS: This study included impressions of 28 volunteers. Alginate impressions were used to make plaster models, and each volunteers' dentition was scanned with a TRIOS Color intraoral scanner. Two examiners performed measurements on the plaster models using a digital caliper and measured the digital models using Ortho Analyzer software. The examiners measured 52 distances, including tooth diameter and height, overjet, overbite, intercanine and intermolar distances, and the sagittal relationship. The paired t test was used to assess intra-examiner performance and measurement accuracy of the two examiners for both plaster and digital models. The level of clinically relevant differences between the measurements according to the threshold used was evaluated and a formula was applied to calculate the chance of finding clinically relevant errors on measurements on plaster and digital models. RESULTS: For several parameters, statistically significant differences were found between the measurements on the two different models. However, most of these discrepancies were not considered clinically significant. The measurement of the crown height of upper central incisors had the highest measurement error for both examiners. Based on the interexaminer performance, reproducibility of the measurements was poor for some of the parameters. CONCLUSIONS: Overall, our findings showed that most of the measurements on digital models created using the TRIOS Color scanner and measured with Ortho Analyzer software had a clinically acceptable accuracy compared to the same measurements made with a caliper on plaster models, but the measuring method can affect the reproducibility of the measurements.

Acurácia de modelos ortodônticos por escaneamento a laser, luz estruturada e tomografia computadorizada / Accuracy of orthodontic models scanned by laser, structured light, and computed tomography

Introdução: com a crescente utilização dos modelos digitais em Ortodontia, aumenta também a necessidade de se conhecer as opções disponíveis para sua obtenção. Atualmente, a alternativa mais utilizada é o escaneamento de modelos de gesso, que pode ser realizado em scanners a laser, por luz estruturada ou por tomografia computadorizada. O objetivo deste trabalho foi avaliar, através de uma análise por sobreposição de modelos digitais, a acurácia dos modelos digitais gerados por estes três métodos de escaneamento e a influência de dois diferentes níveis de resolução de escaneamento. Material e métodos: 30 pares de modelos de gesso foram escaneados utilizando as três tecnologias. O escaneamento por luz estruturada foi realizado com duas configurações do nível de resolução: máxima e padrão. Os modelos digitais gerados foram sobrepostos e as diferenças entre as superfícies foram calculadas. Mapas de cores foram utilizados para evidenciar as discrepâncias entre os modelos. Resultados: para todos os parâmetros avaliados, foram obtidas diferenças estatisticamente significantes. As diferenças entre os modelos escaneados a laser e por luz estruturada foram menores, o que sugere maior similaridade entre eles. Conclusão: as diferenças encontradas entre os modelos digitais obtidos pelas três tecnologias de escaneamento estudadas foram estatisticamente significantes. No entanto, por serem muito pequenas quantitativamente, não foram consideradas clinicamente significantes. Não houve diferença entre os dois níveis de resolução estudados, portanto, os três métodos de escaneamento avaliados possuem uma acurácia clinicamente aceitável para ser utilizado em Ortodontia.

Introduction: the increasing use of digital models in orthodontics demands knowledge of the available options for their acquisition. Currently, the most used option is the plaster model scanning, which can be made by laser, structured light and computed tomography scanners. The aim of this study was to evaluate, by a model superimposition analysis, the accuracy of digital models acquired by these three scanning methods and the influence of two different resolution levels of scanning. Methods: thirty pairs of plaster models were scanned using three different scanning technologies: laser, structured light and computed tomography. The structured light scanning was performed using two different resolution levels: maximum and standard. The respective digital models were superimposed and their mean differences were compared using color maps by Geomagic Qualify software. Results: for all parameters studied, statistically significant differences were found. Lower differences were presented between models scanned by laser and structured light techniques, which suggests a higher similarity between them. Conclusion: the differences found between digital models obtained by the three scanning technologies were statistically significant. However, they were quantitatively very small, which was considered clinically insignificant. There was no difference between the two resolution levels of scanning studied. Therefore the three scanning methods studied presented accuracy clinically acceptable to be used in orthodontics.

Effect of polyvinylsiloxane material and impression handling on the accuracy of digital models.

INTRODUCTION: The objective of this study was to evaluate the accuracy and reliability of measurements on digital models obtained by scanning impressions 5, 10, and 15 days after they were made from 2 soft putty polyvinylsiloxane (PVS) materials. METHODS: Thirty volunteers were selected for making impressions of their dentitions with alginate to create a plaster model and with PVS impression material to create a digital model by laser scanning. Three examiners made the plaster model measurements with digital calipers and repeated these measurements on the digital models made from the scanned PVS impressions. A total of 34 distances were evaluated. Paired t tests were used to evaluate intraexaminer error and the accuracy of the digital model measurements. Measurement reproducibility and reliability among examiners were tested. RESULTS: Although statistically significant differences between measurements on plaster and digital models were found, these discrepancies were not clinically significant except for overbite. Both plaster and digital models had high intraclass correlation coefficient values. CONCLUSIONS: Digital models acquired by laser scanning of 2 types of soft putty PVS material may be used with clinically acceptable accuracy, reliability, and reproducibility, even at a postscanning interval of 15 days.

Avaliação da acurácia e confiabilidade de modelos digitais por escaneamento do modelo de gesso / Evaluation of the accuracy and reliability of digital models by scanning the plaster cast

Introdução: o objetivo deste estudo foi avaliar a acurácia e a confiabilidade de medições feitas em modelos digitais obtidos com um scanner a laser de superfície (R700; 3Shape, Copenhagen, Dinamarca). Material e métodos: foram selecionados 30 modelos ortodônticos de gesso de dentições permanentes. As medições foram realizadas por três examinadores com um paquímetro digital, diretamente sobre os modelos de gesso, e digitalmente, através do programa Ortho Analyser (3Shape, Copenhagen, Dinamarca), nos modelos digitais. Foram determinadas 62 medidas, incluindo diâmetro e altura dentária, overjet, overbite, distâncias intercanino e intermolar, e relação sagital bilateral. Utilizou-se o teste t pareado para avaliar o erro intraexaminador e a acurácia das medições nos modelos digitais. Avaliou-se a reprodutibilidade entre os examinadores por meio do coeficiente de correlação intraclasse e a confiabilidade pelo teste de Bland e Altman. Resultados: apesar de existirem diferenças estatisticamente significantes entre as medições realizadas entre os modelos de gesso e os digitais, as discrepâncias foram consideradas clinicamente não significantes. Tanto os modelos de gesso quanto os modelos digitais apresentaram altos valores no coeficiente de correlação intraclasse entre os examinadores. Conclusão: os modelos digitais por escaneamento do modelo de gesso, utilizando o scanner R700 e o programa Ortho Analyser, podem ser utilizados com acurácia clinicamente aceitável e uma excelente confiabilidade e reprodutibilidade. Os modelos digitais podem substituir os modelos de gesso com segurança.

Introduction: the aim of this study was to evaluate the accuracy and reliability of measurements made on digital models obtained with a laser scanner surface (R700; 3Shape, Copenhagen, Denmark). Material and methods: thirty orthodontic plaster models of permanent dentition were selected. The measurements were performed by three examiners with a digital caliper directly on the plaster casts and digitally, through Ortho Analyser software (3Shape, Copenhagen, Denmark), in digital models. It was determined sixty two measures, including diameter and tooth height, overjet, overbite, intercanino and intermolar distances and bilateral sagittal relationship. It was used paired t test to assess intra-examiner error and the accuracy of measurements in digital models. It was evaluated the reproducibility between examiners using the intraclass correlation coefficient and reliability by Bland and Altman test. Results: although there were significant differences between the plaster casts and the digital models measurements, the discrepancies were considered clinically insignificant. Plaster casts and digital models showed high values of intraclass correlation coefficient among examiners. Conclusion: digital models by scanning plaster cast using the R700 scanner and Ortho Analyser software can be used with clinically acceptable accuracy and excellent reliability and reproducibility. Digital models can replace the plaster models safely.

A utilização do fluxo de trabalho digital no tratamento ortodôntico e orto-cirúrgico / The use of digital workflow for orthodontic and surgical treatment

A introdução de ferramentas 3D, como as TCFCs, fotografias 3D e modelos digitais, proporcionaram novas possibilidades na Odontologia. É possível planejar os casos clínicos digitalmente com maior agilidade, facilitando a comunicação entre profissionais e pacientes e sem a necessidade de armazenar documentos físicos. Este artigo objetiva apresentar e discutir alguns dos novos desenvolvimentos no planejamento digital em Ortodontia e cirurgia bucomaxilofacial.

The introduction of 3D resources, such as CBCTs, 3D photos and digital models, enabled new possibilities for Dentistry. It is possible to plan clinical cases digitally and faster, facilitating the communication between professionals and patient, and without the need of storing physical documents. This article aims to show and discuss some of the new developments of digital planning in Orthodontics and maxillofacial surgical treatment.

A utilização dos modelos digitais em ortodontia / The use of digital orthodontic models

O modelo digital pode se tornar em breve uma realidade na clínica ortodôntica, pois apresenta grandes vantagens e facilita o planejamento dos casos clínicos, com a possibilidade de inter-relação com outros arquivos digitais. Os trabalhos publicados na literatura demonstraram que os modelos digitais apresentam precisão e confiabilidade aceitáveis para serem aplicados como método de diagnóstico, além de auxiliar no planejamento ortodôntico. No entanto, este recurso ainda é pouco explorado no Brasil. Este trabalho objetiva apresentar o panorama atual da utilização dos modelos digitais em Ortodontia.

The digital model may soon become a reality in clinical orthodontics because it presents great advantages and facilitates treatment planning, with the possibility of interrelation with other digital files. The published papers have shown that digital models exhibit acceptable accuracy and reliability to be applied as a method to assist the diagnosis and orthodontic planning. However, this resource is still little explored in Brazil. This paper aims to present a current overview of the use of digital models in orthodontics.

Posttreatment stability in Class II nonextraction and maxillary premolar extraction protocols.

AIM: To cephalometrically compare the overjet, overbite, and molar and canine relationship stability of Class II malocclusion treatment with and without maxillary premolar extractions. METHOD: Two groups of 30 patients each with pre- and posttreatment matching characteristics and satisfactory finishing were used. Group 1 consisted of 30 patients treated with nonextraction at a mean pretreatment age of 12.14 years, while group 2 consisted of 30 patients treated with maxillary first premolar extractions at a mean pretreatment age of 12.87 years. Lateral cephalograms obtained before and after treatment and at a mean of 8.2 years after the end of treatment were compared. Student t tests were used to compare the initial and final dental relationships of the groups and the amount of treatment and long-term posttreatment changes. Pearson correlation coefficients were calculated to investigate correlations between treatment and long-term posttreatment dental relationship changes. RESULTS: In groups with matching canine relationship treatment changes, long-term stability of the overjet, overbite, and molar and canine relationships were similar in the groups. There were significant but weak correlations between treatment changes in overjet, overbite, and canine relationships with their long-term posttreatment changes. CONCLUSION: Nonextraction and maxillary premolar extraction treatment of complete Class II malocclusion have similar long-term posttreatment stability in terms of overjet, overbite, and canine and molar relationships.

A influência do protocolo de extração de dois pré-molares superiores na estabilidade oclusal do tratamento da Classe II / Influence of the extraction protocol of two maxillary premolars on the occlusal stability of Class II treatment

OBJETIVO: com o propósito de avaliar a influência da extração de dois pré-molares superiores na estabilidade oclusal do tratamento da má oclusão de Classe II completa, foi realizada uma comparação com o protocolo de tratamento sem extrações. MÉTODOS: selecionou-se, a partir das documentações do arquivo da Disciplina de Ortodontia da Faculdade de Odontologia de Bauru, uma amostra composta pelas documentações de 59 pacientes com má oclusão de Classe II completa. Em seguida, dividiu-se essa amostra em dois grupos, apresentando as seguintes características: Grupo 1, constituído por 29 pacientes, tratados sem extrações; e Grupo 2, composto por 30 pacientes, tratados com extrações de dois pré-molares superiores. Os modelos ao início do tratamento, ao final do tratamento e em um período mínimo de 2,4 anos após o tratamento foram medidos e avaliados por meio dos índices oclusais IPT e PAR. As condições oclusais ao final do tratamento e no estágio pós-tratamento, o percentual de recidiva e as alterações oclusais pós-tratamento foram comparados por meio do teste t. RESULTADOS: os resultados demonstraram que os protocolos de tratamento sem extração e com extrações de dois pré-molares superiores não apresentaram, em nenhuma das variáveis avaliadas, diferenças estatisticamente significativas em relação à estabilidade oclusal do tratamento da má oclusão de Classe II completa. CONCLUSÃO: a extração de dois pré-molares superiores no tratamento da má oclusão de Classe II completa não influenciou a estabilidade dos resultados oclusais alcançados ao final da correção ortodôntica. Portanto, terminar o tratamento com uma relação molar em Classe II ou em Classe I proporciona estabilidade semelhante.

OBJECTIVE: With the purpose of evaluating the influence of two upper premolar extraction on the occlusal stability of full cusp Class II malocclusion treatment, a comparison was performed with a non-extraction treatment protocol. METHODS: To this end, a sample consisting of 59 patients with complete Class II malocclusion was selected from the files of the Department of Orthodontics of the Dental School of Bauru. This sample was split into two groups according to the following characteristics: Group 1 included 29 patients treated without extractions and Group 2 included 30 patients treated with the extraction of two upper premolars. Using the TPI and PAR occlusal indices the subjects' study models were evaluated at the beginning and end of treatment, and at a minimum of 2.4 years after treatment. The occlusal conditions at the end of treatment and in the post-treatment period, the percentage of relapse and post-treatment occlusal changes were compared using Student's t-test. RESULTS: The results showed no statistically significant differences between the nonextraction and the extraction of two maxillary premolars treatment protocols in terms of the occlusal stability of complete Class II malocclusion treatment in any of the evaluated variables. CONCLUSIONS: The extraction of two upper premolars in the treatment of Class II malocclusion did not influence the stability of the occlusal results achieved at the end of the orthodontic treatment. Therefore, a similar stability is achieved by finishing a treatment with either a Class II or a Class I molar relationship.

Treatment stability in patients with Class II malocclusion treated with 2 maxillary premolar extractions or without extractions.

INTRODUCTION: The purpose of this study was to compare the occlusal stability of Class II malocclusion treatment with and without extraction of 2 maxillary premolars. METHODS: A sample of 59 records from patients with complete Class II malocclusion was used. This sample was divided into 2 groups with the following characteristics: group 1, comprising 29 patients treated without extractions, and group 2, comprising 30 patients treated with extraction of 2 maxillary premolars. Dental cast measurements were obtained before and after treatment and at a minimum of 2.4 years after treatment. The pretreatment, posttreatment, and postretention occlusal statuses were evaluated with the peer assesment rating index. The occlusal indexes at the postretention stage and the posttreatment changes and percentages of posttreatment changes were compared with t tests. RESULTS: The nonextraction and the 2 maxillary premolar extraction treatment protocols of complete Class II malocclusions had no statistically significant differences in occlusal stability. CONCLUSIONS: Finishing Class II malocclusion treatment with the molars in a Class II relationship has similar occlusal stability as finishing with the molars in a Class I relationship.

Treatment of a Class II subdivision malocclusion with multiple congenitally missing teeth.

This case report describes the treatment of a patient with a Class II Division 1 subdivision right malocclusion with 8 congenitally missing teeth, incompetent lips, and incisor protrusion. The treatment plan included extractions and space closure with retraction of the anterior teeth; symmetric mechanics were used in the mandibular arch and asymmetric mechanics in the maxillary arch. Because of the mechanics used, some midline deviations were expected. Knowledge of diagnosis and treatment planning of asymmetric malocclusions and dental esthetics are essential for success when correcting asymmetic problems, but, even so, small clinical compromises should be expected.

Avaliaçäo clínica do efeito preventivo de verniz fluoretado em dentes permanentes em erupçäo / Clinical evaluation of the preventive effect of fluoridate varnish in permanent teeth during eruption

O objetivo deste trabalho foi avaliar clinicamente a eficácia do verniz fluoretado Duraphat© na prevençäo da cárie oclusal, durante a erupçäo de primeiros molares permanentes, em 1 ano. Foram selecionadas 60 crianças divididas em dois grupos de 30 pacientes. Em um grupo, a aplicaçäo foi trimestral e, no outro, semestral. A aplicaçäo do verniz foi realizada em um primeiro molar permanente de uma hemiarcada, enquanto o elemento homólogo foi observado para controle. Näo obtivemos uma diferença significativa na eficácia do Duraphat© entre o dente com verniz e seu homólogo e entre as aplicaçöes trimestral e semestral, em relaçäo ao aparecimento de cárie