Computer in orthodontics

role of computer in orthodontics

1. Computers In Orthodontics By – Dr. Neha Agarwal

2. The development of computer has had a huge influence on both the individual & society across the whole spectrum of everyday living. Digital revolution no longer is the domain of only a few. The use of computers in dental education and practice goes back to the mid 1960's when they were used for specific and limited tasks in the administration of dental schools and large dental practices. An early educational use was in the marking and collating of multiple choice examinations in some universities. Introduction

3. Orthodontists with their love for technolgy and miniaturization have not remained untouched. Orthodontic offices use computers for many purposes ranging from administrative applications, clinical applications to research applications. The advantages of computers outweigh their only disadvantage of lacking the flexibility & insight of a human brain

4. A Computer can be described as an automatic electronic device capable of accepting information (data), perform operations and calculations according to instructions given and supply the results of operations

5. Components Of Computer

6. Characteristics of a computer

7. Uses Of Computers In Orthodontics

8. Administrative application

9. Clinical Application

10. Other Application

11. Image Archiving Applications

12. Digital camera / Intraoral camera

13. RMO’S jiffy orthodontic evaluation: First to provide a computer aided cephalometric diagnosis to the dental profession in the late 1960’s Marketed a software package described as JOE JOE generates tracings of lateral or frontal cephalograms using Ricketts,Jarabak , Sassouni-plus,Steiner and Grummons analyses Computerized Systems

14. JOE can also provide visual representation of normal for comparison to the patient tracings, generate collection of cephalometric values listed in a logical order along the norms and amount of deviation from normal, and put together a list of orthodontic problem analyses.

15. Is a cephalometric IBM compatible system whose development is aimed to provide orthodontists with an user friendly program. PorDios works with a digitizer in the standard way and also enables the use of a video or scanner as means of digitization of X-rays. Cephalometric analyses used are Bjork,Burstone , Coben , Downs, Frontal, McNamara, PROFILE,Ricketts , Steiner and Tweed PorDIOS (Purpose on Request Digitizer Input Output System)

16. Produces occlusograms from photocopies of dental casts User can alter the existing programmed analyses or can develop his own Has built in calculation functions for showing discrepancies between the actual mean and its deviation from the norms. Main system can automatically alter the orientation of a picture in order to have the profile looking to the left or right side of the screen. PorDios is multilingual .

17. PHOTOCEPHALOMETRIC APPLICATIONS

18. Photocephalomeric application work by linking digitized lateral cephalograms to lateral facial bitmapped images for automatic facial transformation. Treatment visualization application perform cephalometric prediction & image transformation in a manner that appears to be virtually simultaneous . The cephalometric profile tracing is superimposed over the image profile . Manipulation of the skeletal & dental structures is done on the cephalometric portion of the pair. The predicted cephalometric profile changes are automatically applied to facial image changes

19. Digi graph is a synthesis of video imaging, computer technology and sonic digitizing. Enables to perform non- invasive and non radiographic cephalometric analysis It was developed by Dr.Mark Lemschen & Mr.Gary Engle’ Digigraph workstation comprise a computer, an RGB videocamera , a sonic digitizing probe with receptor microphones & patient seat with a headholder to stabilize the patient during digitizing. Digigraph

20. Cephalometric land marks are digitized by lightly touching the sonic digitizing probe to a point on the patients skin corresponding to it. This emits a sound, which is then recorded by the microphone and monitored as x, y & z co- ordinates.

21. Landmarks can be identified as a point in 3 dimensions Landmarks can be digitized in less than 5 minutes & any of the commonly used ceohalometric analyses generated. The program is capable of 14 analyses including Ricketts lateral & frontal, Vari simplex, Holdaway , Alabama,Jarabak , Steiners , Downs, Burstone , Mc.Namara , Tweed, Grummons frontal,Standard lateral & Standard frontal. Measurements for any selected analysis can be displayed on the monitor and the observed values are shown along with the patient norm adjusted for age, sex, race and head size including standard deviations. Patients radiograph tracings, cephalograms , photos & models to be stored on the computer disk, reducing storage requirements.

22. CT Scan Tomography is the general term used for an imaging technique that provide an image of a layer of tissue CT uses computer to aid in generating the image & allow multiple slices to be “stacked” to represent 3 dimensional form

23. Cone beam CT has gained considerable popularity & application in medical field It mainly uses a cone shaped x-ray beam with special image intensifier & a solid state sensor or amorphous silicon plate for capturing the image Scan time is 10-90 sec It can take the image of the patient in 1 rotation sweep CBCT

24. Provides additional diagnostic information on size, shape, and position of the condylar heads Width of the tooth bearing portion Morphology, inclination, displacement or deviation of the lateral and medial surface of mandibular rami and body. Dental root positioning Localization of impacted or supernumerary tooth Palatal morphology & morphology of sites for placing implants & osteotomies CBCT APPLICATIONS

25. OrthoCAD ™ software has been developed by CADENT,Inc . (Computer Aided Dentistry, Fairview, NJ, USA)to enable the orthodontist to view, manipulate, measure and analyze 3D digital study models easily and quickly Impressions of the maxillary and mandibular dentitions, together with a bite registration are sent overnight to an ORTHOCAD processing facility & within few days 3D digital study models, are downloaded manually or automatically from the worldwide website using a utility called OrthoCAD Downloader. The average file size for each 3D model is 3 Mb. OrthoCAD ™ Technology

26. The operator can browse and view the models separately and together from any direction and in any desired magnification on screen

27. The software comes with several diagnostic tools such as: measurement analysis (e.g. Bolton analysis, arch width and length analyses); midline analysis (the ability to split the model sagittally or transversely for better comparisons); and overbite and overjet analysis

28. The Occlusogram illustrates the amount of Inter occlusal contacts using color coded scales Overbite and overjet can be assessed accurately by splitting the model along the mid- sagittal plane.

29. In addition to midline analysis, splitting can be performed at any point and in any angle. Measuring mesio -distal widths of teeth .

30. Space analysis Three measurements of arch widths in the lower dentition.

31. Align® Technology, Inc. developed the Invisalign appliance for orthodontic tooth movement in the USA in 1998. It is an ‘invisible’ way to straighten teeth into a perfect occlusion using thin, clear, overlay sequential appliances. Align® Technology

32. Initial treatment planning with patients’ photographs and radiographs are sent to Invisalign ® laboratorie Impressions are converted into positive plaster models & checked for quality.

33. In the laboratory, models are first coated with protective shells, and encased in a mixture of resin and a hardener. After chemical setting, they become blocks of hardened resin with many plaster models inside. Each tray is placed in a destructive scanning machine

34. Graphic designers cut out each tooth and save it as a separate geometric unit Once the teeth are separated and re-assembled back into the arches, the designers create a final set-up of what the patient’s teeth will look like when the treatment is completed

35. For each stereolithographic constructed model (which represents a treatment stage), a clear Invisalign ® aligner of 0.030 inch thickness, is created by heat These aligners are trimmed, polished, cleaned and finally sent to the prescribing orthodontist.

36. The patient is instructed to wear each aligner for approximately 1–2 weeks, and then to move forward to the next stage. A series of evenly divided 0.15 to 0.25mm movements are brought about at each stage of treatment.

37. Virtual treatment sequence presents an opportunity to the clinician & the patient for evaluation of the proposed post treatment occlusion on screen, before treatment commences Proposed treatment can be evaluated by thorough examination of the entire sequence of tooth movement ,from many visual perspectives Advantages

38. It is obvious that the treatment procedures do not allow for continued eruption of teeth or significant arch changes during growth. Dental movements can be achieved with this system, but not basal orthopedic change. change of tooth morphology during the treatment phase (e.g. restorations or composite build-ups) can destroy the use of subsequent aligners. Technique may not fully take into account optimum root positions at the end of the treatment, thereby ignoring one of the key factors in achieving prolonged stability and function. Diadvantages

39. The scope of computer use in orthodontics is enormous. It finds applications from simple databases for orthodontics practice to complex image processing techniques for efficient diagnosis. The trends of computer technology, particularly Internet technology, will turn orthodontic treatment into a new face, where information can be obtained not only in a digital manner but also in a remote manner. Summary

40. Technology is now available to run a practice almost paper free. It is possible to store clinical notes, photographs, study models & radiographs on disc & refer to consultant online. The ability to establish a fellow computerized 3-dimensional dental models & images is a great leap ahead for more accurate diagnosis for treatment planning and a better understanding of patient’s treatment progress.