Zacharias Fourie

Accuracy of linear measurements from cone-beam computed tomography-derived surface models of different voxel sizes.

INTRODUCTION The aims of this study were to determine the linear accuracy of 3-dimensional surface models derived from a commercially available cone-beam computed tomography (CBCT) dental imaging system and volumetric rendering software and to investigate the influence of voxel resolution on the linear accuracy of CBCT surface models. METHODS Glass sphere markers were fixed on 10 dry mandibles. The mandibles were scanned with 0.40 and 0.25 voxel size resolutions in 3 sessions. Anatomic truth was established with 6 direct digital caliper measurements. The surface models were rendered by a volumetric rendering program, and the CBCT measurements were established as the mean of the 3 measurements. RESULTS The intraclass correlation coefficients between the physical measurements and the measurements of the CBCT images of 0.40 and 0.25 voxels were all more than 0.99. All CBCT measurements were accurate. There was no difference between the accuracy of the measurements between the 0.40 and 0.25 voxel size groups. The smallest detectable differences of the CBCT measurements were minimal, confirming the accuracy of the CBCT measurement procedure. CONCLUSIONS The measurements on 3-dimensional surface models of 0.25 and 0.40 voxel size data sets made with the 3D eXam CBCT scanner (KaVo Dental GmbH, Bismarckring, Germany) and SimPlant Ortho Pro software (version 2.00, Materialise Dental, Leuven, Belgium) are accurate compared with direct caliper measurements. An increased voxel resolution did not result in greater accuracy of the surface model measurments.

Evaluation of anthropometric accuracy and reliability using different three-dimensional scanning systems.

The aim of this study was to evaluate the accuracy and reliability of standard anthropometric linear measurements made with three different three-dimensional scanning systems namely laser surface scanning (Minolta Vivid 900), cone beam computed tomography (CBCT), 3D stereo-photogrammetry (Di3D system) and to compare them to physical linear measurements. The study sample consisted of seven cadaver heads. The reliability and accuracy were assessed by means of a series of 21 standardized, linear facial measurements derived from 15 landmarks taken both directly on the face with a set of digital callipers and indirectly from a three-dimensional (3D) soft tissue surface models derived from CBCT, laser surface scans and 3D photographs. Statistical analysis for the reliability was done by means of intraclass correlation coefficients (ICCs). Accuracy was determined by means of the absolute error (AE) and absolute percentage error (APE) by comparison of the 3D measurements to the physical anthropometrical measurements. All the 3D scanning systems were proved to be very reliable (ICC>0.923-0.999) when compared to the physical measurements (ICC; 0.964-0.999). Only one CBCT measurement (t-g) and one Di3D measurement (t-sn left) had a mean AE of more than 1.5mm. There are clear potential benefits of using 3D measurements appose to direct measurements in the assessment of facial deformities. Measurements recorded by the three 3D systems appeared to be both sufficiently accurate and reliable enough for research and clinical use.

Accuracy and reliability of facial soft tissue depth measurements using cone beam computer tomography

It is important to have accurate and reliable measurements of soft tissue thickness for specific landmarks of the face and scalp when producing a facial reconstruction. In the past several methods have been created to measure facial soft tissue thickness (FSTT) in cadavers and in the living. The conventional spiral CT is mostly used to determine the FSTT but is associated with high radiation doses. The cone beam CT (CBCT) is a relatively new computer tomography system that focuses on head and neck regions and has much lower radiation doses. The aim of this study is to determine the accuracy and reliability of CBCT scans to measure the soft tissue thicknesses of the face. Seven cadaver heads were used. Eleven soft tissue landmarks were identified on each head and a punch hole was made on each landmark using a dermal biopsy punch. The seven cadaver heads were scanned in the CBCT with 0.3 and 0.4mm resolution. The FSTT at the 11 different sites (soft tissue landmarks) were measured using SimPlant-ortho volumetric software. These measurements were compared to the physical measurements. Statistical analysis for the reliability was done by means of the interclass coefficient (ICC) and the accuracy by means of the absolute error (AE) and absolute percentage error (APE). The intra-observer (0.976-0.999) and inter-observer (0.982-0.997) correlations of the CBCT and physical measurements were very high. There was no clinical significant difference between the measurements made on the CBCT images and the physical measurements. Increasing the voxel size from 0.4 to 0.3mm resulted in a slight increase of accuracy. Cone beam CT images of the face using routine scanning protocols are reliable for measuring soft tissue thickness in the facial region and give a good representation of the facial soft tissues. For more accurate data collection the 0.3mm voxel size should be considered.

Evaluation and comparison of postero-anterior cephalograms and cone-beam computed tomography images for the detection of mandibular asymmetry

The aim of this study was to evaluate and compare postero-anterior (PA) cephalograms and cone-beam computed tomography (CBCT) images for the detection of mandibular asymmetry. Six asymmetric anonymous dry human skulls with visible chin deviation were available for this study. Metallic markers were glued on the anatomical landmarks to avoid identification error. PA cephalograms and CBCT scans were made by means of a standardized set-up. Each scan and cephalogram was measured three times by a single observer and the means used for analysis. Asymmetry was defined by the subtraction of the left side and right side measurements. CBCT was reliable [intraclass correlation coefficient (ICC) > 0.957] and very accurate (within 0.5 mm) in detection of all asymmetry. PA cephalograms were not accurate in detection of asymmetry of the mandibular ramus length, the mandibular body length, and the total mandibular length. PA cephalograms were the least reliable in determining the mandibular body length asymmetry (ICC = 0.686). The use of CBCT to detect mandibular asymmetry was validated with this study. CBCT images are very reliable and accurate for the detection of asymmetry and should be considered over conventional PA cephalometry when a chin deviation is present.

Accuracy and repeatability of anthropometric facial measurements using cone beam computed tomography

Objective The purpose of this study was to determine the accuracy and repeatability of linear anthropometric measurements on the soft tissue surface model generated from cone beam computed tomography scans. Materials and Methods The study sample consisted of seven cadaver heads. The accuracy and repeatability were assessed by means of a series of 21 standardized, linear facial measurements derived from 11 landmarks taken both directly on the face with a set of digital calipers and indirectly from a three-dimensional soft tissue surface model generated from a cone beam computed tomography scan of the heads using SimPlant® Ortho Pro software. The landmarks and measurements were chosen to cover various regions of the face with an emphasis on the oral-nasal region. The cone beam computed tomography measurements were compared with the physical measurements. Statistical analysis for the repeatability was done by means of the intraclass coefficient. Accuracy was determined by means of the absolute error and absolute percentage error. Results The cone beam computed tomography measurements were very accurate when compared with the physical measurements (0.962 to 0.999). Except for one measurement, between point tragion (t) and nasion (n) (mean, 1.52 mm), all the measurements had a mean absolute error of less than 1.5 mm. Conclusions The three-dimensional surface models derived from cone beam computed tomography images are sufficiently precise and accurate for the anthropometric measurements.

Reliability and the smallest detectable differences of lateral cephalometric measurements

INTRODUCTION The aim of this study was to determine the reliability and the measuring error (by means of the smallest detectable error) of 11 angular and 4 linear measurements commonly used for cephalometric analysis. METHODS Twenty-five digital lateral cephalograms were randomly selected and traced with Viewbox software (version 3.1.1.13, dHAL Software, Kifissia, Greece). This was repeated 3 times by 2 observers during 3 sessions. There was at least 1 week between each session. Differences were analyzed with a repeated measurement analysis of variance (ANOVA). Intraobserver and interobserver reliabilities were calculated with intraclass correlation coefficients (ICC) based on absolute agreement. Measurement error was determined by means of the smallest detectable difference. RESULTS The intraobserver agreement of the measurements was good (ICC >0.82). SNA, SNB, ANB, and ANS-Me had the smallest intraobserver errors for both observers (>1.86 mm or degrees). Except for SN-FH (ICC = 0.76), interobserver agreement was good (ICC >0.87). CONCLUSIONS Determining the appropriate measuring error of cephalometric measurements by means of the smallest detectable difference is necessary to find the true difference between the start and the end of active treatment. Depending on the magnitude of clinical significance, the measuring error was possibly clinically significant for all variables tested and, therefore, questions the use of these variables to detect the true treatment effect.

Simple technique to achieve a natural position of the head for cone beam computed tomography

We developed a modified laser level technique to record the natural position of the head in all three planes of space. This is a simple method for use with three-dimensional images and may be valuable in routine craniofacial assessment.

Comparison between two-dimensional and midsagittal three-dimensional cephalometric measurements of dry human skulls

The aim of this study was to compare two- and three-dimensional cephalometric values by using a three-dimensional analysis based on the midsagittal plane. Spherical metal markers were fixed on to the anatomical landmarks of 10 human skulls, which were examined radiographically with conventional lateral cephalograms and cone-beam computed tomographic (CBCT) scans. Preprogrammed analyses calculated the 18 angular and linear two- and three-dimensional cephalometric values. An error study was made to assess the accuracy and reliability of the methods used. Both sets of values were compared using Wilcoxons signed-rank test. Probabilities of less than 0.05 were accepted as significant. Reliability of the measurements was assessed by intraclass correlation coefficients (ICC) based on absolute agreement. The method error (ME) was tiny (mean ME<0.61 measuring unit) and reliable (ICC>0.97). Comparison of the two- and three-dimensional measurements showed that that they were reliable (ICC>0.88) and that there were no significant differences (P=0.41-1.00). The values from the cephalometric analyses were comparable and interchangeable when using the midsagittal three-dimensional approach as described.

The influence of the segmentation process on 3D measurements from cone beam computed tomography-derived surface models

To compare the accuracy of linear and angular measurements between cephalometric and anatomic landmarks on surface models derived from 3D cone beam computed tomography (CBCT) with two different segmentation protocols was the aim of this study. CBCT scans were made of cadaver heads and 3D surface models were created of the mandible using two different segmentation protocols. A high-resolution laser surface scanner was used to make a 3D model of the macerated mandibles. Twenty linear measurements at 15 anatomic and cephalometric landmarks between the laser surface scan and the 3D models generated from the two segmentation protocols (commercial segmentation (CS) and doctor’s segmentation (DS) groups) were measured. The interobserver agreement for all the measurements of the all three techniques was excellent (intraclass correlation coefficient 0.97–1.00). The results are for both groups very accurate, but only for the measurements on the condyle and lingual part of the mandible, the measurements in the CS group is slightly more accurate than the DS group. 3D surface models produced by CBCT are very accurate but slightly inferior to reality when threshold-based methods are used. Differences in the segmentation process resulted in significant clinical differences between the measurements. Care has to be taken when drawing conclusions from measurements and comparisons made from different segmentations, especially at the condylar region and the lingual side of the mandible.

Effect of dental arch convexity and type of archwire on frictional forces

INTRODUCTION Friction measurements in orthodontics are often derived from models by using brackets placed on flat models with various straight wires. Dental arches are convex in some areas. The objectives of this study were to compare the frictional forces generated in conventional flat and convex dental arch setups, and to evaluate the effect of different archwires on friction in both dental arch models. METHODS Two stainless steel models were designed and manufactured simulating flat and convex maxillary right buccal dental arches. Five stainless steel brackets from the maxillary incisor to the second premolar (slot size, 0.22 in, Victory, 3M Unitek, Monrovia, Calif) and a first molar tube were aligned and clamped on the metal model at equal distances of 6 mm. Four kinds of orthodontic wires were tested: (1) A. J. Wilcock Australian wire (0.016 in, G&H Wire, Hannover, Germany); and (2) 0.016 x 0.022 in, (3) 0.018 x 0.022 in, and (4) 0.019 x 0.025 in (3M Unitek GmbH, Seefeld, Germany). Gray elastomeric modules (Power O 110, Ormco, Glendora, Calif) were used for ligation. Friction tests were performed in the wet state with artificial saliva lubrication and by pulling 5 mm of the whole length of the archwire. Six measurements were made from each bracket-wire combination, and each test was performed with new combinations of materials for both arch setups (n = 48, 6 per group) in a universal testing machine (crosshead speed: 20 mm/min). RESULTS AND CONCLUSIONS Significant effects of arch model (P = 0.0000) and wire types (P = 0.0000) were found. The interaction term between the tested factors was not significant (P = 0.1581) (2-way ANOVA and Tukey test). Convex models resulted in significantly higher frictional forces (1015-1653 g) than flat models (680-1270 g) (P <0.05). In the flat model, significantly lower frictional forces were obtained with wire types 1 (679 g) and 3 (1010 g) than with types 2 (1146 g) and 4 (1270 g) (P <0.05). In the convex model, the lowest friction was obtained with wire types 1 (1015 g) and 3 (1142 g) (P >0.05). Type 1 wire tended to create the least overall friction in both flat and convex dental arch simulation models.