Computers in orthodontics

COMPUTERS IN ORTHODONTICS

PRESENTED BY:KHUSHBU AGRAWAL

MIDSR DENTAL COLLEGE,

LATUR

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CONTENT

• INTRODUCTION • HISTORY OF COMPUTER TECHNOLOGY• CLASSIFICATION OF COMPUTERS• COMPONENTS OF COMPUTER

• CHARACTERISTICS OF COMPUTER• APPLICATIONS IN ORTHODONTICS

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• COMPARISON OF CONVENTIONAL AND COMPUTERIZED CLINICDigitalized photographs Digitalized radiographsSoftware for cephalometric analysisDigital study modelsCAD/CAM system

• PAPERLESS PRACTICE • INVISALIGN• REFERENCES• CONCLUSION

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• The word ‘computer’ originated from Latin word which meant ‘someone who computes’

• The American Heritage Dictionary (1980) gives its first computer definition as –

“a person who computes”

INTRODUCTION

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The Techencyclopedia (2003) defines computer as –

“a general purpose machine that processes data according to a set of instructions that are stored internally either temporarily

or permanently”

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• Four basic periods of computer technology are known:

HISTORY OF COMPUTER TECHNOLOGY

Pre-mechanical (300 BC – 1450 AD)

Mechanical (1623-1940S)

Electro-mechanical (Till 1940s)

Electronic (1940s till present)

From an article: HISTORY OF THE COMPUTERS: by ADEBOWALE ONIFADE, ELECTRICAL ELECTRONIC ENGINEERING DEPARTMENT UNIVERSITY OF IBADAN, NIGERIA

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A] Pre-mechanical Era (300 BC – 1450 AD)

• The first calculators – ABACUSS, the first information processors (2400 BC)• Antikythera wreck, the world’s earliest mechanical analog

computer (150-200 BC)

FROM HISTORY OF THE COMPUTERS: by ADEBOWALE ONIFADE, ELECTRICAL ELECTRONIC ENGINEERING DEPARTMENT UNIVERSITY OF IBADAN NIGERIA

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B] Mechanical Era (1623 – 1940S)• CHARLES BABBAGE – Father of computers • Invented the first mechanical computer in the early

19th century (1822)

Analytical Engine by Babbage

This is a portion of the mill with a

printing mechanism

From History of Computers: A Brief Timeline by Kim Ann Zimmermann, Live Science Contributor September 08, 2015

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C] Electro-mechanical (Till 1940s)

• The discovery of ways to harness electricity by Benjamin Franklin was the key advance made during this period.

• Information could now be converted into electrical impulses

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• Alan Mathison Turing – Father of Modern Computer Science• Concept of algorithm and computation: the Turing

machine• Designed one of the FIRST electronic programmable

digital computers THE COLOSSUS (1936)

First electronic digital programmable computing device, and was used to break German ciphers during World War II

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• The Four Generations of Digital Computing :

1. The First Generation (1951-1958) Punch Cards

2. The Second Generation (1959-1963) Transistors

3. The Third Generation (1964-1979) Integrated Circuits

4. The Fourth Generation (1979-Present) Mobile computers

D] Electronic Era (1940S till present)

From History of Computers: A Brief Timeline by Kim Ann Zimmermann, Live Science Contributor September 08, 2015

12TRS-80 (1977)

Dynabook By Alan Kay (1968)

IBM System 360(1952)

Harvard Mark I(1944)

Manchester Baby(Mid 1948)

ENIAC(1948)

SOME HALLMARK DEVICES DURING THE PAST

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DESKTOPS LAPTOPS iPADS and SMART PHONES

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A] Based on what performs the computer operations –

1. Flesh

2. Wood

3. Metal

4. Electromechanical devices

5. Electronic metals

CLASSIFICATION OF COMPUTER


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B] Based on capacity –

1. Microcomputers

2. Minicomputers

3. Medium-sized computers

4. Large computers

5. Supercomputers


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C] Based on basic operating system –

1. Analog computers

2. Digital computers

3. Hybrid computers


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COMPONENTS OF COMPUTER SYSTEM

• All mechanical devices• Machinery and

electronic components • Perform physical

functions

Hardware

• Organized set of specially written instructions

• Makes the equipment work

Software

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ORGANISATION OF A COMPUTER

MEMORY UNIT

INPUT DEVICE

OUTPUT DEVICE

CONTROL UNIT

+ALRITHMETI

C LOGIC UNIT

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• Following are some input devices :1. Keyboard2. Mouse3. Scanner4. Digital Camera , Camcorder5. Gamepad, Joystick, Steering wheel.6. Barcode Reader7. Touch Screen8. Webcam9. Biometrics (Thumb impression / Face detection)

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Memory unit

Internal memory

RAM

ROM

External memory

Floppy drive disc, CD-Rom,

hard drive disc, tapes

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• Following are some output devices :

1. Monitor

2. Printers

3. Plotters

4. Speakers

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CHARACTERISTICS OF COMPUTER

Speed

Accuracy and reliabil

ity

Versatility

Memory

Integrity

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APPLICATIONS IN ORTHODONTICS

1. Administrative applications

2. Clinical applications

3. Others

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Patient appointments and recalls Billing

Accounting

Correspondence Inventory control and supply

ordersDental insurance claims

Document preparation

Referral information

ADM

INIS

TRAT

IVE

APPL

ICAT

IONS

:

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Patient record storage and retrievalPatient evaluation,

examination and treatment planning

Patient motivation Appliance designing using

CAD/CAM Computerized imaging

Computerized cephalometryComputerized growth

predictionsClinical diagnosis and treatment planning

CLIN

ICAL

APPL

ICAT

IONS

:

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Data base for survey information

Continuing medical education

Reviewing of literature

Research

Case presentations

Conference presentations

Entertainment and family use

OTHE

RS:

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COMPARISON OF CONVENTIONAL AND

COMPUTERIZED CLINICS

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CONVENTIONAL

Case paperImpressions and

diagnostic records

Radiographs

Manual tracings

Cephalometric analysis

Diagnostic setup

Treatment- Preformed system

Mid-term evaluations

COMPUTERIZED

Data sheets

3D photography

RVG and Digital radiography

Digitized tracing

Advanced software

VTO / VTP

Treatment customizedContinuous monitoring

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DIGITALIZED PHOTOGRAPHS

• All 2-dimensional (2D) images are distorted except at the central beam. This is true for both photographs and x-rays. The farther from the central beam, the larger the distortion.

• Therefore, it is like apples to oranges to compare 2D photographs with 3D information from actual facial measurements (divine proportions).

Joe H. Mayes Am J Orthod Dentofacial Orthop 2009;135:4

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• Digital photography has become ubiquitous in modern society and its importance in dentistry is unquestionable

• This technology dates back to the 1970s and the first digital camera was launched in the market in the 1990s

Andre Wilson Machado. What's new in digital photography? Dental Press J Orthod 2010;15(2)

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ADVANTAGES:

1. Allows to view photographs on spot

2. Elimination of films

3. Reduces film development cost and inexpensive storage

4. Manipulation and editing capabilities

5. Streamline interpersonal communication


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• Currently, there are digital cameras with resolutions of up to 28MPs, enabling users to print images as large as 52 x 39 cm in high resolution (300 dpi)

• In orthodontics, most tasks involve viewing digital photos on computers and multimedia projectors and printing them with conventional equipment, specialized laboratories and scientific articles

• Digital camera compatible with the current standard market, typically featuring 10 to 15MP can be used for routine orthodontic purpose


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DIGITALIZED RADIOGRAPHS

A] DIGITAL RADIOVISIOGRAPHY • RVG - latest X-ray technology in

dentistry.• Digital radiovisiograph is

equipped with special image analysis software, and in digital technology it is possible to enlarge the images and their saving in the patient's file.

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B] DIGITAL CEPHALOGRAM

• Conversion of analogue information into digital form • Reduces radiation exposure by

a factor of 2• Gives better radiation

protection

Heiko Visser et al. Dose Reduction by Direct-Digital Cephalometric Radiography Angle Orthod 2001;71:159–163

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ADVANTAGES OF DIGITAL OVER CONVENTIONAL RADIOGRAPHS:

1. Reduced radiation of the patient compared with classic X-ray up to 80%

2. Faster imaging without X-ray film and developing images 3. Digital intraoral sensor is used instead of X-ray film4. Immediate imaging on the computer screen 5. High quality of the digital image that can be analyzed and

processed6. Saving images in the patient's file

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C] DIGIGRAPH

• Introduced by Dolphin imaging systems• Non-radiographic system• ‘Digigraph workstation’ • Video images also possible • VTO • Reduces time required for records

Spiro J. Chaconas et al. The DigiGraph Work Station, Part 1: Basic Concepts JCO 1990;24(6):360-7

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SOFTWARE FOR CEPHALOMETRIC TRACING

• Rapid advances in computer science have led to the wide application of computers in cephalometry.• The software program can generate the values of

cephalometric measurement instantaneously, when the locations of all the required landmarks are entered.• The digital cephalometric images can be integrated

with patients’ records to establish a computer-based filing system and to take advantage of image processing, storage, and transmission.

Cecilia Goraccia, Marco Ferrari Reproducibility of measurements in tablet-assisted, PC-aided, and manual cephalometric analysis Angle Orthod. 2014;84:437–442

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• A number of softwares are available for cephalometric analysis.

• Some of them are as below:

1. Nemoceph by SureSmile

2. Nemotec

3. Dentofacial planner system (or DFP Plus)

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DIGITALIZED IMAGING AND STUDY MODELS

OrthoCAD • It is a digital study model capture, assessment and storage

system.• It provides a 3D record of the original malocclusion, any

stages during treatment and the outcome of the treatment

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VISTADENT • Image management system VISTADENT COMPLETE™

ability to modify an image that is stored in the program, as well as the ability to do Visual Treatment Objective (VTO).• Images can easily be manipulated to show treatment

objectives by using standard editing features such as cut and paste or more advanced features like the Smile Library.

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• Ideal system requirements:1. Win 98 operating system or above 2. Pentium processor II 3. 64 MB RAM Other attachments4. Digital camera or scanner 5. RGB camera 6. Printer ( color)

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• Easy to calculate cephalometric analysis. • The Ceph program allows one to trace and identify your

points directly from a scanned X-RAY. • After points and tracings are entered they can easily be

edited for accuracy purposes. • Then Tracings, Analysis and Measurements can all be

printed on one page with the image. • The VTO feature automatically illustrates soft tissue

changes based on measurements for most orthodontic treatment as well as many surgeries

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CONE BEAM COMPUTED TOMOGRAPY

• Renders bone transparent that allows to determine position of developing or impacted tooth • Useful to evaluate significant

facial asymmetries• To determine surgical

positions of implants

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• 3D superimposition of the anatomic teeth, before treatment [A & B] and after [C & D] the setup to visualize the amount of teeth movement before and after treatment [ E ] by making use of 3D setup using computers.• By making use of this set up we can analyse a degree of

correction achieved in malocclusion and discrepensies like fenestrations.

(Am J Ortho Dentofacial Orthop, MAY 2006)

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• Airway volume assessment in pt. with mouth breathing, adenoid hypertrophy, or sleep apnea, by application of transfer function to 3D CT scan

• Bone rendering with transparent soft tissues by application of transfer function ,which render soft tissue invisible on 3D CT scan.

• Visualization of internal anatomic structures by removal of cranium by box cut to peek inside a 3D volume by use of transfer function.

(Am J Ortho Dentofacial Orthop, MAY 2005)

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Tooth-width analysis

• Introduced by Christopher T.C. Ho and Terrence Freer • Named as Ho-Freer Graphical

analysis of tooth width Discrepancy (GATWD)

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• Base line data obtained from pre treatment orthodontic casts. • Direct input using digital calipers or manual input using

visual basic• Upto 24 tooth width measurements can be done • Caliper used is a Mitutoyo 6”/ 150mm, with tapered

beaks • Connected to a Mitutoyo digimatic mini processor IBM

compatible computer

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ADVANTAGES: 1. Less time consuming2. Use of digital calipers reduces errors during transfer of

measurements3. Mathematical calculations done by the computer4. Eliminates reference to standard value tables

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CAD/CAM SYSTEM

• Computer-aided design and computer aided manufacturing systems: useful for the diagnostic setup of casts for orthodontic diagnosis and treatment planning

N Motohashi, T Kuroda A 3D computer-aided design system applied to diagnosis and treatment planning in orthodontics and orthognathic surgery European J of Orthod 1999;21:261-73

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• The system comprises a measuring unit which obtains 3D information from the dental model using laser scanning, and a personal computer to generate the 3D graphics.• When measuring the 3D shape of the model, to minimize blind

sectors, the model is scanned from two different directions with the slit-ray laser beam by rotating the mounting angle of the model on the measuring device.


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• For computed simulation of tooth movement, the representative planes, defined by the anatomical reference points, are formed for each individual tooth and are arranged along a guideline descriptive of the individual arch form.• Subsequently, the 3D shape is imparted to each of the teeth

arranged on the representative plane to form an arrangement of the 3D profile.• When necessary, orthognathic surgery can be simulated by

moving the mandibular dental arch three-dimensionally to establish the optimum occlusal relationship.


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APPLICATIONS:1. Making diagnostic models 2. Treatment planning, determination of amount of tooth

movement3. Mock surgical in case of orthognathic surgeries4. Alignment of tooth 5. Movement of dental arch 6. Bracket positioning

Noor Al Mortadi et al CAD/CAM/AM applications in the manufacture of dental appliances. AJODO 2012;142(5):727-33

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ADVANTAGES:1. High speed processing 2. Quantitative evaluation3. Time saving 4. Labor saving

DISADVANTAGES:5. Difficulty in measuring the overhangs, such as anterior oral

vestibule in dental models with severe labio-lingual tipping of anterior teeth

6. Need to develop software to automatically align teeth for computer stimulation of diagnostic casts

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ROBOTICS IN ORTHODONTICS

• Recent developments• Useful for:- Wire bending of 1st order bends - Bracket positioning • BAS – by Helge Fisher Brandies 1993• LAMDA – by Alfredo Gilbert in 2011

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PAPERLESS PRACTICE

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• The main hurdle today for discussing future in orthodontist practice is eliminating paper from daily operations • However, many orthodontist have realized that paperless

operations can be a reality and it does increase practice efficiency

PAPERLESS PRACTICE

Warren hamula et al. The paperless Practice JCO 1998

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• Changing the practice into high-tech operations• All paper records and manual systems is replaced by

central, computerized practice management system• These records include:

1. Demographic (patient information forms)2. Diagnostic (health histories, photographs, models, X-

rays)3. Treatment (charts, plans, notes)4. Scheduling (appointment book)5. Financial (ledger charts)


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VARIOUS ASPECTS WHILE CONVERTING TO PAPERLESS:

1. Technological considerations - computer system providing companies should

have considerable experience with paperless operations

2. Financial considerations - 2-5% of gross income

3. Physical considerations - location of work station, operating system

requirements, present and future software requirements


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• ADVANTAGES:

1. Security benefits

2. Economic benefits

3. Professional benefits

4. Legal issues

5. Personal benefits


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“ Initial steps ”

• Create treatment plans from within your software• Go digital with X-rays • Use some type of digital document software

“ Not to do ”

• Going paperless at one step • Throwing out all your progress notes, X-ray films, and

other systems

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• What is Invisalign®?

• Invisalign® is the invisible way to straighten teeth without braces.

• Uses a series of clear removable aligners to straighten teeth without metal wires or brackets.

• Co-founded by Zia Chishti and Kelsey Wirth in 1997 Based in Sunnyvale, California.

INVISALIGN

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• Align Technology the treatment procedure is handled by the computer technicians in Pakistan - process takes 3 weeks to a month.• After approval from the orthodontist, specifications are

transmitted to the manufacturing plant in Mexico • Procedure Impressions are made using Polyvinyl Siloxane• After wearing all of the aligners in the series, Impression

and bite send along with a detailed treatment plan.• advanced imaging technology transforms plaster models

into a highly accurate 3-D digital image.

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• customized set of aligners are made from From the approved file, these models, sent to the laser scanning to build a doctor, and given to the set Invisalign® • wear each actual aligner for about two each stage of the

weeks. treatment plan.• A computerized movie called ClinCheck® depicting the

movement of teeth from the beginning to the final position is created.• Using the Internet, the doctor reviews the ClinCheck file -

if necessary, adjustments to the depicted plan are made.• Patient gets the first aligner 6 weeks after the 1st visit • Most treatments require 20 – 60 aligners worn for 2

weeks each Should be taken off only for eating and brushing

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Contraindications:1. Patients with severe malocclusions 2. All children – growing jaws and erupting teeth too

complicated for the computer to model

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CONCLUSION

The saying that ‘there is nothing

absolutely new under the sun’ is indeed

real because the same world resources

but fresh ideas have been used over the

years to improve on existing

technologies.

CONCLUSION

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• Comtemporary Orthodontics by William profit, 5th edition

• Andre Wilson Machado. What's new in digital photography? Dental Press J Orthod 2010;15(2)

• Spiro J. Chaconas et al. The DigiGraph Work Station, Part 1: Basic Concepts JCO 1990;24(6):360-7

• Cecilia Goraccia, Marco Ferrari Reproducibility of measurements in tablet-assisted, PC-aided, and manual cephalometric analysis Angle Orthod. 2014;84:437–442

• N Motohashi, T Kuroda A 3D computer-aided design system applied to diagnosis and treatment planning in orthodontics and orthognathic surgery European J of Orthod 1999;21:261-73

• Noor Al Mortadi et al CAD/CAM/AM applications in the manufacture of dental appliances. AJODO 2012;142(5):727-33

• Warren hamula et al. The paperless Practice JCO 1998

REFERENCES

Health & Medicine

Computers in orthodontics