Imaging in orthodontics

Defined as representation of external form of any object especially of

person

Types of imaging
1) Clinical photography
2) Radiographic
3) Optical
4) Video
5) Digital

Two dimensional imaging systems

Panoramic radiography
It employs principle of tomography or sectional radiology by
producing image of a thin slice of tissues by creating a focal trough or
region of focus within a generic jaw form and size. Greater value for
screening than diagnostic purposes.

Scanora
It produces both DPT images and spiral tomography directly onto film
and it is useful for assessment of impacted teeth

Digital photography
Advantages

1. Speed

2. Immediate review and re-exposure if needed

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3. Storage

4. Online share

5. No processing

6. No aging of the film

Three dimensional imaging systems

There are three main steps involved in the generation of 3D images
(Hajeer et al., 2004). These are:

1. Modelling

Modelling uses mathematics to describe the physical properties of an

object, and the object is viewed as a ‘polygonal mesh’. The mesh is
made up of triangles or polygons and is used as a mode of
visualization. A surface layer of pixels called ‘image’ or texture
mapping is added.

2. Shading and lighting

This step brings an element of realism to the 3D object.

3. Rendering

Rendering is the final step which a computer used to converts the

anatomical data collected from the patient into a life-like 3D object
viewed on the computer screen.

Types

1. 3D Cephalometry
• This technique is based on extrapolating 3D data from 2 radiographs
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 taken perpendicular to each other, usually a lateral and anteroposterior
radiograph

• This method relatively not expensive and can be obtained easily.

• However, the drawbacks of this technique are

1. That the patient is exposed to ionising radiation,

2. Difficulties in locating landmarks which will produce a source of error,

3. Shows little soft tissue definition

4. Provides no photorealistic soft tissue texture.

2. Morphoanalysis
• Morphonalysis is a method of obtaining 3D measurements from
photographs, radiographs and study casts of the patient.

• It has been suggested that morphoanalysis were valid and accurate tool
for recording facial appearance

• However, expensive equipment needed for this method and it takes

long time to obtain the records.

3. Moire Topography and Contour Photography

• The pattern consists of alternative light
and dark bands, which fall on the
subject face and can be captured by a
camera.

• This method is not invasive, the patient

dose not exposed to ionising radiation.

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• It has not found favour in facial imaging since it works best on
smoothly contoured faces

• Minor changes in head position can alter the fringe pattern greatly.

4. 3D Facial Morphometry
• In this system 2 charged-coupled device (CCD) cameras used to
capture the human face, using real time hardware for the recognition of
markers placed on the landmarks of the face.

• Placing landmarks on the face is time and labour consuming and

cannot performed consistently between succeeding sessions due to
movement of facial features.

5. 3D Ultrasonography
• A special probe is placed in contact with the area of interest which
emits a high frequency sound wave range from 3.5 to 7.0 mhz.

• These waves do not pass through air which acts as a barrier and thus a
specific contact probe with a coupling media is needed to generate 3D
data from the subject face.

• Ulrasonography is good in capturing soft tissue but is not able to

visualise hard tissue abnormalities

• However, this procedure is time consuming and requires a skilful

operator.

• Measurements errors can be increased due to distortion of the skin

when the probe contacts the face.

• Also, this technique cannot capture natural photographic facial

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 appearance or skin texture

• Any movement of the head may introduce errors.

6. Structured Light Techniques

• The structured light technique is based on
triangulation principles where a pattern of
structured light projected into a surface to
be scanned. The light pattern distorts and
bends when the light illuminates the
surface. The reflected light is captured be
one camera and data is translated via a computer software to generate
3D image.

• It has been reported good accuracy on a system

• This method is time consuming because the face needs to be

illuminated several times with random patterns of light and any
movement of the head will introduce errors.

• This technique does not obtain photorealistic images and does not
capture natural skin texture.

7. Conventional 3D Spiral CT Scanning

• This technique depends on capturing multiple slices of the human head
which can be stacked together, it is then possible to reconstruct a 3D
image using an appropriate computer software.

• However, this technique exposes the patient to a high radiation dose.

• The equipment is very expensive,

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• Time consuming technique

• Can easily have artefacts created from metal objects intra-orally

• It also lacks the ability to capture the natural photographic facial

appearance or skin texture.

8. Cone Beam Computed Tomography

• Cone beam computed tomography (CBCT) was developed in the 1990s
to overcome some of the disadvantages of the conventional CT
scanning system.

• Cone beam computed tomography has been used in soft and hard tissue
changes after orthognathic surgery in patients with skeletal class III

• It has been reported that the total radiation for CBCT was 20% of the
conventional CT systems and equivalent to a full mouth periapical
radiation

• CBCT produces images which could be comparable to conventional

CT

• Also, it is less expansive and smaller in size than the conventional CT.
However, it is the same as with the conventional CT, cannot obtain a
photorealistic soft tissue image

9. Magnetic resonce imaging (MRI)

• It is a type of tomography technique. MRI creates an image without
using ionizing radiation and is good for soft tissues

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10.Stereolithography
• Stereolithograph is a method of physical model production based on
computed tomography (CT) scans enables the representation of
complex 3D anatomical structures.

• However, it requires experienced and skilled operators to produce

accurate 3D modelling.

• Expensive equipment needed and patient exposed to ionising radiation

for (CT) scans. It does not produce a photorealistic facial image.

11.Laser Scanning
• A laser beam projected from two scanners as a vertical line after
passing through a cylindrical lens. The lines are projected onto the
face and viewed obliquely by a video camera. The image captured by
the video camera transformed into a computer to generate a 3D image.

• Laser scanning is simple, easy to use and can provide valid, accurate
and reproducible .

• The 3D laser scanning system has been used clinically to assess soft
tissue changes with orthognathic surgery to determine facial changes in
identical twins and to analysis facial morphology changes with growth
.

• It is also used to generate digital models (advantages of digital model:

reduce storage, reduce the risk of breakage, view and shared online,
diagnostic set up possible, and it is valide)

• The main shortcoming is that the time taken to scan the face is
approximately 8-10 seconds, so any changes to the patient’s head or

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 facial muscle will distort the scanned image. This may not be suitable
for imaging children,

• In addition, scanning of the patients is performed with their eyes closed

which may interfere with the natural facial expression and localization
of the landmarks around the eyes

12.Stereophotogrammetry
• Stereophotogrammetry refers to special case where two cameras,
configured the face by means of triangulation.

• Thus, it is the process of conversion of photographs, taken from two

different positions, into 3D images that can be viewed from any
perspective

• Stereophotogrammetry is a non-invasive method

• The 3D image obtained has a high quality lifelike visualisation that any
point in the imaged faced can be viewed, this is known as a
photorealistic rendering.

13.4 D or Video imaging

• Useful for evaluation of soft tissue profile
• Video images are produced instantly and stored digitally
• Digital information may be used to interact with other data e.g.
Combine hard tissue image of a R/G with soft tissue clarity of a video
• Helpful tool in visualising effect of surgery and allowing patients to
make an informed decision
• Predicted upper lip and submental areas were perceived to be most
similar to actual post surgical result
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• Lower lip and labiomental regions deemed least reliable
• Not accurate enough for detailed diagnosis and treatment planning
• Video imaging shows poor validity and reproducibility

Requirements of an optimum 3D image system

1. The technique should be simple and easy to use,

2. High resolution that can capture images of high quality.

3. True three-dimensional image that can be viewed from any aspect.

4. Quick (within 5 seconds)

5. Natural facial soft tissue surface texture.

6. Measurements errors which is clinically acceptable.

7. Cost effective, good data storage and retrieval.

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• Lower lip and labiomental regions deemed least reliable
• Not accurate enough for detailed diagnosis and treatment planning
• Video imaging shows poor validity and reproducibility

Requirements of an optimum 3D image system

1. The technique should be simple and easy to use,

2. High resolution that can capture images of high quality.

3. True three-dimensional image that can be viewed from any aspect.

4. Quick (within 5 seconds)

5. Natural facial soft tissue surface texture.

6. Measurements errors which is clinically acceptable.

7. Cost effective, good data storage and retrieval.

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