COMPUTERS IN ORTHODONTICS

The computer is basically an automatic electronic machine that performs calculations or derives results based on the data fed into it.

A computer is capable of accepting data, performing operations acc. to instructions and providing the results of these operations in comparatively shorter duration of time and with greater accuracy.

 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.

History of Information Technology & Systems

Four Basic Periods of Information Technology

Pre mechanical Mechanical Electromechanical Electronic

The Pre-mechanical Age: 3000 B.C. - 1450 A.D. First Calculators: The Abacus

Alan Mathison Turing Father of Modern Computer Science

British mathematician & cryptographer Concept of algorithm & computation: The Turing machine

Designed one of the first electronic programmable digital computers: THE COLOSSUS

The Electronic Age: 1940 - Present

First Generation (1951-1958) - Punch Cards

Second Generation (1959-1963) Transistors Third Generation Circuits (1964-1979) -Integrated

Fourth Generation (1979-Present)

Classification Of Applications
1) Administrative applications Patient case records Recall appointments Accounts Patient correspondence Billing Inventory lists Prescription formats Post-treatment instructions Insurance claims Referral information Missed appointment follow up.

2) Clinical applications
Patient photographs & radiographs Patient motivation Appliance design using CAD CAMs Growth predictions Visual treatment objectives Generation of pre & post-treatment photographs Survey information/epidemiological data Presentations Continuing dental/ medical education Literature reviews Entertainment

3) Miscellaneous applications Survey information / epidemiological data Presentations Continuing dental / medical education Literature reviews

Entertainment

CAD / CAM
CAD Computer Aided Designing CAM Computer Aided Manufacturing Occlusal Splints Planning Surgeries Bone Implants Restorations Designing structures for FEAnalysis Appliances and equipment

Application of computers in orthodontics Research

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Procedure for designing a splint

Surface geometry of casts - scanned by 3D laser surface scanner Facial morphology 3D triangular facets connecting spatial coordinates landmarks from frontal & lateral cephalograms 3D virtual image for surgical simulation

Application of computers in orthodontics Research/Clinical / Manufacturing

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 3D virtual image used to plan the amount and direction of bone displacement post surgically Surgical splint designed on this image
3D graphic image of surgical splint is transferred to a laser lithography unit for polymerization
Application of computers in orthodontics Research / Clinical / Manufacturing sem1/sb/09-04

CAD/CAM FABRICATION OF OCCLUSAL SPLINT FOR ORTHOGNATHIC SURGERY

LASER SCANNING OF THE CAST

IMAGE OF CAST ON MONITOR

IMAGES OF STUDY CASTS AND FACIAL SKELETON COMBINED FOR SIMULATION

SAGITTAL SPLIT RAMUS OSTEOTOMY SIMULATED ON 3D IMAGE

CONTACT AREAS OF OCCLUSAL SPLINT DRAWN FROM COMPUTER IMAGE OF STUDY CAST

FINISHED 3D IMAGE OF OCCLUSAL SPLINT

OCCLUSAL SPLINT POLYMERIZED BY LASER LITHOGRAPHY UNIT

Bending Art System (B A S)

Fischer - Brandies and Orthuber Wolfgang invented BAS in 1983 1st prototype of BAS manufactured in 1993 Components of BAS 1. Stereoscopic camera 2. Personal computer and its software 3. Arch wire bending device
Application of computers in orthodontics Research sem1/sb/09-04

Stereoscopic camera
Stereoscopic camera consists of CCD which can be directly used in the patients mouth Procedure - SS measuring plates placed on the bracket slots & molar tubes - Mirror of camera moves two times forward and backward - Scans using White light
Application of computers in orthodontics Research sem1/sb/09-04

Bending Art System (B A S)

Application of computers in orthodontics Research

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Arch Wire Bending Component

Three components > Holding cone > Inner cone > Partial cone

Application of computers in orthodontics Research / Manufacturing

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- Round wire and Rectangular wire used

- SS, TMA or Ni-Ti wires - Bending begins only after all bends are manipulated - Approximately takes 5 7 min
Application of computers in orthodontics Research / Manufacturing sem1/sb/09-04

Advantages Precision arch wires Rapid fabrication Fabricate full size passive arch wires for surgical cases T loop & L loop construction Utility arches made

Disadvantages Time required for the insertion of measuring plates & their identification Clinical judgment is still vital Steel wire easily deformed

Application of computers in orthodontics Research / Manufacturing

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FUNDAMENTALS OF COMPUTER GRAPHICS

GRAPHIC APPLICATIONS - Software applications that convey information pictorially Information is displayed graphically on a cathode ray tube (CRT) monitor or flat panel display

Pixel
The image space on a monitor is made of tiny square picture elements, called pixels (using the common abbreviation "pix" for "picture) Arranged in the series of horizontal lines called Raster lines

Graphic images
Bitmaps

Digital images are stored in a matrix of rows & columns of pixel values Image-editing programs are designed to work primarily with bitmapped images Corel Paint, Microsoft Photo Editor and Photoshop are examples of bitmap editing programs.

Bitmapped image

RADIOGRAPHIC IMAGE ACQUISITION

Denoptix
Digital radiographic technique which uses Phosphor imaging plates to capture and store images Advantages - Alternative to conventional film - Same machine and settings - No dark room required - Environment friendly- no heavy metal wastage - Can be reused thousands of times
Application of computers in orthodontics Clinical / Graphic sem1/sb/09-04

Imaging cycle

1.Load intraoral or panoramic imaging plate

5. Erase imaging plates for reuse

2. Take X ray

Image on computer

3. Mount imaging plates in carousel

4. Place in scanner & Scan images

CEPHALOMETRIC APPLICATIONS

CEPHALOMETRIC APPLICATION WORKFLOW DIGITIZATION DISPLAY

ANALYSIS
TREATMENT PLANNING HARD COPY

DIGITIZATION
Is the form by which analog information is converted to digital form 2 methods used: A digitizing table or digitizer with fine cross hairs, to locate landmarks & contours on radiographs manually. This is transmitted to computer & recorded for various cephalometric determinations

MODE OF DIGITIZATION
POINT MODE

discrete location of individual landmarks

 STREAM MODE

a stream of co-ordinated pairs are recorded as the user traces the radiographic contour

DIGICEPH
IIT and AIIMS New Ceph placed on Delhi digitizer Computerised ceph digitisation Automatic analysis Plot superimposition 13 Ceph analysis
Application of computers in orthodontics Clinical / Graphic

Point mode used to move cursor Stream mode to finish X Y co-ordinates are recorded and analysed
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Digigraph
Introduced by Dolphin imaging systems Non radiographic system Video imaging is also possible

Application of computers in orthodontics Clinical / Graphic

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The Digi-Graph work station is about 5 feet long, 3 feet wide and 7 feet high. The main cabinet contains the electronic circuitry, and the patient sits next to the cabinet in an adjustable chair similar to those used with cephalometers.

The head holder is suspended from a beam, supported by a vertical column attached to the cabinet.
Ear rods and forehead and posterior head pieces are used to minimize patient movement.

ear rods can be removed so that facial and intra-oral images can be recorded while the patient is sitting

A light box can also be attached to the head holder for imaging head films, wrist films and panoramic x-rays.

The video monitor is attached that can be rotated as the operator moves.

The images, text and numerical data can be displayed, stored & modified using either a light pen or a standard computer keyboard.

The digitizing handpiece is used to record cephalometric data The removable, sterilizable tip of the handpiece is placed directly on the patient to record a series of facial and intraoral landmarks. As each landmark is located, the handpiece button is depressed and the location is recorded in three-dimensional coordinates (x,y,z). Each time the

handpiece button is depressed, an audible sound is picked up by an array of four microphones on the beam. The
time it takes the sound to reach each of the microphones determines the landmark location.

Any image appearing on the screen can be reproduced instantaneously with one of three "hard copy" output devices: Sony video imager: makes 5 " x 7 " color prints in 60 seconds Polaroid freeze-frame camera produces Polaroid prints in 10 seconds; Hewlett Packard Paintjet printer makes 8 " x 10 " paper color copies in 4 to 8 minutes.

RMOS JIFFY ORTHODONTIC EVALUATION First to provide a computer aided cephalometric diagnosis to the dental profession in the late 1960s Marketed a software package described as JOE JOE generates tracings of lateral or frontal cephalograms using Ricketts, Jarabak, Sassouni, Steiner & Grummons analyses

 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.

PorDIOS (Purpose on Request Digitizer Input Output System)

Is a cephalometric IBM compatible system whose development is aimed to provide orthodontists with a 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

 Produces occlusograms from photocopies of dental casts 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 .

 During registration, points can be declared as missing or digitized at a later time.

Drawings can be printed either on a matrix printer as a screen dump, on a laser printer, or on a colour plotter.

Dentofacial Planner
Is a computer aided software for diagnostic and treatment planning in orthodontics and orthognathic surgery Works with an IBM compatible processor Analyses included are Steiner, McNamara, COGS, Downs, Grummons, Legan & Jarabak. allows the user to do superimposition, estimate facial growth, to simulate skeletal and soft tissue effects of orthopedic appliances and to simulate orthodontic tooth movements.

Computer Aided Space Analysis

Chen Hsing Yen

Bolton ratio
Tooth size relation of U & L arches Overjet and Overbite Posterior intercuspation Arch length
Application of computers in orthodontics Clinical / Graphic sem1/sb/09-04

Computerised Tooth Width Analysis

Christopher T.C.Ho Five Screens & Terrence.J.Freer Ho Freer Graphical Patient details analysis Mesiodistal tooth Digital callipers or width manual input for Tooth width ratio Windows Tooth width excess Graphic display Advantages

Convenient, Consistent and Easy to operate

Application of computers in orthodontics Clinical / Graphic sem1/sb/09-04

Align Technology
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.

Initial treatment planning with patients photographs and radiographs are sent to Invisalign laboratory

Impressions are converted into positive plaster models & checked for quality.

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 plaster models inside. Each tray is placed in a destructive scanning machine

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 patients teeth will look like when the treatment is completed

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.

 The patient is instructed to wear each aligner for approximately 12 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.

Advantages :
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

Contraindications patients with severe malocclusions All children growing jaws and erupting teeth make it too complicated for the computer to model

Magnetic Resonance Imaging

Magnetism is a dynamic invisible phenomenon consisting of discrete fields of forces. Magnetic fields are caused by moving electrical charges or rotating electric charges. Images generated from protons of the hydrogen nuclei.

Equipment
The Gantry - houses the patient Patient is surrounded by magnetic coils

Operating console - where the operator controls the computer and scanning procedure
Computer room network.

presence of specific magnetic properties found within atomic nuclei containing protons and neutrons. Inherent property of rotating about their axis Causes a small magnetic field to be generated around the electrically charged nuclei.

The dipoles exposed within a strong electric field

Cause Orientation in response to the field

Signal is interpreted and image produced

 Indications Assessing diseases of the TMJ Cleft lip and palate Tonsillitis and adenoiditis Cysts and infections Tumors

 CONTRAINDICATIONS Patients with cardiac pacemakers Patients with cerebral metallic aneurysm clips. Slight movement of the clip could produce bleeding

Stainless steel and other metals produce artifacts, obliterate image details of the facial area.

 Shortcomings

Inability to identify ligament tears or perforations Dynamics of tissue joint not possible
Cannot be used in patients suffering from Claustrophobia.

Computed Tomography
Invented by Sir Godfrey Hounsfield who was awarded a Nobel prize in 1979

CT is an image display of the anatomy of a thin slice of the body developed from multiple x- ray absorption measurements made around the bodys periphery.

Parts of the Equipment: Scanner ( movable x ray table + gantry) Computer system A display console

Principle: An x-ray source and array of detectors mounted within the gantry rotate around the patient during each scan.
Detectors record the attenuation values of the beam emerging from the patient Information from each traverse is a

Profile

 The tube and detectors are further angled and another traverse is made.

A series of Profiles are built up.

The computer analyses the data and an image is produced.

 Useful in determining changes in bone density Primary imaging method when internal derangement or arthrosis is suspected Has advantages when planning treatment or operations on jaws and TMJ diseases and deformities.

Communication
Orthodontists Perspective

Searching Websites for Information Medline, Pub med, NML Net Discussion Net Conferencing Multispeciality Tele Surgery

Application of computers in orthodontics Miscellaneous

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