Contribution of IT to orthodontics

Contribution of IT to orthodontics

1. INTRODUCTION :

The practice of dentofacial orthopedics (DFO), like all fields, is experiencing continuous improvement thanks to IT.

This technical progress will therefore be revealed at different levels of the ODF practice: management of the consultation, assistance with diagnosis (cephalometric analyses, digitalization of models) and at the therapeutic level (visualization of treatment objectives, design and manufacture of equipment such as custom brackets);

The use of the computer tool in ODF has allowed for better organization, and a considerable saving of time and effort, ensuring the satisfaction of the patient and the orthodontist himself.

2. History of computing in the field of dentistry

1971 : DR. François DURET et al were able to begin their work to enable the birth of Computer Aided Design and Manufacturing ( CAD/CAM) in order to revolutionize the practices of restorative dentistry.

1981 : Appearance of the first software aimed at medical and management such as Medigest and 123 Santé .

1990 : appearance of the Cone Beam New Tom QRDVT 9000 , the latest development in sectional imaging dedicated to odontostomatology, very economical in terms of irradiation.

1997 : Introduction of the Invisalign technique , an orthodontic technique that allows teeth to be moved using a series of removable polycarbonate aligners.

2013 : Creation of the DIGITAL SMILE DESIGN (DSD ) Concept by the Brazilian Christian Coachman. DSD Connect allows all the information from the 2D virtual aesthetic project, created with Keynote or PowerPoint, to be transferred into compatible CAD/CAM software .

2017 : In China, a robot dentist successfully performed the first dental implant placement without any human intervention.

3. IT assistance for office management:

Management software is constantly evolving. Practice management software refers to the environment that allows you to manage your practice’s activity:

Advantages of IT tools in an orthodontic practice

*Simplification of administrative and accounting tasks: which are carried out by automatic processing.

*Complete patient administrative file, management of appointment dates, financial management.

*Material management and storage, the digitalization of casts solves a relevant problem in orthodontic practices, which is their storage.

*Statistics and sample studies.

*The drafting of social security forms (and documents intended for mutual insurance companies and other insurance companies.

*Daily backup of computerized data (patient records, x-rays, income and expense books, etc.) on an external hard drive reduces the risk of data loss and reduces the space required in the orthodontic practice after several years of practice.

*Continuing training is an ethical obligation. Due to lack of time, practitioners can train online via the various sites available on demand, 24/7.

*Computer assistance for communication :

The Internet provides access to a global network through the creation of:

-Email addresses of forums and specialized sites for the dental profession.

-Bibliographic support and research services.

*The practitioner can communicate with other colleagues via electronic message (email). The transfer of multiple data (x-rays, photographs, medical history, etc.).

*Thanks to new technology, the patient understands the practitioner’s explanations more easily, this is ensured by software that allows a preview of the result on a tablet.

4. Computer assistance for orthodontic diagnosis:

Digital ODF developed alongside computer science with the advent of digital photography, a new tool for diagnostic assessment. Then, the increase in computer power and, therefore, ODF software, made it possible to use digital technology to calculate, construct, and demonstrate therapeutic solutions.

1. Digital photography

With digital technology, photography has become an essential tool for the diagnosis, implementation and monitoring of dental treatments.

Photography is a simple and common visualization method, serving as a reference for the patient’s aesthetic assessment. The purpose of this assessment is therefore to visualize, diagnose and plan the tasks to be performed.

The interests of digital photography:

– Instant evaluation of photography results.

– Possibility of immediate or delayed deletion of the snapshot.

• Modification and improvement via image processing software ranging from simple rotation, to cropping or even changing the exposure of the photograph
• Saving photographs and archiving them easily on a computer.
• Easy transfer to computers (USB connection, memory card reading or even WIFI connection).
• Printing on various media.
• Modeling of the patient’s face with the possibility of creating a morphing and its use in planning software for soft tissue management.
• Inter-practitioner communication in the case of collaborations but also with the patient with easy sharing of images.

-No degradation of the image over time.

The practitioner then creates a photographic file using various images. These photographs must be identified and numbered. This assessment constitutes forensic evidence of the initial condition.

2.  Digital imaging:

Digital radiology now offers practitioners the ability to take all kinds of images (ortho-pantomograms, teleradiographies, retro-alveolar radiographs) right in the office. Immediate image acquisition, a significant reduction in the doses of ionizing radiation received by patients, and ease of image storage and transfer.

*The contribution of sectional imaging, through computed tomography (CT) and especially cone beam computed tomography (CBCT), finds its indications.

This technique, which appeared in the late 1990s, uses a conical-shaped irradiation beam. As a result, it is much less irradiating than a conventional CT scan.

The dental scanner (denta scanner ) and more recently cone beam tomography (cone beam), allow 3D three-dimensional reconstructions which can be of major interest in certain cases such as:

* clinical assessment of the impacted teeth (root anatomy, periapical lesions), and their anatomical environment (neighboring teeth and bone quality).

The cone beam has the following advantages:

-Be less irradiating than the scanner.

• To be able to concentrate the examination field on a specific area (a few teeth, a jaw) to avoid unnecessarily irradiating other parts of the skull.
• Be more precise than dental panoramic (it gives images without distortion or crushing of the planes).
• Provide a resolution similar to, or even higher than, that of the scanner.
• Provide more detailed information on small bone structures that are difficult to visualize on a scanner.

-Allow 3D digital reconstruction.

-Highlight the existence of certain obstacles to dental movement (root ankyloses, tumor obstacles, etc.).

-Detect anatomical proximities that may hinder orthodontic treatment (maxillary sinus, inferior dental nerve).

3.  Computerized cephalometric analyses:

Various existing analyses are already programmed on cephalometric software, which also allows the execution of a certain number of settings to personalize classic analyses, or to create new ones.

 Benefits :

-Simple operation.

-Fast and automatic production.

– Save time and immediate reading of results and storage possibilities.

– Possibility of carrying out the study of several cases at the same time.

– Obtaining results with precision and a tiny margin of error.

There are two types:

*Two-dimensional (2D) analyses Steiner, Sassouni, Delaire, Rikcetts, Tweed)

*Three-dimensional scenographic analyses (3D): using the software: C 2000 and CEPHA 3DT. PROCUSTUS.

Procrustes, a special cephalometric analysis software

Diagnosis is made by visually examining the differences between the case and an optimum. According to Sassouni, an optimum is a personalized treatment goal based on the typology, growth stage, and ethnicity of each case. (Procrustes has thousands of Class 1 patients in memory.)

The method allows the effects of different treatments to be modeled and thus virtual therapies to be tested before carrying out the actual treatment. (Procrustes has hundreds of cases in memory treated with classic Activators, PULLs and extractions of 4 premolars).

For the actual superposition of the start and end of a treatment, the Procrustes method uses the positions of the cephalometric points directly. There is therefore no use of angular values ​​as with conventional analyses, which allows for a good analysis of therapeutic changes.

4.  Visualization of Treatment Objectives (VTO):

It is a graphical construction of the image of what a subject’s profile will be in a certain number of years, depending on the growth forecast and the effects of treatment.

Thanks to current databases, forecasting software such as: “ QUICK CEPH or

DOLPHIN IMAGIN » the therapeutic project is refined and allows:

*Consider different therapeutic solutions.

*Judge the feasibility of each solution.

*During processing, the comparison of the different shots with the VTO allows the achievement of the set objectives to be checked.

4-5 The optical impression:

The optical impression allows the practitioner to obtain a three-dimensional image of one or more teeth using an intraoral camera coupled with a computer. These impressions have many advantages such as: they are compact, comfortable for the patient and offer great stability.

Optical impression is defined as the projection of a light signal onto dental surfaces. The reflected signal will be captured by the camera, which will create the 3D three-dimensional model.

It can be done either by:

-Scanning of the model within the laboratory with an extra-oral scanner or table scanner (with or without contact) which digitizes a plaster model from an impression or directly a classic physical impression.

-An intraoral camera directly in the mouth.

It represents a serious alternative to conventional impression techniques.

* Advantages of optical impression :

-Precision equivalent to superior to conventional materials in the order of µ

-Optical measurements are the most accurate at present.

– Unalterable, invariable, duplicable: no wear and no deformation over time.

-Easily storable and transportable/transferable: hard drive, USB key, secure servers.

– Retouching possible: simply erase the area and rescan.

-Direct link between the mouth and the master model: less risk of information error.

-In complex cases, such as patients at high risk of nausea or

multiple prints, the print can be taken gradually in order to maintain the quality of the recording.

-An excellent communication tool, whether with patients to explain the prosthetic work to be done or with the prosthetist. We can communicate together in real time by consulting the same file.

4-6 The digital setup (The digital model)

The rise of optical impression cameras has allowed the widespread use of a very powerful tool, the digital set-up. This is a three-dimensional simulation of a treatment plan, made from a

recording of dental arches and occlusion (optical impressions) and which can be carried out in the office or using commercial systems. The Set-Up is used for diagnosis and construction of the treatment plan, stages

essential for the success of orthodontic treatment.

It is completed by a recording of the face (if possible in 3D), including the patient’s teeth, with

photographs, X-rays and dental models (optical impressions). Using these simulations, different therapeutic objectives can be assessed, such as

need for dental extraction or interproximal reduction for example.

A Set-Up is therefore a very useful diagnostic tool, which can be used to validate, modify or reject a treatment plan, allowing certain difficulties to be anticipated, particularly in complex cases. It has also enabled the development of more precise, custom-made devices, which have shaken up conventional orthodontics in recent years.

*The advantages :

• Storage
• Saving time. Thanks to recent IT tools
• Creating a virtual set-up is much faster than a conventional set-up.

-But the main advantage of the digital Set-Up lies in the precision it brings to the diagnosis, with much more complete measurements,

• A speed of analysis which allows the orthodontist to have a significant amount of information at his disposal to study each malocclusion.

-They are easy to duplicate, modify or manipulate, the shape of the dental arch can be planned in advance using charts for example,

• The possibility of making superpositions with respect to the initial state and one can obtain extremely precise information on all the dental movements carried out in the 3 dimensions

-They allow us to easily and simply test different hypotheses

therapeutics, and we can mix different 3D examinations in order to obtain an even more precise simulation, in particular with the use of a Cone Beam (CBCT) to have a Set-Up including the dental roots and the alveolar bone

-Finally, the digital set-up allows for better communication. With patients, by showing them the “before/after” result using 3D models,

More than a diagnostic tool, Set-Ups were then used to “create treatments” and make custom orthodontic devices. They are at the heart of these treatments,

because the success of orthodontic treatment depends on the construction of a quality digital Set-Up (dental movements and movement sequences).

5.  Computer assistance for orthodontic treatment:
   1.  Computer-aided design and manufacturing (CAD/CAM)

* Computer-aided design and manufacturing of individual brackets :

It is an American technique presented in 1994, it uses an optical impression of the mold obtained using a high definition 3D scanner.

The precision of this optical impression allows custom brackets to be machined with the base adapted to the lingual surfaces of the teeth.

* Computer-aided design and manufacture of arches:

The BENDING ART SYSTEM (BAS) is a German-made system that custom-makes an arch for the patient based on the desired values ​​for each tooth.

A three-dimensional optical impression is taken using an intraoral camera connected to a computer. From this impression, the computerized machine tool shapes the wire to insert torques, offsets, and angulations.

2.  Simulation of orthodontic treatments (The virtual set-up):

* ALIGN TECHNOLOGY performs a computer-assisted therapeutic simulation based on an animated 3D model (set-up) called Clin check, it is a computer video showing the movements of the teeth from their initial positions to the final position.

*ALIGN TECHNOLOGY performs the treatment using a series of thermoformed medical plastic (polycarbonate) aligners called “aligners” or kits.

3. 3D printing:

It should be noted that before undertaking the printing of a part, it is first necessary to carry out its design on suitable software. This involves the digitalization of the dental impression, either directly in the mouth using optical impression systems, or using extra-oral scanners that allow the direct scanning of impressions or models once cast.

5.4. Orthognathic surgery:

The traditional treatment protocol is based on pre-surgical orthodontic preparation for orthodontic dentoalveolar decompensation and a pre-surgical assessment with a set-up to quantify surgical displacements based on the results of the orthodontic preparation. Then, surgical guides are made and surgery is performed. This is followed by an essential post-surgical step as well as orthodontic finishing if necessary.

5.5 Digital Smile Design (DSD)

It is a technology that was developed by Christian Coachman in the 2000s. It allows for the creation and structuring of a dental treatment plan. But it is also a means of communication, of discussion between the different professionals who collaborate in the design of a dental treatment (orthodontist, implantologist, prosthodontist, laboratory technician, patient). The DSD is used both in orthodontics and in implantology (the creation of composite or ceramic veneers).

6.  Conclusion :

Today, the integration of these digital techniques into our daily practice is inevitable and the benefit is not negligible, the arsenal of diagnostic and treatment means is evolving and the practitioner must adapt to these changes.

For several years, digital technology has been introduced in orthodontics, first with photography, then with radiology and, more recently with casts, especially in lingual orthodontics.

To summarize, digital technology is evolving the range of therapeutic means available to the practitioner with techniques derived from the development of computer-aided design and manufacturing (CAD/CAM). Applied to ODF, this field of

Computer science combines modeling and visualization with the automatic construction of devices using robots.

Contribution of IT to orthodontics

  Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.

Contribution of IT to orthodontics