58 research outputs found

    A 3D environment for surgical planning and simulation

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    The use of Computed Tomography (CT) images and their three-dimensional (3D) reconstruction has spread in the last decade for implantology and surgery. A common use of acquired CT datasets is to be handled by dedicated software that provide a work context to accomplish preoperative planning upon. These software are able to exploit image processing techniques and computer graphics to provide fundamental information needed to work in safety, in order to minimize the surgeon possible error during the surgical operation. However, most of them carry on lacks and flaws, that compromise the precision and additional safety that their use should provide. The research accomplished during my PhD career has concerned the development of an optimized software for surgical preoperative planning. With this purpose, the state of the art has been analyzed, and main deficiencies have been identified. Then, in order to produce practical solutions, those lacks and defects have been contextualized in a medical field in particular: it has been opted for oral implantology, due to the available support of a pool of implantologists. It has emerged that most software systems for oral implantology, that are based on a multi-view approach, often accompanied with a 3D rendered model, are affected by the following problems: unreliability of measurements computed upon misleading views (panoramic one), as well as a not optimized use of the 3D environment, significant planning errors implied by the software work context (incorrect cross-sectional planes), and absence of automatic recognition of fundamental anatomies (as the mandibular canal). Thus, it has been defined a fully 3D approach, and a planning software system in particular, where image processing and computer graphic techniques have been used to create a smooth and user-friendly completely-3D environment to work upon for oral implant planning and simulation. Interpolation of the axial slices is used to produce a continuous radiographic volume and to get an isotropic voxel, in order to achieve a correct work context. Freedom of choosing, arbitrarily, during the planning phase, the best cross-sectional plane for achieving correct measurements is obtained through interpolation and texture generation. Correct orientation of the planned implants is also easily computed, by exploiting a radiological mask with radio-opaque markers, worn by the patient during the CT scan, and reconstructing the cross-sectional images along the preferred directions. The mandibular canal is automatically recognised through an adaptive surface-extracting statistical-segmentation based algorithm developed on purpose. Then, aiming at completing the overall approach, interfacing between the software and an anthropomorphic robot, in order to being able to transfer the planning on a surgical guide, has been achieved through proper coordinates change and exploiting a physical reference frame in the radiological stent. Finally, every software feature has been evaluated and validated, statistically or clinically, and it has resulted that the precision achieved outperforms the one in literature

    Three dimensional study to quantify the relationship between facial hard and soft tissue movement as a result of orthognathic surgery

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    Introduction Prediction of soft tissue changes following orthognathic surgery has been frequently attempted in the past decades. It has gradually progressed from the classic ā€œcut and pasteā€ of photographs to the computer assisted 2D surgical prediction planning; and finally, comprehensive 3D surgical planning was introduced to help surgeons and patients to decide on the magnitude and direction of surgical movements as well as the type of surgery to be considered for the correction of facial dysmorphology. A wealth of experience was gained and numerous published literature is available which has augmented the knowledge of facial soft tissue behaviour and helped to improve the ability to closely simulate facial changes following orthognathic surgery. This was particularly noticed following the introduction of the three dimensional imaging into the medical research and clinical applications. Several approaches have been considered to mathematically predict soft tissue changes in three dimensions, following orthognathic surgery. The most common are the Finite element model and Mass tensor Model. These were developed into software packages which are currently used in clinical practice. In general, these methods produce an acceptable level of prediction accuracy of soft tissue changes following orthognathic surgery. Studies, however, have shown a limited prediction accuracy at specific regions of the face, in particular the areas around the lips. Aims The aim of this project is to conduct a comprehensive assessment of hard and soft tissue changes following orthognathic surgery and introduce a new method for prediction of facial soft tissue changes. ā€ƒ Methodology The study was carried out on the pre- and post-operative CBCT images of 100 patients who received their orthognathic surgery treatment at Glasgow dental hospital and school, Glasgow, UK. Three groups of patients were included in the analysis; patients who underwent Le Fort I maxillary advancement surgery; bilateral sagittal split mandibular advancement surgery or bimaxillary advancement surgery. A generic facial mesh was used to standardise the information obtained from individual patientā€™s facial image and Principal component analysis (PCA) was applied to interpolate the correlations between the skeletal surgical displacement and the resultant soft tissue changes. The identified relationship between hard tissue and soft tissue was then applied on a new set of preoperative 3D facial images and the predicted results were compared to the actual surgical changes measured from their post-operative 3D facial images. A set of validation studies was conducted. To include: ā€¢ Comparison between voxel based registration and surface registration to analyse changes following orthognathic surgery. The results showed there was no statistically significant difference between the two methods. Voxel based registration, however, showed more reliability as it preserved the link between the soft tissue and skeletal structures of the face during the image registration process. Accordingly, voxel based registration was the method of choice for superimposition of the pre- and post-operative images. The result of this study was published in a refereed journal. ā€¢ Direct DICOM slice landmarking; a novel technique to quantify the direction and magnitude of skeletal surgical movements. This method represents a new approach to quantify maxillary and mandibular surgical displacement in three dimensions. The technique includes measuring the distance of corresponding landmarks digitized directly on DICOM image slices in relation to three dimensional reference planes. The accuracy of the measurements was assessed against a set of ā€œgold standardā€ measurements extracted from simulated model surgery. The results confirmed the accuracy of the method within 0.34mm. Therefore, the method was applied in this study. The results of this validation were published in a peer refereed journal. ā€¢ The use of a generic mesh to assess soft tissue changes using stereophotogrammetry. The generic facial mesh played a major role in the soft tissue dense correspondence analysis. The conformed generic mesh represented the geometrical information of the individualā€™s facial mesh on which it was conformed (elastically deformed). Therefore, the accuracy of generic mesh conformation is essential to guarantee an accurate replica of the individual facial characteristics. The results showed an acceptable overall mean error of the conformation of generic mesh 1 mm. The results of this study were accepted for publication in peer refereed scientific journal. Skeletal tissue analysis was performed using the validated ā€œDirect DICOM slices landmarking methodā€ while soft tissue analysis was performed using Dense correspondence analysis. The analysis of soft tissue was novel and produced a comprehensive description of facial changes in response to orthognathic surgery. The results were accepted for publication in a refereed scientific Journal. The main soft tissue changes associated with Le Fort I were advancement at the midface region combined with widening of the paranasal, upper lip and nostrils. Minor changes were noticed at the tip of the nose and oral commissures. The main soft tissue changes associated with mandibular advancement surgery were advancement and downward displacement of the chin and lower lip regions, limited widening of the lower lip and slight reversion of the lower lip vermilion combined with minimal backward displacement of the upper lip were recorded. Minimal changes were observed on the oral commissures. The main soft tissue changes associated with bimaxillary advancement surgery were generalized advancement of the middle and lower thirds of the face combined with widening of the paranasal, upper lip and nostrils regions. In Le Fort I cases, the correlation between the changes of the facial soft tissue and the skeletal surgical movements was assessed using PCA. A statistical method known as ā€™Leave one out cross validationā€™ was applied on the 30 cases which had Le Fort I osteotomy surgical procedure to effectively utilize the data for the prediction algorithm. The prediction accuracy of soft tissue changes showed a mean error ranging between (0.0006mmĀ±0.582) at the nose region to (-0.0316mmĀ±2.1996) at the various facial regions
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