3D multidisciplinary approach in orthodontics

Aim: The aim of this study was to combine the huge amount of information of low dose Cone Beam CT with a cephalometric simplified protocol thanks to the latest informatics aids. The quality of the images with CBCT machines is comparable to conventional CTs, but the image taking is faster, less expensive, and provide less radiation exposure. Material and methods: 130 patients were selected randomly for the study. They ranged in age from 8 to 42 years; there were 80 females and 50 males. Each patient had already lateral and posteroanterior cephalograms taken less than 6 months earlier. The cephalometric analysis was performed by three operators repeating the measurements twice (15 days apart) with a calibration meeting. The positions of the maxilla and mandible in 3D space were determined using low-dose CBCT by assigning three reference planes to obtain the (x, y, z) position of each point of the skull relative to point S with coordinates (0, 0, 0), which was automatically determined by the computer as the intersection of the reference planes. The position of the jaws in 3D space was determined by assigning 18 easily identified, repeatable cephalometric points, to establish two solid figures representing spatial changes of points of orthodontic interest in terms of the shape or position of the jaw bones. Results: Statistically significant differences were found between cephalometric angular and linear measurements taken with conventional radiographs vs those taken with CBCT (p<0.01). In contrast to those on radiographs, the angular and linear measurements three-dimensionally detected, become real, moreover the selection of fewer points and the automatic measurements made by the computer reduced human error, for a much more reliable and repeatable diagnosis. (p<0.01) Conclusion: Three-dimensional imaging provides information and images of craniofacial structures free from perspective distortion, with none of the magnification or superimposition associated with 2D images. This method saves time and increases precision, offering a valuable aid to orthodontic-surgical diagnosis. The value of a 3D image model directly corresponds to the quality of the information 3D cephalometrics allows clinicians to analyze, diagnose, plan, communicate. Treatment changes can then be recommended based on a patient's individual preference within his or her biologic, physiologic, and anatomic limits.