Digital diagnosis records in orthodontics : An overview

Actualmente la tecnología digital es una realidad que cada vez se impone más en todos los ámbitos clínicos y, por tanto, existe una incorporación también de los ortodoncistas a la digitalización de los registros ortodóncicos diagnósticos. En este trabajo queremos hacer una valoración sobre las ventajas y desventajas, del uso de la radiografía digital, la fotografía digital así como de la última incorporación, los modelos de estudio digitalizados. Basados en encuestas previas, mostraremos la situación actual en nuestro país en cuanto al número de profesionales que utilizan estos registros digitales de manera sistemática

A new 3D method for measuring cranio-facial relationships with cone beam computed tomography (CBCT)

Objectives: CBCT systems, with their high precision 3D reconstructions, 1:1 images and accuracy in locating cephalometric landmarks, allows us to evaluate measurements from craniofacial structures, so enabling us to replace the anthropometric methods or bidimensional methods used until now. The aims are to analyse cranio-facial relationships in a sample of patients who had previously undergone a CBCT and create a new 3D cephalometric method for assessing and measuring patients. Study Design: 90 patients who had a CBCT (i-Cat®) as a diagnostic register were selected. 12 cephalometric landmarks on the three spatial planes (X,Y,Z) were defined and 21 linear measurements were established. Using these measurements, 7 triangles were described and analysed. With the sides of the triangles: (CdR-Me-CdL); (FzR-Me-FzL); (GoR-N-GoL); and the Gl-Me distance, the ratios between them were analysed. In addition, 4 triangles in the mandible were measured (body: GoR-DB-Me and GoL-DB-Me and ramus: KrR-CdR-GoR and KrL-CdL-GoL). Results: When analyzing the sides of the CdR-Me-CdL triangle, it was found that the 69.33% of the patients could be considered symmetric. Regarding the ratios between the sides of the following triangles: CdR-Me-CdL, FzR-Me-FzL, GoR-N-GoL and the Gl-Me distance, it was found that almost all ratios were close to 1:1 except between the CdR-CdL side with respect the rest of the sides. With regard to the ratios of the 4 triangles of the mandible, it was found that the most symmetrical relationships were those corresponding to the sides of the body of the mandible and the most asymmetrical ones were those corresponding to the base of such triangles. Conclusions: A new method for assessing cranio-facial relationshps using CBCT has been established. It could be used for diverse purposes including diagnosis and treatment planning

Dental arch changes from adolescence to adulthood in a spanish population : a cross-sectional study

Objectives: Given the controversy in the literature about the variations in intercanine and intermolar distances and arch perimeter once the eruption of permanent teeth is completed, the aims of this study were to assess the changes of these measures with age, analyzing its sexual dimorphism and variability in a Spanish population. Study Design: 188 Spanish individuals distributed in three age groups were selected: 63 adolescents (mean age: 14.15 years), 62 young adults (mean age: 21.9 years) and 63 adults (mean age: 40 years). The intercanine and intermolar distances and arch perimeter were measured in each dental cast from each individual of the sample using a digital method. The results were compared between sex and age groups, the sexual dimorphism percentage (%) of each measure and its variability coefficient (VC%) were calculated. Results: The results depend on sex and age and, therefore, these two factors will be analyzed jointly for each of them with the variation coefficient of the measurement. Intercanine and intermolar distances and arch perimeter were greater in men than in women, especially in the young adult and adult groups. Conclusions: The intercanine distance and arch perimeter tended to decrease with age particularly in the female sex, whilst the intermolar distance didn't undergo significant changes. The intercanine distance is the dimension that presented the greatest variability, whereas the intermolar distance presented the least. The changes occur in the transition from adolescence (14 years of age) to adulthood (22 years of age) and the subsequent alterations are not relevant. © Medicina Oral S. L

Tooth size changes with age in a Spanish population : percentile tables

Objectives: The aims of this work were: firstly, to draw up tables of percentile tooth sizes similar to those of Sanin and Savara for three age groups of a Spanish population; secondly, to describe changes in tooth size between those groups over time, as well as observing any sexual dimorphism and, finally, to compare both the Spanish and Sanin and Savara's American population samples. Material and methods: The sample included 359 patients and was divided into three age groups: adolescents, young adults and adults, of both genders. After dental cast digitalization, mesiodistal tooth-size was measured on each dental cast using a digital method. Dental size tables organized by percentiles for each group of age and gender were drawn up. Percentiles under 30 were considered as small, between 30 and 70 as average, and above 70 as large. As symmetry was found between contralateral teeth, the mean between the teeth of the two semi-arches was considered. Results: The mesiodistal tooth sizes of adolescents did not present statistically significant differences between genders, in contrast to the two other age groups. Conclusions: Mesiodistal tooth diameters tended to diminish with age, especially in women, in the Spanish population. The values obtained for our dental tables, organized by percentiles, were slightly higher than those found by Sanin and Savara in an American population, especially for women. © Medicina Oral S. L

Evaluation of the validity of the Bolton Index using cone-beam computed tomography (CBCT)

Aims: To evaluate the reliability and reproducibility of calculating the Bolton Index using cone-beam computed tomography (CBCT), and to compare this with measurements obtained using the 2D Digital Method. Material and Methods: Traditional study models were obtained from 50 patients, which were then digitized in order to be able to measure them using the Digital Method. Likewise, CBCTs of those same patients were undertaken using the Dental Picasso Master 3D® and the images obtained were then analysed using the InVivoDental programme. Results: By determining the regression lines for both measurement methods, as well as the difference between both of their values, the two methods are shown to be comparable, despite the fact that the measurements analysed presented statistically significant differences. Conclusions: The three-dimensional models obtained from the CBCT are as accurate and reproducible as the digital models obtained from the plaster study casts for calculating the Bolton Index. The differences existing between both methods were clinically acceptabl

Influence of first and second premolar extraction or non-extraction treatments on mandibular third molar angulation and position. A comparative study

The mandibular third molar (3M) is the tooth that is most often impacted, with lack of space being one of the reasons. In some orthodontic treatments, premolars are extracted in order to create space. The aims of our study are: firstly, to assess the changes in the angulation and position of the 3M in cases treated either with or without extraction of the first or second premolars; secondly, to analyse the variation in the gonial angle and the degree of inclusion of the 3M; and lastly, to establish a predictive impaction model for 3M. This study included 88 patients: 28 patients treated with extractions of first premolars, 30 with second premolars and 30 without. The initial and final orthopantomography was analysed and the angulation of the 3M was measured, a new variable being created to determine the degree of 3M inclusion in the mandibular ramus. The results show that the angulation of 3M improves with time, regardless of treatment, and presents a greater disinclusion in cases treated with extractions. The gonial angle tends to diminish with age in all cases. The conclusions suggest that other factors may influence the angulation and position of 3M and that it is not possible to establish a predictive impaction model

Use of self-organizing maps for analyzing the behavior of canines displaced towards midline under interceptive treatment

Displaced maxillary permanent canine is one of the more frequent findings in canine eruption process and it?s easy to be outlined and early diagnosed by means of x-ray images. Late diagnosis frequently needs surgery to rescue the impacted permanent canine. In many cases, interceptive treatment to redirect canine eruption is needed. However, some patients treated by interceptive means end up requiring fenestration to orthodontically guide the canine to its normal occlusal position. It would be interesting, therefore, to discover the dental characteristics of patients who will need additional surgical treatment to interceptive treatment. To study the dental characteristics associated with canine impaction, conventional statistics have traditionally been used. This approach, although serving to illustrate many features of this problem, has not provided a satisfactory response or not provided an overall idea of the characteristics of these types of patients, each one of them with their own particular set of variables. Faced with this situation, and in order to analyze the problem of impaction despite interceptive treatment, we have used an alternative method for representing the variables that have an influence on this syndrome. This method is known as Self-Organizing Maps (SOM), a method used for analyzing problems with multiple variables. We analyzed 78 patients with a PMC angulation higher than 100º. All of them were subject to interceptive treatment and in 21 cases it was necessary to undertake the above-mentioned fenestration to achieve the final eruption of the canine. In this study, we describe the process of debugging variables and selecting the appropriate number of cells in SOM so as to adequately visualize the problem posed and the dental characteristics of patients with regard to a greater or lesser probability of the need for fenestration

A study on the reproducibility of cephalometric landmarks when undertaking a three-dimensional (3D) cephalometric analysis

Objectives: Cone Beam Computerized Tomography (CBCT) allows the possibility of modifying some of the diagnostic tools used in orthodontics, such as cephalometry. The first step must be to study the characteristics of these devices in terms of accuracy and reliability of the most commonly used landmarks. The aims were 1- To assess intra and inter-observer reliability in the location of anatomical landmarks belonging to hard tissues of the skull in images taken with a CBCT device, 2- To determine which of those landmarks are more vs. less reliable and 3- To introduce planes of reference so as to create cephalometric analyses appropriated to the 3D reality. Study design: Fifteen patients who had a CBCT (i-CAT®) as a diagnostic register were selected. To assess the reproducibility on landmark location and the differences in the measurements of two observers at different times, 41 landmarks were defined on the three spatial axes (X,Y,Z) and located. 3.690 measurements were taken and, as each determination has 3 coordinates, 11.070 data were processed with SPSS® statistical package. To discover the reproducibility of the method on landmark location, an ANOVA was undertaken using two variation factors: time (t1, t2 and t3) and observer (Ob1 and Ob2) for each axis (X, Y and Z) and landmark. The order of the CBCT scans submitted to the observers (Ob1, Ob2) at t1, t2, and t3, were different and randomly allocated. Multiple comparisons were undertaken using the Bonferroni test. The intra- and inter-examiner ICC ?s were calculated. Results: Intra- and inter-examiner reliability was high, both being ICC ? 0.99, with the best frequency on axis Z. Conclusions: The most reliable landmarks were: Nasion, Sella, Basion, left Porion, point A, anterior nasal spine, Pogonion, Gnathion, Menton, frontozygomatic sutures, first lower molars and upper and lower incisors. Those with less reliability were the supraorbitals, right zygion and posterior nasal spine