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    How to use a 3D digital workflow for ortho treatment

    3D digital treatment planning and diagnostic case workup can lead to improved patient care.

    The world of 3D processes in orthodontics has arrived, and the digital workflow necessary to manipulate and work with the information is being developed. Cone beam computed tomography serves as the framework for diagnostics and treatment planning purposes upon which the intraoral, along with potentially a 3D facial analysis, can be added to improve diagnostic capabilities. At the heart of 3D orthodontic diagnostics and treatment planning are the CBCT and intraoral scan. Along with these, we can add intraoral photos and a clinical exam. With this information, we can begin our diagnostic workup as well as begin thinking about our treatment plan.

    In this case presentation, one will see how 3D orthodontic digital treatment planning and diagnostic case workup with virtual setup and ultimately design and manufacturing of appliances is possible and beneficial to patient care.

    There will also be discussion regarding 3D printing and clear aligner therapy as used by some practitioners. This information provides the direction to create the patient database necessary to do proper diagnostic and treatment planning.

    Inputs:

    1. CBCT
    2. Intraoral scan
    3. Digital photography and/or 3D photography

    Output:

    1. Diagnosis
    2. Treatment plan
    3. Analysis with super imposition
    4. 3D printing
    5. Clear aligners therapy

    Case study

    Diagnosis and etiology

    A 14-year-old male presented with a chief complaint of “My bite is off … my teeth turn in on the right side.” His medical history was insignificant, and he had no previous orthodontic treatment. He presents with a Class I skeletal relationship with the mandibular midline 2 mm to the right and a crossbite present on the right side in centric occlusion.

    Read more: How to use digital technology to make cases easier

    Upon opening, the lower midline is 0.5 mm to the right, revealing a slight functional shift. A TMJ exam revealed no joint sounds and joints were asymptomatic. The patient has balanced upper and lower facial heights and his lips are competent with average upper lip length.  He shows 100 percent of incisors upon smiling with 1 mm of the gingival display.

    Radiographic analysis

    Cephalometric analysis revealed a normodivergent, Class I skeletal pattern with well-balanced upper and lower facial heights, increased convexity, and moderately proclined and protruded maxillary and mandibular incisors were noted (Fig. 1).

    Fig. 1

    Fig. 1

    Panoramic analysis showed no pathology and third molars were developing normally (Fig. 2). When this case was started, CBCTs weren’t routinely being taken on all patients. That has changed because of Ultra Low Dose™ technology, which has been developed by Planmeca. Currently, the author is using the ProMax® 3D Mid X-ray Unit, which allows for an Ultra Low Dose CBCT full field of view (FFOV) to be taken with lower radiation (<15 microsieverts) than traditional 2D digital radiography. 

    Fig. 2

    Fig. 2

    Continue to page two to read more...

    Jay B. Burton
    Dr. Jay B. Burton is the owner and orthodontist at SmileMaker Orthodontics, with two locations in Nashville, Tennessee. He completed his ...

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