Exploring the Validity of an Optoelectronic Integrated Cone Beam Computed Tomography Jaw Tracking System.

Jaw motion tracking functionalities of cone beam computed tomography (CBCT)-scanners can visualize, record, and analyze movements of the mandible. In this explorative study, the validity of the 4D-Jaw Motion module (4D-JM) of the ProMax 3D Mid CBCT scanner (Planmeca, Helsinki, Finland) was tested in vitro. The validity of the 4D-JM was accepted if values differed less than 0.6 mm (three voxels sizes) from the gold standard. Three dry human skulls were used. CBCT scans, the gold standard, were taken in eight jaw positions and exported as three-dimensional (3D) models. Individualized 3D-printed dental wafers ensured the correct positioning of the mandible. Jaw positions were recorded with the 4D-JM tracking device and exported as 3D models. The coordinates of six reference points for both superimposed 3D models were obtained. The differences in the x, y and z-axis and the corresponding vector differences between gold standard 3D models and 4D-JM models were calculated. For the mandible 10% and for the maxilla 90% of the vector differences fell within 0.6 mm of the gold standard. With an increasing vertical jaw opening, larger differences between the gold standard and the 4D-JM 3D models were found. The smallest differences of the mandible were observed on the x axis. In this study, the 4D-JM validity was not acceptable by the authors' predefined standards.

Skeletal Changes in Growing Cleft Patients with Class III Malocclusion Treated with Bone Anchored Maxillary Protraction-A 3.5-Year Follow-Up.

This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. SUBJECTS AND METHOD: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography (CBCT) scans were taken before the start of BAMP (T0), 1.5-years after (T1) and 3.5 y after (T2). Seventeen age- and malocclusion-matched, untreated cleft subjects with cephalograms available at T0 and T2 served as the control group. Three dimensional skeletal changes were measured qualitatively and quantitatively on CBCT scans. Two dimensional measurements were made on cephalograms. RESULTS: Significant positive effects have been observed on the zygomaticomaxillary complex. Specifically, the A-point showed a displacement of 2.7 mm ± 0.9 mm from T0 to T2 (p < 0.05). A displacement of 3.8 mm ± 1.2 mm was observed in the zygoma regions (p < 0.05). On the cephalograms significant differences at T2 were observed between the BAMP and the control subjects in Wits, gonial angle, and overjet (p < 0.05), all in favor of the treatment of Class III malocclusion. The changes taking place in the two consecutive periods (ΔT1-T0, ΔT2-T1) did not differ, indicating that not only were the positive results from the first 1.5-years maintained, but continuous orthopedic effects were also achieved in the following 2-years. CONCLUSIONS: In conclusion, findings from the present prospective study with a 3.5-years follow-up provide the first evidence to support BAMP as an effective and reliable treatment option for growing cleft subjects with mild to moderate Class III malocclusion up to 15-years old.

3D Computer aided treatment planning in endodontics.

OBJECTIVES: Obliteration of the root canal system due to accelerated dentinogenesis and dystrophic calcification can challenge the achievement of root canal treatment goals. This paper describes the application of 3D digital mapping technology for predictable navigation of obliterated canal systems during root canal treatment to avoid iatrogenic damage of the root. METHODS: Digital endodontic treatment planning for anterior teeth with severely obliterated root canal systems was accomplished with the aid of computer software, based on cone beam computer tomography (CBCT) scans and intra-oral scans of the dentition. On the basis of these scans, endodontic guides were created for the planned treatment through digital designing and rapid prototyping fabrication. RESULTS: The custom-made guides allowed for an uncomplicated and predictable canal location and management. CONCLUSION: The method of digital designing and rapid prototyping of endodontic guides allows for reliable and predictable location of root canals of teeth with calcifically metamorphosed root canal systems. CLINICAL SIGNIFICANCE: The endodontic directional guide facilitates difficult endodontic treatments at little additional cost.

Calculating nasoseptal flap dimensions: a cadaveric study using cone beam computed tomography.

We hypothesize that three-dimensional imaging using cone beam computed tomography (CBCT) is suitable for calculating nasoseptal flap (NSF) dimensions. To evaluate our hypothesis, we compared CBCT NSF dimensions with anatomical dissections. The NSF reach and vascularity were studied. In an anatomical study (n = 10), CBCT NSF length and surface were calculated and compared with anatomical dissections. The NSF position was evaluated by placing the NSF from the anterior sphenoid sinus wall and from the sella along the skull base towards the frontal sinus. To visualize the NSF vascularity in CBCT, the external carotic arteries were perfused with colored Iomeron. Correlations between CBCT NSFs and anatomical dissections were strongly positive (r > 0.70). The CBCT NSF surface was 19.8 cm(2) [16.6-22.3] and the left and right CBCT NSF lengths were 78.3 mm [73.2-89.5] and 77.7 mm [72.2-88.4] respectively. Covering of the anterior skull base was possible by positioning the NSF anterior to the sphenoid sinus. If the NSF was positioned from the sella along the skull base towards the frontal sinus, the NSF reached partially into the anterior ethmoidal sinuses. CBCT is a valuable technique for calculating NSF dimensions. CBCT to demonstrate septum vascularity in cadavers proved to be less suitable. The NSF reach for covering the anterior skull base depends on positioning. This study encourages preoperative planning of a customized NSF, in an attempt to spare septal mucosa. In the concept of minimal invasive surgery, accompanied by providing customized care, this can benefit the patients' postoperative complaints.

Reliability and validity of measurements of facial swelling with a stereophotogrammetry optical three-dimensional scanner.

Volume changes in facial morphology can be assessed using the 3dMD DSP400 stereo-optical 3-dimensional scanner, which uses visible light and has a short scanning time. Its reliability and validity have not to our knowledge been investigated for the assessment of facial swelling. Our aim therefore was to assess them for measuring changes in facial contour, in vivo and in vitro. Twenty-four healthy volunteers with and without an artificial swelling of the cheek were scanned, twice in the morning and twice in the afternoon (in vivo measurements). A mannequin head was scanned 4 times with and without various externally applied artificial swellings (in vitro measurements). The changes in facial contour caused by the artificial swelling were measured as the change in volume of the cheek (with and without artificial swelling in place) using 3dMD Vultus software. In vivo and in vitro reliability expressed in intraclass correlations were 0.89 and 0.99, respectively. In vivo and in vitro repeatability coefficients were 5.9 and 1.3 ml, respectively. The scanner underestimated the volume by 1.2 ml (95% CI -0.9 to 3.4) in vivo and 0.2 ml (95% CI 0.02 to 0.4) in vitro. The 3dMD stereophotogrammetry scanner is a valid and reliable tool to measure volumetric changes in facial contour of more than 5.9 ml and for the assessment of facial swelling.

Applicability and accuracy of an intraoral scanner for scanning multiple implants in edentulous mandibles: a pilot study.

STATEMENT OF PROBLEM: In the past 5 years, the use of intraoral digitizers has increased. However, data are lacking on the accuracy of scanning implant restorative platforms for prosthodontics with intraoral digitizers. PURPOSE: The purpose of this clinical pilot study was to assess the applicability and accuracy of intraoral scans by using abutments designed for scanning (scan abutments) in edentulous mandibles. MATERIAL AND METHODS: Twenty-five participants with complete mandibular overdentures retained by 2 implants and frameworks were included in this study. Scan abutments were placed on the implants intraorally and scanned with the iTero intraoral scanner. Also, scan abutments were placed on the implant analogs of the definitive casts and scanned with an extraoral laboratory scanner (Lava Scan ST scanner). Two 3-dimensional computer-aided design models of the scan abutments with predetermined center lines were subsequently imported and registered, together with each of the scanned equivalents. The distance between the centers of the top of the scan abutments and the angulations between the scan abutments was assessed. These values were compared with the measurements made on the 3-dimensional scans of the definitive casts, which were the participants' original definitive casts used for fabrication of soldered bars. The threshold for distance error was established to be 100 µm. RESULTS: Four of the 25 intraoral scans were not suitable for research because the intraoral scanner was not able to stitch the separate scans together. Five of the 21 suitable scans demonstrated an interimplant distance error >100 µm. Three of the 25 intraoral scans showed interimplant angulation errors >0.4 degrees. Only 1 scan showed both an acceptable interimplant distance (<100 µm) and an acceptable angulation error (<0.4 degrees). CONCLUSIONS: Based on the intraoral scans obtained in this study, distance and angulation errors were too large to fabricate well-fitting frameworks on implants in edentulous mandibles. The main reason for the unreliable scans seemed to be the lack of anatomic landmarks for scanning.

Digital planning of cranial implants.

Computer-aided techniques can be used in the reconstruction of defects in the skull, although there are limitations for large defects. We describe a technique for the digital design of an implant for cranioplasty using one, easy-to-use, piece of generic industrial software that shows a curvature-based, hole-filling algorithm. This approach is suitable for all kinds of defects, including those that extend across the midline of the skull. The workflow gives the user full control over the design, production, and material used for the implant.

Application of intra-oral dental scanners in the digital workflow of implantology.

UNLABELLED: Intra-oral scanners will play a central role in digital dentistry in the near future. In this study the accuracy of three intra-oral scanners was compared. MATERIALS AND METHODS: A master model made of stone was fitted with three high precision manufactured PEEK cylinders and scanned with three intra-oral scanners: the CEREC (Sirona), the iTero (Cadent) and the Lava COS (3M). In software the digital files were imported and the distance between the centres of the cylinders and the angulation between the cylinders was assessed. These values were compared to the measurements made on a high accuracy 3D scan of the master model. RESULTS: The distance errors were the smallest and most consistent for the Lava COS. The distance errors for the Cerec were the largest and least consistent. All the angulation errors were small. CONCLUSIONS: The Lava COS in combination with a high accuracy scanning protocol resulted in the smallest and most consistent errors of all three scanners tested when considering mean distance errors in full arch impressions both in absolute values and in consistency for both measured distances. For the mean angulation errors, the Lava COS had the smallest errors between cylinders 1-2 and the largest errors between cylinders 1-3, although the absolute difference with the smallest mean value (iTero) was very small (0,0529°). An expected increase in distance and/or angular errors over the length of the arch due to an accumulation of registration errors of the patched 3D surfaces could be observed in this study design, but the effects were statistically not significant. CLINICAL RELEVANCE: For making impressions of implant cases for digital workflows, the most accurate scanner with the scanning protocol that will ensure the most accurate digital impression should be used. In our study model that was the Lava COS with the high accuracy scanning protocol.

Reliability of linear measurements on a virtual bilateral cleft lip and palate model.

OBJECTIVE: To assess the reliability and validity of measurements performed on three-dimensional virtual models of neonatal bilateral cleft lip and palate patients, compared with measurements performed on plaster cast models. MATERIALS AND METHODS: Ten high-quality plaster cast models of bilateral cleft lip and palate patients were scanned with an LDI-scanner to obtain a three-dimensional virtual model. Linear measurements were performed on the plaster cast models using a digital caliper and also on the three-dimensional virtual model using Viscam RP version 2.1 software. The measurements were performed by two observers on two occasions. RESULTS: Intraclass correlations ranging from .81 to .96 were found for all measurements except the measurement between the constructed reference point pr and reference point i (intraclass correlation = .40). A post hoc procedure in which top-view screen prints of the three-dimensional virtual model were used to perform the measurement between reference points pr and i demonstrated an intraclass coefficient of .90. CONCLUSIONS: Three-dimensional virtual models obtained by laser scanning neonatal cast models of bilateral cleft lip and palate patients can be used reliably and validly to perform linear measurements between existing reference points on the surface of the model using Viscam RP version 2.1 software. Measurements between reference points constructed outside the surface of the model cannot be validly performed on the three-dimensional virtual model with the software used in this study. For these measurements, top-view screen prints of the three-dimensional virtual model can be used.