Comparing different software packages for measuring the oropharynx and minimum cross-sectional area.

INTRODUCTION: Several imaging software packages report the ability to measure the oropharynx and minimum cross-sectional area (MCA). This study aimed to compare 4 imaging software packages for measuring the oropharynx volume and MCA. METHODS: Twenty-eight randomly selected cone-beam computed tomography scans had oropharynx volume and MCA calculated by 2 experienced operators using 4 different programs: Dolphin 3D (version 11.95.8.64; Dolphin Imaging & Management Solutions and Management Solutions, Chatsworth, Calif), InVivo Dental (version 6; Anatomage Inc, San Jose, Calif), OnDemand3D (version 1.0.10.7510; CyberMed, Seoul, South Korea), and ITK-SNAP (version 3.8.0; www.itksnap.org). The measurements were repeated after 2 weeks, and intraclass correlation coefficients were used for the reliability tests. Analysis of variance with the Tukey post-hoc test was used to compare the measurements of oropharynx and MCA with different software programs. Paired t tests were used to compare measurements of both investigators and software programs. Bland-Altman analysis was used to assess interexaminer reliability and agreement between the software programs. RESULTS: The intraclass correlation coefficients revealed excellent repeatability for the 4 programs for both investigators. Analysis of variance showed no statistically significant difference between programs when comparing the oropharynx and MCA. There were no significant differences in software programs when measuring the airway. Bland-Altman showed the maximum difference as 4.1 cm3 for volume and 35 mm2 for MCA. Those differences were below the standard deviations of 5.33 cm3 for volume and 73.75 mm2 for MCA. CONCLUSIONS: The use of 4 different software packages to measure the airway for oropharynx volume and MCA showed high intraoperator and interoperator reliability, no statistically significant difference when using analysis of variance, Tukey post-hoc, paired t tests, and variations within one standard deviation when using Bland-Altman.

The Relationship Between Dental Agenesis and Maxillary Hypoplasia in Patients With Cleft Lip and Palate.

ABSTRACT: Both dental agenesis and maxillary growth restriction are well-recognized sequelae in patients with unilateral cleft lip and palate, but their etiology remains controversial. The aim of this study was to evaluate the relationship between hypodontia and maxillary volume. A retrospective review of patients age 6 to 9 with Veau III (unilateral) cleft palate who underwent Cone Beam Computer Tomography in preparation for alveolar bone grafting at 2 major Children's Hospitals between 2010 and 2016 was conducted and serial panoramic radiographs were reviewed. Thirty-eight patients were identified that met inclusion criteria and had adequate imaging. Group 1 ("poor growers") consisted of the bottom 50% of Sella-Nasion-A point minus Sella-Nasion-B point (ANB) angles and Group 2 ("good growers") consisted of the top 50% of ANB angles. Group 1 had a significantly higher mean number of missing teeth (1.58 ±â€Š0.28 missing teeth) compared to Group 2 (0.74 ±â€Š0.23 missing teeth), and significantly lower maxillary volume (12.88 ±â€Š0.61 cm3 versus 15.24 ±â€Š0.88 cm3, respectively). The severity of maxillary hypoplasia in cleft patients increases with increased dental agenesis. These data indicate that intrinsic factors play a significant role in maxillary growth restriction in cleft patients, independent of the sequelae of surgical intervention.

Accuracy of Three-Dimensional Upper Airway Prediction in Orthognathic Patients Using Dolphin Three-Dimensional Software.

BACKGROUND: Orthodontists and surgeons have been looking for more accurate methods to predict surgical outcomes in patients with skeletal discrepancies. METHODS: The sample consisted of 20 patients from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bilateral sagittal split osteotomy, with or without genioplasty. All patients had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin 3-dimensional (3D) software. The 3D voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft-tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The upper airway was segmented and exported as stereolithography surface files in both T1 and Tp. The measurements of the 3D volume of the airway were calculated and compared among T1 and Tp by using surface superimposition technique. Mean and standard deviations of upper airway volume were compared and correlated using paired t-test. RESULTS: There was no statistically significant difference between the upper airway volume of T1 and Tp. CONCLUSION: Dolphin 3D delivers accurate airway prediction which is an important step in 3D virtual planning.

Accuracy of Three-Dimensional Soft Tissue Prediction in Orthognathic Cases Using Dolphin Three-Dimensional Software.

INTRODUCTION: Orthodontists and surgeons have been looking for more accurate methods to plan and predict surgical outcomes in patients with skeletal discrepancies. METHODS: The sample consisted of 20 subjects from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bisagittal split osteotomy, with or without genioplasty. All subjects had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin three-dimensional (3D) software version 11.9 in digital imaging and communications in medicine format. Three-dimensional voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The differences between Tp and T1 for all patients were measured using linear and angular measurements visualized by surface mapping. RESULTS: Significant differences were found between Tp and T1 in Nasolabial angle, Soft tissue A point, and Subalar area. CONCLUSIONS: The soft tissue prediction accuracy after double jaw surgery using Dolphin 3D is limited in some areas, especially upper lip and base of the nose.

The vocabulary of dentofacial deformities.

Planning the reconstruction of patients with skeletal and dental anomalies requires medical, surgical, and dental specialties working together. Language frequently is a common barrier and this article provides a glossary of terms that can be used as a guide.