3D in de orthodontie, een nieuw tijdperk

3D in de orthodontie, een nieuw tijdperk

• Specific radiodiagnostics in
orthodontics
• Prof Dr Bart Vande Vannet, VU Brussel
Cone Beam
3D in de orthodontie,
een nieuw tijdperk
Transitie van 2D naar 3D in de
Orthodontische Diagnostiek
Klinisch onderzoek: Anas Fardounni – 12 jaar
Anamnese
-
Reden van consult: initiatief van de ouders
Houding ten opzichte van behandeling: matig - slecht
Gezondheidsgegevens: ASA II  mentaal gehandicapt & neurologische medicatie
Tonsilectomie / Adenotomie: /
Medicatie: Hablief
Familiale orthodontische afwijkingen: /
Oro-faciale functies
-
Ademhaling: mondademhaling
Interdentaal slikken: ja
Tongrustpositie: normale positie
Massetercontractie bij slikken: /
Mentalishabit: /
Zuig- en bijtgewoonten: /
Spraak: goed
Logopedie: licht sigmatisme
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
Extra-oraal onderzoek: Anas Fardounni – 12 jaar
-Profiel: Klasse ll
-L.A.F.H.: normaal
- Nasolabiale hoek: recht
- Plica mentalis: normaal - verdiept
-Gelaatssymmetrie: kinpunt naar links
- Lippositie: normaal
- Liprelatie: vergroot & gesloten
- Tandboog midden tov gelaat: rechts
- Kaakgewrichten: goed
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
Intra-oraal onderzoek: Anas Fardounni – 12 jaar
-
Dentitie: 2de wisselfase
Mondhygiëne: matig - slecht
Restauratie/Cariës: 160, 140, 63D, 260
Vroegere extractie: /
Gingiva: gingivitis
Tong/frenula: /
Abrasie: /
Verkleuringen / Leucomas / Structuur: /
Naam practicus
Erkend Orthodontist 3/xxxxx/xx/007
- Occlusie
- Molaar
RE: ½ M
LI: neutro
- Hoektand RE:/
LI:/
- Kruisbeet: anterieur
- OB:
1 mm
OJ: -1 mm
- Hoektanden: ingesloten en niet palpeerbaar
Maand en Jaar
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
Klinisch onderzoek: Anas Fardounni – 12 jaar
Groeifase
- Stemverlaging: begin
- Voor / Begin / Top / Einde: begin
Modelanalyse
- OB = mm
(palatumbeet)
- Midlines
- Sagittale occlusie
- Molaren
- Hoektanden
- Transversale occlusie zijdelings: RE:
- Verticale occlusie zijdelings
- Spee-curve:
- DDM:
Moyers
OJ = mm
RE:
RE:
LI:
RE:
OK Re
OK Li
LI:
LI:
LI:
BK Re
BK Li
Alignatieruimte 1-2
Afstand 2-6
Voorspelde afm 3-4-5
Kans
Mm te kort
- Nivellering:
Totaal:
- DDD / BOLTON:
Naam practicus
Anterior ratio
Oprichten incisieven:
Overall ratio:
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
RÖNTGEN Onderzoek: OPG (Anas Fardounni – 12 jaar)
-
Misvormde elementen: /
Agenesieën: 35
Verstandskiezen: 18, 28, 38 en 48 zijn aangelegd
Cariës: /
Parodontale / Peri-apicale afwijking: /
Ingesloten elementen: 15, 13, 23, 25, 45
Endo-behandeling: /
Wortelresorpties: /
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
RÖNTGEN Onderzoek: TELERADIOGRAFIE (Anas Fardounni – 12 jaar )
Cephalometrie:
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
RÖNTGEN Onderzoek: TELERADIOGRAFIE (Anas Fardounni – 12 jaar )
Cephalometrie:
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
RÖNTGEN Onderzoek: TELERADIOGRAFIE (Anas Fardounni – 12 jaar )
Cephalometrie:
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
RÖNTGEN Onderzoek: CBCT(Anas Fardounni – 12 jaar)
13:
Horizontaal
gepositioneerd
met resorptie
op 12
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
RÖNTGEN Onderzoek: CBCT(Anas Fardounni – 12 jaar)
23:
Horizontaal
gepositioneerd
met resorptie
op 22 en
kroontop B van
apex 22
Naam practicus
Maand en Jaar
Erkend Orthodontist 3/xxxxx/xx/007
Tandheelkundige Kliniek – Jette
Laarbeeklaan 103 – 1090 Brussel
Today’s Objectives
• Discuss the use of CBCT technology in orthodontic practice
– the diagnostic value, patient exposure to radiation,
liability and economics
• Review some significant literature
• Present a systematic approach to reviewing CBCT
Interradicular insertion: maxilla buccally
- Attached gingiva (otherwise ligature)
- Position of the sinus
Lea S
30/11/2002
Van tekening naar realiteit
Brain fills in the gaps and/or alters
your reality based on past
expectations, surrounding
information and intentions.
““Ceoinsdr the anmzaig pweor of the hmuan
biran. It dseno’t metatr in what oredr the lrttees
in a wrod are, the olny tihng taht is iproamtnt is
the frsit and lsat ltetres are in the rghit pclae. The
rset can be a tatol mses and you can sitll raed it
wuhotit a plboerm. Azanimg huh?”
Heidi Haavik
Evidence for the use of Cone
Beam computed tomography in
Orthodontics
introduction
Introduction
Introduction
voxels
Introduction
Hardware
and
software improve
at a fast rate and
lead to better
image quality. The
images that are
seen today may
not
be
representative for
the state of the
art tomorrow.
Conclusion
•
•
•
•
CBCT image data is inherently different from MDCT image data
generating smoother images with lower image contrast.
CBCT is therefore less susceptible to metal artefacts and slightly
more reliable for quantitative measurements.
MDCT, however, remains superior for qualitative appraisal.
Therefore, in practice, the clinician's choice over which CT device to
use should depend on the intended diagnostic purpose
3D imaging
•
•
•
•
•
The technological developments of recent years have opened
new possibilities in three-dimensional (3D) imaging of the
dentition and the surrounding tissues. 3D imaging has the
potential to improve diagnosis and complement treatment
planning and communication.
It also plays a decisive role in the customization of orthodontic
appliances.
These new imaging technologies, however, require that clinicians
understand their nature and are aware of the shortcomings and
problems.
This lecture aims to present the state of the art in 3D imaging of
the dentition and surrounding tissues and will discuss
advantages, disadvantages and shortcomings of the main
imaging methods.
Moreover, it will deal with the impact of new imaging
technologies in everyday clinical practice in the light of the
current scientific evidence.
The influence of slice orientation in 3D CBCT
images on measurements of anatomical
structures
Jacquet, Nyssen, Politis, Vande Vannet,
Bottenberg
CBCT een digitale evolutie
CBCT en Intra Oral Scanning Merged
Voxel based vs Surface based
Integratie van soft tissue
Patient-specific numerical Finite Element models
G. Boonena, G.Bekaert d , S. Debruyne e, JF Cuzinb and B. Vande Vannetc
a Department of Orthodontics, Free University Brussels (VUB), Brussels, Belgium
d KULeuven Campus Oostende Faculty of Engineering Technology , Belgium
b Department of Orthodontics, Vrije Universiteit Brussel (VUB) Private Practice, Nancy, France and Luxembourg e KULeuven Campus Oostende Faculty of Engineering Technology , Belgium
c Department of Orthodontics, Free University Brussels (VUB), Brussels, Belgium
INTRODUCTION
In the past decades finite element models have been developped to study biomechanics in orthodontics. All of these lead to definitions of a standard model to study stresses of the different materials
composing teeth and jaws. However customised appliances are delivered now. Recently in many today’s Orthodontic practices Intra Oral Cameras and 3 Dimensional X-ray procedures are used.
What about creating a fully customised Finite Element Model? What about creating a patient-specific numerical Finite Element model coming from patient individual records ( CBCT, Intral Oral camera )
and even including his own appliance in order to have a really customised point of view on biomechanics.
Aim
Creating numerical models of anatomical areas to estimate the tissues adaptation processes
and dental displacements induced by mechanical stimulus in lingual orthodontic custom
appliances. These models simulate and predict the behaviour of biological tissues in order to
evaluate the clinical and histological effects, and to realize new dental appliances or improve
existing ones.
.
Material and methods
The general and diverse finite element (FE) method is used for analysis of coupled dental
displacements. This method treats teeth, brackets, connection wire and cancellous bone as a
set of structural components. Each of these is characterized by elastic properties such as
Young’s modulus, shear modulus and Poisson’s ratio of its isotropically assumed material. By
dividing each structural component into a coupled finite number of small elements, a
numerical analysis of component stress or structural deformations.
STL files obtained from intra-oral 3D Camera (Trios®, 3 shape, Denmark) and CBCT
(Vatech, NJ, US) were converted to STEP files. Using Siemens NX software it was possible
to convert the data to solid geometry. Non linear structures with contact points (unavoidable in
that study) are defined. In a first approximation teeth are supposed to be infinitely stiff. This is
allowed as teeth have a stiffness which is in orders of magnitude larger than stiffness of jaw
bone. The outer surfaces of teeth are merely used to establish contact between teeth. Forces
are transferred to dental root via RBE2 elements, which are of infinite stiffness. The lingual
brackets were modelled with solid elements. This enabled their connection to the teeth and
contact between lingual brackets and single bracket connection wire was established. The
driving force which causes the teeth to move relative to jaw bone was modelled by a preload
in the one-dimensional connection wire between brackets. Creep phenomenon is used to
simulate growth and bone remodelling.
Intra Oral CAMERA
CBCT Cone Beam
STL
Files
Results
The different steps in setting up a finite element model suitable for an adequate numerical
analysis of coupled dental deformations were performed. In detail important relevant
numerical issues such as the optimal estimation of elastic properties of cancellous bone were
incorporated.
And this model is patient-specific.
Three alignment experiments were conducted.
DICOM Files
.
Recent evolutions
1. The focus was placed on the cranial base and the acoustic meatus to visualize overall growth and
treatment effects.
2. The palatum was focussed to study maxillar growth, changes in dentition, and orthodontic treatment.
3. The mandibular symphysis was chosen as focus to assess mandibular growth, changes in dentition,
and orthodontic treatment.
This research demonstrates the possibilities of having a finite element
method to be quickly created from imaging processes coming current in
Orthodontic offices. In our “customised orthodontics” times, customised
biomechanical studies are near to us.
After alignment the images were subtracted (Figs. 4, 9, and 14).
STEP
Files
The pixels of the subtraction image were subdivided into three gray values bins of equal size. The pixels
corresponding to the lowest bin (meaning more radiodensity in test than the reference image) were
represented using shades of blue. Pixels with grey value in the middle bin (small or no difference between
test and reference image) were represented using shades of green. Pixels with gray value in the higher bin
(lower radiodensity compared to the reference image) were represented using shades of red (Figs. 5, 10,
and 15).
Meshing
References
Junning C. , Wei L. , MIichael V. , Swain M. , Ali D. , Qing L.
A periodontal ligament driven remodeling algorithm for orthodontic tooth movement
J. Biomech. 47 (2014) 1689-1695
Hussein H. Ammar, Peter Ngan, Richard J. Crout, Victor H. Mucino, Osama M. Mukdadi
Three dimensional modeling and finite element analysis in treatment planning for orthodontic tooth movement
Am J Orthod Dentofacial Orthop 2011;139:e59-e79
Xiulin Yan, Weijun He, Tao Lin, Jun Liu, Xiaofeng Bal, Guangqi Yan, Li Lu
Three dimensional finite element analysis of the craniomaxillary complex during maxillary protraction with bone anchorage vs conventional dental anchorage
Am J Orthod Dentofacial Orthop 2013; 143: 197-205
FEA Studies
Andrew Boryor, Ansgar Hohmann, Martin Geiger, Uwe Wolfram, Christian sander, Franz Günter Sander
A downloadable meshed human canine tooth model with PDL and bone for finite element stimulation
Dental Materials 25 (2009) e57-e62
Joanneke M. Plooij, Thomas J.J. Maal, Piet Haers, Wilfried A. Borstlap, Anne Marie Kuijpers-Jagtman, Stefaan J. Berge
Digital three dimensional image fusion processes for planning and evaluating orthodontics and orthognatic surgery. A systematic review
Int. J. Oral Maxillofac. Surg. 2011; 40 : 341-352
Cattaneo PM., Dalstra M., Melsen B.,
Strains in periodontal ligament and alveolar bone associated with tooth movement analyzed by finite element.
Orthod. Craniofac. Res. 2009; 12: 120-8
Cattaneo PM., Dalstra M., Melsen B.,
The finite element method: a tool to study orthodontic tooth movement.
J. Dent. Res. 2005;84:428-33
Fields C., Ichim I., Swain MV., Chan E., Darendeliler MA., Li W., et al.
Mechanical responses to orthodontic loading: a 3-dimensional finite multi-tooth model.
Am. J. Orthod. Dentofacial Orthop. 2009; 135:174-81
Vrije Universiteit Brussel
Dr G. Boonen
KHBO
Geert Bekaert
Laarbeeklaan 103, 1090 Brussel
Belgium
Tel. +32 2 477 49 08
Lecturer at KUL Campus of Technology Ostend
Faculty of Industrial Sciences
Orthodontie.vub.ac.be
tel. +32 50 40 59 34
Geert.bekeaert@kuleuven.be
KHBO
Stijn Debruyne
KU Leuven | Campus Oostende (@KHBO)
Faculty of Engineering Technology
Cluster WIT
Research Group Propolis
Zeedijk 101 | B-8400 Ostend
tel. +32 50 40 59 34
Stijn.debruyne@kuleuven.be
Dr J-F Cuzin
Private offices in Nancy France and Luxembourg
Tel. +33 3 83 25 22 50
Acceuil@orthodontiestanislas.fr
Vrije Universiteit Brussel
Prof. Dr. B. Vande Vannet
Laarbeeklaan 103, 1090 Brussel, Belgium
Tel. +32 2 477 49 08
Skype : bvandevannet
bart.vande.vannet@vub.ac.be
Orthodontie.vub.ac.be
Articulatoren ?
Van 2D terug naar 3D
Baumrind 1983
Ericson & Kurol 1987
Mozzo 1998
Kapila 2011, Halozenetis 2012, Larson 2012
Een radiografie kan pas genomen worden als er
een diagnostiek hulpmiddel in het belang van
het behandelingsplan voor de patiënt !
RSP (OPG) én CBCT zijn eigenlijk uit den boze …
1. Wanneer CBCT
1. Precieze beoordeling van wortelmorfologie en wortellengte
2. Gedetailleerde informatie over alveolaire morfologie en interdentale relaties
3. Morfometrische analyse van craniofaciale anomaliëen
4. Specifieke analyse van het TMG (fysiologisch en pathologisch)
5. Beoordeling van de luchtwegen (OSAS)
Kapila et al. 2011
Dentomaxillofac
Radiol. 2015;44(1):20140282. doi:
10.1259/dmfr.20140282.
CBCT in orthodontics: assessment of
treatment outcomes and indications for
its use.
Kapila SD1, Nervina JM.
State of the art
• Since its introduction into dentistry in 1998, CBCT
has become an increasingly important source of 3D
volumetric information in clinical orthodontics.
• Over this period, valuable CBCT data have been
gathered on 3D craniofacial morphology in health
and disease, treatment outcomes and the efficacy of
CBCT in diagnosis and treatment planning.
State of the art
• Although CBCT continues to gain popularity, its use
currently is recommended in cases in which clinical
examination supplemented with conventional
radiography cannot supply satisfactory diagnostic
information.
• To date, this applies to impacted teeth, CL/P and
orthognathic or craniofacial surgery patients.
State of the art
• CBCT on other types of cases can also be performed
where there is likely to be a positive benefit-to-risk
outcome such as supernumerary teeth, identification
of root resorption caused by unerupted teeth,
evaluating boundary conditions, TMJ degeneration
and progressive bite changes and for placement of
TADs in complex situations.
• Based on research evidence, orthodontists are
advised to use their best clinical judgment when
prescribing radiographs, including CBCT scans, to
obtain the most relevant data using the least ionizing
radiation possible.
Bibimu
New set of rules
New set of Rules FOV
Protocol bij het voorschrijven van een CBCT
2. Zal het gebruik van CBCT leiden tot
verbeteringen in de
behandelingsplannen en behandelingen
Probleemlijst
cbct
Behandelplan
Evaluatie van het behandelresultaat
Informatie over het alveolaire bot en risico op fenestratie
The role of CBCT in
evaluation of alveolar bone
state during orthodonticperiodontal treatment
alveolar bone density decreased
during orthodontic treatment and
CBCT could be used in evaluation of
alveolar bone state
Localisatie van ectopische gebitselementen
21 jaar vrouw
Wat moet er gebeuren met de derde molaren ?
… Geretineerde 6.3
Bronte 24/11/1994
Conebeam en orthodontie
Bronte
Bronte
Hussam
Hussam
Hussam
Hussam
Hussam
Hussam
Hussam
Seher
Seher, 9 jaar
anamnese : 3 tanden verwijderd
afwachten …
Seher
Seher, 9 jaar
anamnese : 3 tanden verwijderd
afwachten …
Seher
Seher, 9 jaar
anamnese : 3 tanden verwijderd
afwachten …
Seher CBCT
Zes maandelijks bij alg tandarts, nu 11 jaar...
Basis : asymmetriën in doorbraak...
Ik laat nu eerst CBCT maken denk ik?
3
1b
2-1
3
1
4
III
2b
2
4
III
IV
V
IV
v
6
6
De oorzaak zoeken van onverklaarbare symptomen
Beoordeling van de morfologie en de positie van de condyli
bij patiënten met TMG problematiek en beoordeling van
asymmetriëen
Beschrijving en kwantificatie van anomaliëen in het
craniofaciale skelet in alle 3 vlakken met aangepaste 3D
coördinaten
Het gebruik van een
coördinaten systeem
om asymmetriën
beter te kunnen
beoordelen is hierbij
aangewezen.
Beoordeling indien
Orthodontische Camouflage
kan dan wel Chirurgie nodig is
?
Dentale bewegingen :
De krachtvectoren
kunnen in 3D bepaald
worden en toepassing
van correcte
biomechanica wordt
mogelijk
Chirurgie :
Een performatere
planning van de
orthognatische
chirurgie kan
gebeuren.
Leeftijdsbepalingen, antropologie en forensisch onderzoek …
Highlights
•
CBCT is suggested as an alternative to conventional CT in some cases of postmortem imaging.
•
Practical advantages include relatively small size, portability, and low cost.
•
Technical advantages include good spatial resolution and metal artifact reduction.
•
Limitations include limited field size and limited soft tissue contrast.
Opgelet
Wat zie je ?
Thank you for your kind attention !