The accelerated evolution of software and technology will always continue to improve the quality of our treatments and the services rendered to patients, while constantly amazed us.
The latest version of the Smilers orthodontic treatment planning software by Biotech Dental (NemoCast 3D) today succeeds in combining the information from the StL files, provided by optical impressions (or scanned following a traditional impression), and DICOM file information, provided by the Cone Beam or Scanner (CBCT). These 3D elements can also be coupled with the patient’s 2D photos in order to add other options.
Until today, one of the main shortcomings of orthodontics has been the lack of visualization of dental roots, regardless of the technique chosen. Indeed, whether for virtual simulations in the case of aligners, or for the bonding of brackets in conventional orthodontics, the true root axes were not visible to the practitioner and we were satisfied with assumptions. We could use panoramic radios or teleradiographies, but we always had to end up imagining the true positions and angulations of the roots. In addition, we had to imagine the root movements that we wanted to obtain, without being able to really control or monitor them during the treatment, or guarantee their correct positioning at the end of the treatment.
Root segmentation: a new era in orthodontics
The root segmentation option obtained using information from DICOM files allows us to enter a new era in orthodontics. In fact, we will now have access to three-dimensional information about the dental organ in its entirety, which opens up a new field of incredible possibilities.
Checking the occlusal plane and the correct three-dimensional orientation of the models
A first interest is the possibility of controlling the occlusal plane and the correct three-dimensional orientation of the patient’s models by 3D cephalometric superimposition of the impressions, the Cone Beam and the front photo. (Fig. 1).
The assembly and the basing of the models are done with a virtual facebow (Fig. 2).
Fig. 2: 3D virtual facial arch: Anatomical orientation of the models by superimposition of photographic data, DICOM and STL
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This option makes it possible to correct a classic problem of error of inclination of the models, and therefore of the occlusal plane and of the Camper’s plane.
This avoids an error which subsequently had repercussions in the virtual simulations and the occlusal ratios obtained at the end of treatment. Classically, the models are mounted flat while the true orientation of the models is now rectified before proceeding with the setup. (Fig. 3a & 3b).
Fig. 3a: 3D virtual facial arch: Anatomical orientation of the models by s uperposition of photographic data, DICOM and STL. Classic virtual “flat” assembly. / Fig.3a: 3D virtual facial arch: Anatomical orientation of the models by superposition of photographic data, DICOM and STL. Correction of the editing according to the true orientation and visualization of the correct plans.
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In the case, for example, of a classic multidisciplinary treatment of superior lateral agenesis where the goal of orthodontic treatment will be to open the space necessary for implant placement, we will see the interest of root segmentation offered by Smilers ®
We can also note here the advantage of a company such as Biotech Dental which offers complete integrated solutions to practitioners: thus, the patient was able to benefit from a global flow: digital impression taking with the WOW intraoral scanner ®, visualization of orthodontic simulations, implant-prosthetic planning performed using Nemoscan; placement of implants from the Kontact range and CAD CAM prosthetic components. The whole having been monitored by the services of Biotech Dental.
This type of global solutions with a common software platform (NemoStudio) and a single interlocutor simplifies the life of practitioners and communication between colleagues, and even with the patient.
The figure 4 presents the different stages of virtual simulations and preparation upstream of the case.
Fig. 4: root segmentation. A and B: superposition and recovery of root information in orthodontic working models. note the interest of such an option in the present case with the rhisalysis of 11 and 21 following an old multi-attachment treatment.
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Fig. 4: C: Insertion, superposition and orientation in the front photo for Mockup.
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Exact visualization of dental axes
The root segmentation allows, for the first time, an exact visualization of the dental axes and to be able to work on their positioning during the simulation and the development of the treatment plan. And this, from new angles that were not within our reach before.
Thus, the treating orthodontist can predict with great precision the necessary spacing for a future implant for example, control the parallelism of the roots during the movements at each stage, and the desired final position. (Fig. 5).
Fig. 5: Orthodontic setup with segmented roots. Final position of the treatment plan, correction of the root axes and simulations of prosthetic reconstructions in 12 22.
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Multidisciplinary planning to facilitate flows and exchanges
Then, the orthodontic models and setup are switched to the implant planning interface (NemoScan). Initial planning is therefore possible from the start with visualization of space management and planned corrections in orthodontics, as well as the positioning and axis of the future implant-supported crown. (Fig.6). ®
During the simulation of the positioning and the choice of implants, the teams working on the same common platform, it is possible for them to modify the 3D orthodontic treatment plan if necessary in order to rectify the axes and the spacings for an optimal result. (Fig. 6). The errors are thus limited as much as possible and subsequent rework is avoided.
Fig. 6: Implant planning associated with the orthodontic setup. A: planning interface combining the model view after setup, the Cone Beam and 2D sections. Note the practical advantage of the presence on the cuts of the virtual 22, placed during orthodontic planning and which will serve as a positioning guide. B: If the space management is not satisfactory, we can go back to the orthodontic planning interface in order to modify the treatment plan and the dental axes. Conversely, we will find here the implant placed in the implant planning interface.
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Finally, the figure 7 presents the Smilers Design, a 2D Mockup which is an animated simulation (this is an end-of-simulation photo) of dental movements and the aesthetic prosthetic result of the treatment to come on the patient’s photo. This option, also exclusive to Smilers®®, allows a fantastic simulation of the expected final smile, which is certainly useful for the practitioner in his choices but also an important tool for communication with the patient.
D esign. Animated virtual simulation of orthodontic movements and planned reconstructions F ig. 7: 2D animated photo mockup, Smilers ®
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Conclusion
Orthodontics by aligners is evolving and improving day by day: it is now possible to predict and control dental movements in order to cover a wide range of types of cases to be treated. New technologies and 3D software also make it possible to offer multidisciplinary treatment plan architectures with integrated solutions facilitating the daily work of practitioners by offering them and patients clear visibility of the objective to be achieved. The superimpositions of DICOM files on STL files and photos allow a true 3D anatomical orientation of the models, a real vision of the root axes and their movements, a visualization of TMJs and condylar positions and very useful 2D and 3D mockup possibilities. all these new options and Biotech Dental make it possible to achieve the qualities of exclusively proposed by Smilers ® planning and multidisciplinary treatment plans of very high precision while simplifying the work of practitioners.
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