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3D Cephalometry and Artificial Intelligence DOI: 10.1051/odfen/2018117 J Dentofacial Anom Orthod 2016;19:409 © The authors 3D cephalometry and artificial intelligence J. Faure1, A. Oueiss2, J. Treil3, S. Chen4, V. Wong4, J.-M. Inglese4 1 DFO Specialist, University Lecturer and Hospital Practitioner, Private Practice 2 DFO Assistant, Nice. DDS, Dip. Orthodontics (Toulouse III, Anthropobiology) 3 Neuroradiologist (Pasteur Clinic, Toulouse) 4 Research and Development Department, Carestream Health Rochester NY 14608 USA SUMMARY Orthodontists today work more and more in a three-dimensional (3D) universe with cone-beam exam- inations occurring more frequently, now supplemented by digital prints and 3D portraits. So far these documents are used primarily as esthetic imagery; superimposition techniques, issued from geometric morphometrics, allow a pseudoquantified approach. The implementation of true cephalic biometrics requires consideration of the complete craniofacial set at different anatomical levels (alveolodental/basic bone/frame or overall architecture) and in three dimensions. It must lead to a quantified description of the anatomy, dysmorphism, and the necessary therapy to correct it. A parametric approach is needed to choose the landmarking, the definition of the orthogonal refer- ence, the definition, and selection of parameters. Given the number of parameters required for a description without fault, the use of a simple tool with artificial intelligence is inevitable. KEYWORDS 3D cephalometry, 3D biometrics, dental landmarks, bone markers, choice of parameters, artificial intelligence INTRODUCTION For many years now, orthodontists have The fundamental challenge was the ability been trying to achieve a three-dimensional to easily identify the anatomical landmarks (3D) approach to the craniofacial system. To on the three snapshots. Consequently, this end, in the past they would take three points A and B would be relatively discern- conventional cephalometric photographs ible on the snapshot in the lateral view but taken in three dimensions: the lateral inci- impossible to identify in the basal and fron- dence and profile cephalometry, the basal tal images while the transverse position incidence and basal cephalometry, and the remained impossible to pinpoint. frontal incidence and frontal cephalometry. Address for correspondence: Jacques Faure 10, place Lannes – 32021 Auch – France Article received: 21-04-2016. E-mail: [email protected] Accepted for publication: 30-05-2016. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1 Article available at https://www.jdao-journal.org or https://doi.org/10.1051/odfen/2018117 J. FAURE, A. OUEISS, J. TREIL, S. CHEN, V. WONG, J.-M. INGLESE Within recent times, the advent Luebbert et al.31 use the following of the scanner and cone-beam x-ray distances: has brought the orthodontist into the – Between the apices of the central 3D realm. Thereafter, other 3D tools incisors, those of the vestibular appeared; these capture the den- roots of the first premolars, and tal arches and cutaneous envelope those of the vestibulomesial roots with remarkable precision and color of the first maxillary molars. rendering. – Between the pulp chambers of From then on, the manipulation of 3D these same teeth. images pervaded our daily work and – Finally, between the maxillary exter- now 3D cephalometry is continuously nal cortical walls at the apex of the made available to us and can be used vestibular and vestibulomesial roots at the clinic. of both the premolars and the first Of course, all 3D input tools have molars. easy-to-use measuring instruments. For example, a digital impression scan- It is obvious that these measure- ner always uses a tool that measures ments have no daily clinical use, the distance between two points, you these parameters were chosen with a simply have to point at landmarks P research objective, without any diag- and Q and the software immediately nostic benefits. The “landmark” sites, displays the PQ measurement. Similar- particularly the external cortex of the ly, there are instruments for measuring alveolar bone close to the apex, have the angle formed by two intersecting neither the physiological identity nor lines, the angle formed by two planes, the anatomical specificity to permit a the cartesian coordinates, etc. diagnostic analysis. Most often, however, the use of 3D To date, a complete software that tools is limited to the identification of a can be used daily at clinic, which can particular anatomical element (an impact- cover the entire craniofacial system ed tooth for example or odontoma). in the three dimensions of space, Though rare, authors advocate using including the alveolar, dental, basal, the unique measurements or pseu- and architectural floors (or maxillo- do-measurements which result from facial framework), has not yet been the techniques of superimposition. made available. Such a program will, The difference between the individuals of course, have to precisely describe compared (for example the subject’s the anatomy and therefore be able to measurements before treatment and quantify the dysmorphia to be used after surgery) is expressed by a colori- as a guide in the establishment of the metric scale. treatment plan. Finally, we can find articles where In the following sections, we will effective measurements were achieved examine the current uses of 3D imag- using the software tools of the scan- ing for therapeutic purposes and ner or cone-beam x-ray. For example, discuss the constraints and require- in a study on the skeletal effects of ments for a complete and coherent 3D maxillary disjunction by Hyrax, authors cephalometry. 2 Faure J., Oueiss A., Treil J., Chen S., Wong V., Inglese J.-M. 3D cephalometry and artificial intelligence 3D cephalometry AND artificial INTELLIGENCE 3D IMAGING AT THE CLINIC: THE USE OF GEOMETRIC MORPHOMETRIC TOOLS The use of 3D imaging in standard or – The nature of the phenomenon stud- clinical research is currently giving way ied. If the evolution is global, a growth to the geometric morphometric tools process for example, the Procustes of superimposition, either by the direct superimposition will be the desired use of geometric morphological soft- tool. If, however, the evolution is well ware, (Morphological, Rapid Form etc.) localized, for example a mandibular or by integrating analog modules into advancement surgery, a superimpo- the orthodontic or surgical software. sition on the “recorded area” (in this case the ascending ramus posterior Using geometric morphometry: to the osteotomy), will be preferred. the Procustes superimposition – The isolable or “dissectable” nature of the area of interest (actual or vir- Firstly, these tools are used when tual dissection). comparing two individuals: A and B. – The existence and distribution In conventional superimpositions, of landmarks or superimposition the user identifies an area that is zones, on the stable site (recorded assumed to be a stable, “recorded area) and on the supposedly mobile area” and thus visualizes the evolu- site. tion (growth, therapeutic, maturation, etc.) of the areas that are modified in The boundary is not as rigid as it relation to this stable reference area. may seem. With the distribution of the It is therefore an operator-dependent inhomogeneous landmarks, Procustes choice. With the Procustes superim- superimposition will begin to favor the position, the software corrects the area of maximum landmark density, or scale, orienting the two subjects by recorded pseudo-zone. parallelizing the axes of inertia and Procustes superimposition has superimposing as precisely as possi- evolved conventional methods by facil- ble, the minimum distances between itating superimposition on a stable, the homologous points of subjects A recorded area which is often sought and B, on the entire subject studied. after and is considered a recalibration. This technique separates size effects In a maxillofacial surgical study, an from form effects and is non-operator area of superimposition is often taken dependent. in the anterior region of the skull base Superimposition with a supposedly and the tools used to assess the A/B stable recorded area, will better demon- deviations, standard Procustes super- strate the variation observed within imposition tools will demonstrate the range of this area rather than a gener- difference with the skull base recorded alized Procustes superimposition. and unchanged. The choice between these two Oueiss20,36,37 recalibrated points SO, methods will of course depend on the IO, HM (table I), to study the asym­­ following: metry. J Dentofacial Anom Orthod 2016;19:409 3 J. FAURE, A. OUEISS, J. TREIL, S. CHEN, V. WONG, J.-M. INGLESE Table I: The 14 trigeminal points. The eight points of the Treil framework model of the skeletal framework or the global architecture: RHM, LHM, RSO, LSO, RIO, LIO, RM, LM. The landmarks of the maxillary or mandibular bases are represented by: RM, LM, RFM, LFM, UNP, LNP, RGP, LGP. (The mental points are both frame and maxillary base landmarks.) Environment Skeletal Landmarks RHMLHM MHM Hammer Head: right and le Frame RSO LSO MSO Supraorbital: right and le Frame RIO LIO MIO Infraorbital: right and le Frame RM LM MM Chin: right and le Frame and base RFMLFM MFM Mandibular foramen: right and le Base UNP LNP MNP Nasopalataline foramen:
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