Principles and Biomechanics of Aligner Treatment

Visit the link below to download the full version of this book:

https://medidownload.com/product/principles-and-biomechanics-of-aligner-treatmen
t/

Click Download Now

 PRINCIPLES and
BIOMECHANICS of
ALIGNER TREATMENT
Ravindra Nanda, BDS, MDS, PhD
Professor Emeritus
Department of Orthodontics
University of Connecticut Health Center
Farmington, Connecticut, USA

Tommaso Castroorio, DDS, PhD, Ortho. Spec.

Department of Surgical Sciences, Postgraduate School of Orthodontics
Dental School, University of orino
orino, taly

Francesco Garino, MD, Ortho. Spec.

Private Practice
orino, taly

Kenji Ojima, DDS, MDSc

Private Practice
oyo, apan
Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043

PRINCIPLES AND BIOMECHANICS OF ALIGNER TREATMENT, ISBN: 978-0-323-68382-1

FIRST EDITION
Copyright © 2022 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).

Notices

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances
in the medical sciences, in particular, independent verication of diagnoses and drug dosages should
be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or con-
tributors for any injury and/or damage to persons or property as a matter of products liability, negligence
or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in
the material herein.

ISBN: 978-0-323-68382-1

Content Strategist: Joslyn Dumas

Content Development Manager: Ellen Wurm-Cutter
Content Development Specialist: Rebecca Corradetti
Publishing Services Manager: Shereen Jameel
Project Manager: Nadhiya Sekar
Design Direction: Patrick Ferguson

Printed in India

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 To Catherine, for her love, support, inspiration, and
encouragement.
RN

To Katia, for showing me what love is and for keeping

my feet on the ground. To Alessandro, Matilda, and
Sveva, because you made the world a brighter place.
To my friends, rancesco and Keni, for your passion,
enthusiasm, commitment, and support you are always
an eample to follow. To avi, for your trust and friend
ship, for your guidance and leadership you have trans
lated a vision into reality. t was a wonderful ourney
with you thanks for your time and for sharing your
eperience.
TC

 would like to dedicate this book to all my family with a

special thought to my dad, mentor and a visionary, who
shared with me a passion in aligner orthodontics for
 years.
FG

My thanks to rancesco and Tommaso for sharing their

friendship with me over so many years. The time  spent
writing this book with avi was amaing, like a dream
for me.  am truly grateful to my family for all of their
support.
KO
Contributors

Masoud Amirkhani, PhD Aldo iancotti, DDS MS

Institute for Experimental Physics Researcher and Aggregate Professor
Ulm University Department of Clinical Sciences and ranslational
Ulm, Germany edicine
University of ome “or ergata”
Sean K. Carlson, DMD, MS ome, taly
Associate Professor
Department of Orthodontics uan Palo ome Arano, DDS, MSc
School of Dentistry, University of the Pacic Associate Professor
San Francisco, California, USA Orthodontics Program
Universidad Autonoma de aniales
Tommaso Castroorio, DDS, PhD, Ortho. Spec. aniales, Colomia
Researcher and Aggregate Professor
Department of Surgical Sciences, Postgraduate School of Mario reco, DDS, PhD
Orthodontics Visiting Professor
Dental School, University of orino University of ’Auila
orino, taly ’Auila, taly
Orthodontics Unit Visiting Professor
San Giovanni attista ospital University of Ferrara
orino, taly Ferrara, taly

Chisato Dan, DDS uis uanca, DDS, MS, PhD

Private Practice Research Associate
Smile nnovation Orthodontics Department of Orthodontics
oyo, apan University of Geneva
Geneva, Siterland
Iacopo Ciof, DDS, PhD
Associate Professor osef Kučera, MDr., PhD
Division of Graduate Orthodontics and Centre for ultimodal Assistant Professor
Sensorimotor and Pain esearch Department of Orthodontics
Faculty of Dentistry Clinic of Dental edicine
University of oronto First edical Faculty
oronto, Ontario, Canada Charles University
Prague, Cech epulic
Daid Couchat, DDS, Ortho. Spec. Lecturer
Private Practice Department of Orthodontics
Cainet d’Orthodontie du dr Couchat Clinic of Dental edicine
arseille, France Palacý University
Olomouc, Cech epulic
ae lkhol, DDS
Senior Physician ernd . apatki, DDS, PhD
Department of Orthodontics Department Head and hair
Ulm University Department of Orthodontics
Ulm, Germany Ulm University
Ulm, Germany
rancesco arino, MD Ortho. Spec.
Private Practice
Studio Associato dottri Garino
orino, taly

vi
 Contributors vii

uca omardo, DDS, Ortho. Spec. Simone Parrini, DDS, Ortho. Spec.
hairman and Professor Research Associate
Postgraduate School of Orthodontics Department of Surgical Sciences, Postgraduate School in
University of Ferrara Orthodontics
Ferrara, taly Dental School, University of orino
orino, taly
Tianton ou, DMD, MSc
Division of Gradual Orthodontics and Centre for ultimodal Serena aera, DDS, PhD, Ortho. Spec.
Sensorimotor and Pain esearch Research Associate
Faculty of Dentistry Department of Surgical Sciences, Postgraduate School in
University of oronto Orthodontics
oronto, Ontario, Canada Dental School, University of orino
orino, taly
Kam Malekian, DDS, MSc
Private Practice ariele ossini, DDS, PhD, Ortho. Spec.
Clinica io Research Associate
adrid, Spain Department of Surgical Sciences, Postgraduate School in
Orthodontics
ianluca Mampieri, DDS, MS, PhD Dental School, University of orino
Researcher and Aggregate Professor orino, taly
Department of Clinical Sciences and ranslational edicine
University of ome “or ergata” addah Saouni, DDS, Ortho. Spec.
ome, taly Private Practice
Cainet d’Orthodontie du dr Saouni
doardo Mantoani, DDS, Ortho. Spec. andol ivage
Research Associate Sanarysurer, France
Department of Surgical Sciences, Postgraduate School in
Orthodontics Sila Schmidt, DDS
Dental School, University of orino Department of Orthodontics
orino, taly Ulm University
Ulm, Germany
Io Marek, MDr., PhD
Assistant Professor ör Schare, DDS, PhD, Ortho. Spec.
Department of Orthodontics Private Practice
Clinic of Dental edicine ieferorthopädische Prais Dr örg Schare
Palacý University Cologne, Germany
Oloumouc, Cech epulic
onsultant iuseppe Siciliani, MD, DDS
Department of Orthodontics hairman and Professor
Clinic of Dental edicine School of Dentistry
First edical Faculty University of Ferrara
Charles University Ferrara, taly
Prague, Cech epulic
Ali Tassi, Sc, DDS, MClD Ortho
aindra anda, DS, MDS, PhD Assistant Dean and hair
Professor Emeritus Division of Graduate Orthodontics
Division of Orthodontics Schulich School of edicine and Dentistry
Department of Craniofacial Sciences he University of estern Ontario
University of Connecticut School of Dental edicine ondon, Ontario, Canada
Farmington, Connecticut, USA
ohnn Tran, DMD, MClD
Keni Oima, DDS, MDSc Division of Graduate Orthodontics
Private Practice Schulich School of edicine and Dentistry
Smile nnovation Orthodontics he University of estern Ontario
oyo, apan ondon, Ontario, Canada
viii Contributors

laio rie, DDS, MDentSc enedict ilmes, DDS, MSc, PhD

onn rthodontics Alumnianda rthodontics Professor
Endoed hair Department of Orthodontics
Program Director and Chair University of Düsseldorf
Division of Orthodontics Düsseldorf, Germany
Department of Craniofacial Sciences
University of Connecticut
School of Dental edicine
Farmington, Connecticut, USA
 Foreword

Aligners represent the new frontier in the art and science of Aligner treatment requires new knowledge the number
orthodontics. This new frontier offers new opportunities of clinical and scientic reports about all the different as-
and challenges, but also requires the need for additional pects of aligner orthodontics is increasing year by year. This
knowledge. A rethinking of biomechanics and force deliv- book represents an up-to-date summary of the available
ery concepts is needed along with the role of materials used research in the eld as well as a clinical atlas of treated pa-
for aligners. There is a need for combining established con- tients based on the current evidence. We have made an
cepts with new tools and technologies which aligner treat- attempt to provide benchmark for clinicians, researchers,
ment requires. and residents who want to improve their skills in aligner
When considering new methodologies, orthodontists orthodontics.
should always remember that technology is a tool and not We would like to epress our great appreciation to all the
the goal. Diagnosis, treatment plan, and biomechanics are friends and colleagues who have contributed to this book. t
always the key elements of successful treatment, regardless was a pleasure to work with all these talented orthodon-
of the treatment methodology. Aligner orthodontics is quite tists.
different than traditional methods with brackets and wires. We would like to say thank you to the lsevier team for
orce delivery with aligners is through plastic materials. their support, patience, and guidance during the challeng-
Thus, the knowledge of the aligner materials, physical ing ovid pandemic.
properties, attachment design, and the sequentialiation avindra anda
protocol is crucial for treatment of malocclusions. t is also Tommaso astroorio
imperative to understand limitations of aligner treatment rancesco arino
and how to overcome them with the use of miniscrews and eni ima
auiliaries.

ix
Contents

1 Diagnosis and Treatment Planning in the 12 The rid Approach in Class  Malocclusions
Three-Dimensional Era 1 Treatment 13
TOMMASO CASTROFLORIO, SEAN K. CARLSON, and FRANCESCO GARINO, TOMMASO CASTROFLORIO, and
FRANCESCO GARINO SIMONE PARRINI

2 Current Biomechanical Rationale Concerning 13 Aligners and mpacted Canines 1

Composite Attachments in Aligner EDOARDO MANTOVANI, DAVID COUCHAT,
TOMMASO CASTROFLORIO
Orthodontics 13
JUAN PABLO GOMEZ ARANGO
14 Aligner Orthodontics in Prerestoratie
3 Clear Aligners: Material tructures and Patients 1
KENJI OJIMA, CHISATO DAN, and TOMMASO CASTROFLORIO
Properties 3
MASOUD AMIRKHANI, FAYEZ ELKHOLY, and BERND G. LAPATKI
15 oncompliance pper Molar Distaliation
4 nuence o ntraoral actors on Optical and and Aligner Treatment or Correction o Class 
Mechanical Aligner Material Properties 3 Malocclusions 1
FAYEZ ELKHOLY, SILVA SCHMIDT, MASOUD AMIRKHANI, and BENEDICT WILMES and JÖRG SCHWARZE
BERND G. LAPATKI
16 Clear Aligner Orthodontic Treatment o Patients
5 Theoretical and Practical Considerations in ith Periodontitis 
Planning an Orthodontic Treatment ith Clear TOMMASO CASTROFLORIO, EDOARDO MANTOVANI, and
KAMY MALEKIAN
Aligners 
TOMMASO CASTROFLORIO, GABRIELE ROSSINI, SIMONE PARRINI
17 urger irst ith Aligner Therap 3
FLAVIO URIBE and RAVINDRA NANDA
6 Class  Malocclusion 1
MARIO GRECO
18 Pain During Orthodontic Treatment: Biologic
7 Aligner Treatment in Class  Malocclusion Mechanisms and Clinical Management 
TIANTONG LOU, JOHNNY TRAN, ALI TASSI, and IACOPO CIOFFI
Patients 
TOMMASO CASTROFLORIO, WADDAH SABOUNI, SERENA RAVERA,
and FRANCESCO GARINO 19 Retention and tailit olloing Aligner
Therap 
8 Aligners in Etraction Cases 3 JOSEF KUČERA and IVO MAREK
KENJI OJIMA, CHISATO DAN, and RAVINDRA NANDA
20 Oercoming the imitations o Aligner
9 Open-Bite Treatment ith Aligners  Orthodontics: A rid Approach 
ALDO GIANCOTTI and GIANLUCA MAMPIERI LUCA LOMBARDO and GIUSEPPE SICILIANI

10 Deep Bite 1 nde 

LUIS HUANCA, SIMONE PARRINI, FRANCESCO GARINO, and
TOMMASO CASTROFLORIO

11 nterceptie Orthodontics ith Aligners 11

TOMMASO CASTROFLORIO, SERENA RAVERA, and
FRANCESCO GARINO

x
 1 Diagnosis and Treatment
Planning in the
Three-Dimensional Era
TOMMASO CASTROFLORIO, SEAN K. CARLSON,
and FRANCESCO GARINO

Introduction printed models, indirect bonding trays, and custom-made

brackets to robotically bend wires or aligners. Furthermore,
rthodontics and dentofacial orthopedics is a specialty area it is becoming possible to remotely monitor treatment and
of dentistry concerned with the supervision, guidance, and to control it.5
correction of the growing or mature dentofacial structures, The introduction of aligners in the orthodontics eld
including those conditions that reuire movement of teeth led the digital evolution in orthodontics. The two nouns
or correction of malrelationships and malformations of evolution and revolution both refer to a change; however,
their related structures and the adustment of relationships there is a distinctive difference between the change im-
between and among teeth and facial bones by the applica- plied by these two words. volution refers to a slow and
tion of forces andor the stimulation and redirection of gradual change, whereas revolution refers to a sudden,
functional forces within the craniofacial comple. dramatic, and complete change. hat has been claimed
To accurately diagnose a malocclusion, orthodontics has as the “digital revolution” in orthodontics should be
adopted the problem-based approach originally developed claimed as the “digital evolution” in orthodontics. rtho-
in medicine. very factor that potentially contributes to the dontics and biomechanics have always had the same
etiology and that may contribute to the abnormality or in- denitions, and we as clinicians should remember that
uence treatment should be evaluated. nformation is gath- technology is an instrument, not the goal. This differenti-
ered through a medical and dental history, clinical eami- ates orthodontists from marketing people.
nation, and records that include models, photographs, and The diagnosis and problem list is the framework that dic-
radiographic imaging.  problem list is generated from the tates the treatment obectives for the patient. nce formu-
analysis of the database that contains a network of inter- lated, the treatment plan is designed to address those obec-
related factors. The diagnosis is established after a continu- tives. n aligner orthodontics,  software displays
ous feedback between the problem recognition and the da- treatment animations, helping the clinician to visualie the
tabase Fig. .. ltimately, the diagnosis should provide appearance of teeth and face that is desired as treatment
some insight into the etiology of the malocclusion. outcome; however, those animations should be decon-
rthodontics diagnosis and treatment planning are deeply structed by the orthodontist frame by frame or stage by
changing in the last decades, moving from two-dimensional stage, to dene how to address the treatment goal from me-
 hard tissue analysis and plaster cast review toward soft chanics to seuence. nly an accurate control of every sin-
tissue harmony and proportions analyses with the support gle stage of the virtual treatment plan can produce reliable
of three-dimensional  technology.  detailed clinical e- results. s usual, it is the orthodontist rather than the tech-
amination remains the key of a good diagnosis, where many niue itself that is responsible for the treatment outcome.
aspects of the treatment plan reveal themselves as a function ontemporary records should facilitate functional and
of the systematic evaluation of the functional and aesthetic aesthetic  evaluation of the patient.
presentation of the patient.
The introduction of a whole range of digital data acuisi-
tion devices cone-beam computed tomography T, Intraoral Scans and Digital
intraoral and desktop scanner  and , and face scan- Models
ner F, planning software computer-assisted design and
computer-assisted manufacturing  software, s are uickly replacing traditional impressions and plas-
new aesthetic materials, and powerful fabrication machines ter models. These scanners generally contain a source of
milling machines,  printers is changing the orthodon- risk for inaccuracy because multiple single  images are
tic profession Fig. .. assembled to complete a model. ecent studies, however,
s a result, clinical practice is shifting to virtual-based have shown that the trueness and precision of s of com-
workows. Today it is common to perform virtual treat- mercially available scanning systems are ecellent for orth-
ment planning and to translate the plans into treatment odontic applications. igital models are as reliable as tradi-
eecution with digitally driven appliance manufacture and tional plaster models, with high accuracy, reliability, and
placement using various  techniues from reproducibility Fig. ..
1
2 Principles and Biomechanics of Aligner Treatment

Database

Clinical examination
Chief complaint
Medical history
Models Photographs Radiographic imaging
Dental history
Intraoral scan 3-D facial scan CBCT
Extraoral exam
Intraoral exam
Functional exam

Problems

Problem List

Mechanics
plan:
Synthesis Treatment which movements Staging Treatment Virtual setup Treatment
and diagnosis objectives with which definition prescription Virtual patient re-evaluation
auxiliaries
Fig. 1.1 Steps in diagnosis and treatment planning in the digital orthodontics era. (Modied from Uribe FA, Chandhoe
TK, Nanda R. Indiidaied orhodoni dianoi. In Nanda R, ed. Esthetics and Biomechanics in Orthodontics. nd ed.
S Loi, MO Eeier Sander .

Fig. 1.2 Integration of cone-beam computed tomography data, facial three-dimensional scan, digital models from
intraoral scans, and virtual orthodontic setup. Courtesy of dr. Alain Souchet, ulhouse, rance.
 1 • iagnosis and Treatment Planning in the Three-imensional ra 3

B
Fig. 1.3 A igital models and measurements obtained from cone-beam computed tomography data. B igital
models and measurements obtained from intraoral scans.

Furthermore, the models can also be used in various measuring loop andor caliper, digital measurements on
orthodontic software platforms to allow the orthodontist virtual models usually result in the same therapeutic deci-
to perform virtual treatment plans and eplore various sions as evaluations performed the traditional way. Fur-
treatment plans within minutes as opposed to epensive thermore, with their advantages in terms of cost, time, and
and time-consuming diagnostic setups and waups. er- space reuired, digital models could be considered the new
forming digital setups not only allows the clinician to e- gold standard in current practice.
plore a number of treatment options in a simple manner igital impressions have proven to reduce remakes and
but also facilitates better communication with other den- returns, as well as increase overall efciency. The patient
tal professionals, especially in cases that reuire combined also benets by being provided a far more positive eperi-
orthodontic and restorative treatments. The virtual treat- ence. urrent development of novel scanner technologies
ment planning also allows for better communication with e.g., based on multipoint chromatic confocal imaging and
patients and allows them to visualie the treatment out- dual wavelength digital holography will further improve
come and understand the treatment process.5 the accuracy and clinical practicability of .
Further advantages of virtual models of the dental ecently near infrared  technology has been inte-
arches are related to study model analysis, which is an es- grated in . The  is the region of the electromagnetic
sential step in orthodontic diagnostics and treatment plan- spectrum between . and  mm Fig. .. The interaction
ning. ompared to measurements on physical casts using a of specic light wavelengths with the hard tissue of the
4 Principles and Biomechanics of Aligner Treatment

NIRI - A reflective concept of light and its mechanism of action

The iTero Element 5D intraoral NIRI image of a healthy tooth

scanner uses light of 850nm that
penetrates into the tooth structure to
produce a NIRI image

Image interpretation - Healthy tooth

Enamel is mostly
transparent to
NIRI and appears
dark

Dentin is mostly
scattering
to NIRI and
appears bright

Image interpretation - Tooth with caries

ealthy enamel
appears dark

roimal carious
lesions of the
enamel appears
bright

A
Fig. 1.4 e generation of intraoral scanners ith integrated near infrared I technology. A Itero lement 
Align Technology, San osé, CA, SA decays detection scheme.
 1 • iagnosis and Treatment Planning in the Three-imensional ra 5

B
Fig. 1.4, cont’ B Shape Trios  Shape AS, Copenhagen, enmar uorescent technology for surface decay
detection (left) and I technology for interproimal decay detection (right).

tooth provides additional data of its structure. namel is urbaniation and industrialiation becoming more freuent
transparent to  due to the reduced scattering coefcient in the last decades.-5 Therefore, the need for a diagnostic
of light, allowing it to pass through its entire thickness and tool providing information on the  aspects of the dento-
present as a dark area, whereas the dentin appears bright skeletal malocclusion is increasing. hile the clinical ap-
due to the scattering effect of light caused by the orienta- plications span from evaluation of anatomy to pathology of
tion of the dentinal tubules. ny interferencespathologic most structures in the maillofacial area, the key advantage
lesionsareas of demineraliation appear as bright areas in of T is its high-resolution images at a relatively lower
a  image due to the increased scattering within the re- radiation dose.
gion. Therefore  provides information regarding possible posing patients to -rays implies the eistence of a
decays without any -ray eposure. clinical ustication and that all the principles and proce-
Through the use of digital impression making, it has dures reuired to minimie patient eposure are consid-
been determined that laboratory products also become ered. The  concept should always be kept in mind
more consistent and reuire less chair time at insertion.  is an acronym used in radiation safety for as low as
reasonably achievable. This concept is supported by profes-
3D Imaging sional organiations as well as by government institu-
tions.  ecogniing that diagnostic imaging is the single
CONE-BEAM COMPUTED TOMOGRAPHY greatest source of eposure to ioniing radiation for the 
population that is controllable, the ational ommission
 imaging has evolved greatly in the last two decades and on adiation rotection and easurements has introduced
has found applications in orthodontics as well as in oral and a modication of the  concept.  represents
maillofacial surgery. n  medical imaging, a set of ana- as low as diagnostically acceptable. mplementation of this
tomic data is collected using diagnostic imaging euip- concept will reuire evidence-based udgments of the level
ment, processed by a computer and then displayed on a  of image uality reuired for specic diagnostic tasks as
monitor to give the illusion of depth. epth perception well as eposures and doses associated with this level of
causes the image to appear in . ver the last 5 years, uality. ittle research is currently available in this area.
T imaging has emerged as an important supplemental For  imaging modalities used in orthodontics, the ra-
radiographic techniue for orthodontic diagnosis and treat- diation dose for panoramic imaging varies between  and
ment planning, especially in situations that reuire an un-  µv, while a cephalometric eam range is between  and
derstanding of the comple anatomic relationships and 5 µv.  full mouth series ranges from  to 5 µv based
surrounding structures of the maillofacial skeleton. From on the type of collimation used. hile  and  radia-
the introduction of the cephalostat, roadbent stressed the tion doses are often compared for reference, they cannot
need for a perfect matching of the lateral and posteroante- truly be compared because the acuisition physics and the
rior -rays to obtain a perfect  reproduction of the associated risks are completely different and cannot be
skull. T imaging provides uniue features and advan- euated. The actual risk for low-dose radiographic proce-
tages to enhance orthodontic practice over conventional dures such as maillofacial radiography, including T, is
etraoral radiographic imaging. ateral cephalometrics difcult to assess and is based on conservative assumptions
provides information on the sagittal and vertical aspects of as there are no data to establish the occurrence of cancer
the malocclusion with little contribution about unilateral following eposure at these levels. owever, it is generally
or transversal discrepancies. The latter seem to be related to accepted that any increase in dose, no matter how small,
 Principles and Biomechanics of Aligner Treatment

results in an incremental increase in risk. Therefore there demonstrated, allowing precise assessment of unerupted
is no safe limit or safety one for radiation eposure in orth- tooth sies, bony dimensions in all three planes of space,
odontic diagnostic imaging.  recent meta-analysis about and even soft tissue anthropometric measurements—
the effective dose of dental T stated that the mean adult things that are all important in orthodontic diagnosis and
effective doses grouped by eld of view F sie were treatment planning.-
 µv large,  µv medium, and  µv small. The accurate localiation of ectopic, impacted, and su-
ean child doses were 5 µv combined large and me- pernumerary teeth is vital to the development of a patient-
dium and  µv small. arge differences were seen specic treatment plan with the best chance of success.
between different T units. T has been demonstrated to be superior for localiation
The merican ental ssociation ouncil on cientic and space estimation of unerupted maillary canines com-
ffairs  proposed a set of principles for consideration pared with conventional imaging methods.5  ne study
in the selection of T imaging for individual patient care. indicated that the increased precision in the localiation of
ccording to the guidelines, clinicians should perform radio- the canines and the improved estimation of the space con-
graphic imaging, including T, only after professional ditions in the arch obtained with T resulted in a differ-
ustication that the potential clinical benets will out- ence in diagnosis and treatment planning toward a more
weigh the risks associated with eposure to ioniing radia- clinically orientated approach.5 T imaging was proven
tion. owever, T may supplement or replace conven- to be signicantly better than the panoramic radiograph in
tional dental -rays when the conventional images will not determining root resorption associated with canine impac-
adeuately capture the needed information. tion.  ne study supported improved root resorption
ecently, a number of manufacturers have introduced detection rates of  with the use of T when com-
T units capable of providing medium or even full F pared with  imaging. hen used for diagnosis, T
T acuisition using low-dose protocols. y adustments has been shown to alter and improve the treatment recom-
to rotation arc, m, kp, or the number of basis images or mendations for orthodontic patients with impacted or
a combination thereof, T imaging can be performed at supernumerary teeth. 
effective doses comparable with conventional panoramic ased on the ndings of a recent review and in accor-
eaminations range, – µv. This is accompanied by dance with the T entomaillofacial aediatric
signicant reductions in image uality; however, viewer maging n nvestigation Towards ow ose adiation
software can be helpful in improving the clinical eperience nduced isks proect, T can be considered also in
with low-uality images. ven at this level, child doses have children for diagnosis and treatment planning of impacted
been reported to be, on average,  greater than adult teeth and root resorption Fig. .5.
doses. The use of low-dose protocols may be adeuate for aillary transverse deficiency may be one of the
low-level diagnostic tasks such as root angulations. most pervasive skeletal problems in the craniofacial re-
gion. ts many manifestations are encountered daily by
BENEFT OF CBCT FOR ORTHODONTC the orthodontist.
AEMENT lthough many analyses of the lateral cephalometric
headlm have been developed for use in orthodontic and
The benets of T for orthodontic assessment include orthognathic treatment planning, the posteroanterior
accuracy of image geometry. T offers the distinct ad- cephalogram has been largely ignored. The diagnosis of
vantage of  geometry, which allows accurate measure- transverse discrepancy is uite challenging in the daily
ments of obects and dimensions. The accuracy and reli- practice because of several methodologic limitations of the
ability of measurements from T images have been proposed methods.

Fig. 1.5 Cone-beam computed tomography data elaboration for enhancing diagnosis and treatment planning.
 1 • iagnosis and Treatment Planning in the Three-imensional ra 

Fig. 1. Case of impacted loer canine in hich the cone-beam computed tomography data are helpful in dening
the right mechanics.

The maillary and mandibular skeletal widths at differ- asymmetry cases. They can also be used to generate substi-
ent tooth level, buccolingual inclination of each tooth, and tute grafts when warranted. T can be useful as a valu-
root positions in the alveolar bone can be determined and able planning tool from initial evaluation to the surgical
evaluated from the T Fig. .. ith this information, procedure and then the correction of the dental component
the clinician can make a proper diagnosis and treatment in the surgery-rst orthognathic approach.
plan for the patient. n addition, databases may be interfaced with the ana-
The temporomandibular oint T can be assessed for tomic models to provide characteristics of the displayed tis-
pathology more accurately with T images than with sues to reproduce tissue reactions to development, treat-
conventional radiographs. The T volume for orthodon- ment, and function. The systematic summariation of the
tic assessment will generally include the T and therefore results presented in the literature suggests that computer-
is available for routine review. everal retrospective analy- aided planning is accurate for orthognathic surgery of the
ses of T volumes indicate 5 to  of incidental mailla and mandible, and with respect to the benets to
ndings are related to T Fig. ., which is signicant the patient and surgical procedure it is estimated that
enough for further follow-up or referral. computer-aided planning facilitates the analysis of surgical
T data can also be used to obtain the volumetric ren- outcomes and provides greater accuracy Fig. ..
dering of the upper airways. tudies of the upper airway  recent systematic review was conducted to evaluate
based on T scans are considered to be reliable in dening whether T imaging can be used to assess dentoalveolar
the border between soft tissues and void spaces i.e., air, relationships critical to determining risk assessment and
thus providing important information about the morphol- help determine and improve periodontal treatment needs in
ogy i.e., cross-sectional area and volume of the pharyngeal patients undergoing orthodontic therapy. The conclusion
airway5 Fig. .. owever, despite the potentials offered was that pretreatment orthodontic T imaging can as-
by the techniue in this eld and the potential role of ortho- sist clinicians in selecting preventive or interceptive peri-
dontists as sentinel physicians for sleep breathing disorders, odontal corticotomy and augmentation surgical reuire-
limited, poor uality, and low evidence level literature is ments, especially for treatment approaches involving buccal
available on the effect of head posture and tongue position tooth movement at the anterior mandible or maillary pre-
on upper airway dimensions and morphology in  imag- molars to prevent deleterious alveolar bone changes. This
ing. atural head position at T acuisition is the sug- assumption seems more suitable for skeletally mature pa-
gested standardied posture. owever, for repeatable mea- tients presenting with a thin periodontal phenotype prior to
sures of upper airway volumes it may clinically be difcult to orthodontic treatment Fig. ..
obtain. ndications and methods related to tongue position
and breathing during data acuisition are still lacking. Fur- 3D FACA RECONTRUCTON TECHNUE
thermore, a recent study focusing on the reliability of air-
way measurements stated that the oropharyngeal airway The accurate acuisition of  face appearance character-
volume was the only parameter found to have generalied istics is important to plan orthognathic surgery, and ecel-
ecellent intra-eaminer and inter-eaminer reliability. lent work is based on an eact  face modeling.  precise
n orthognathic surgery, igital maging and ommuni- approach to  digital face prole acuiring, which is ap-
cations in edicine  data from T can be used to plied to simulate and design an optimal plan for face sur-
fabricate physical stereolithographic models or to generate gery by modern technologies such as , is reuired.
virtual  models. The  reconstructions are etremely Three types of  face modeling methods are currently
useful in the diagnosing and treatment planning of facial used to etract human face proles T technology, 