Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-02-22, 09:42:08 | version 1.38.0
Dental Tribune Middle East & Africa Edition | 6/2017 mCME ◊Page 10 Fig. 4: MaxAlign patient image indicating facial references planes the images together to generate an accurate replica of the patient’s oral anatomy.16, 17 Patients can therefore have a better understanding of their oral situation and the treatment pro- cedures.17 Furthermore, the precise- ness of the data provides the clini- cian the required records to design and fabricate prostheses, such as orthodontic appliances, crowns and bridges, all without the need for im- pressions or models.15, 17 This eliminates the time and cost associated with impressions, model fabrication, potential for material distortion and the issue of patient discomfort. In addition, the True Definition Scanner digital files can be used with any system that ac- cepts STL files, a common file format used for saving three dimensional objects.15, 16 Dentists can easily share files and work with laboratories and other open source technologies to design and fabricate prostheses and delivery quality treatment to the pa- tient.16 However, there are limitations to the technology. Like any new technol- ogy, there is the period of skill acqui- sition for the clinician and, although the unit is mobile, it does require space (note: a compact, tablet-based unit has been recently released). Ad- ditionally, while the True Definition Scanner captures the dentition, there is a lack of reference to the patient. Once the scans have been complied into an image, the image has the abil- ity for rotation in three dimensions (Fig. 2). Figure 3 depicts the same clinical image but oriented in differ- ent positions. The incisal edges of the laterals have been demarcated. De- termining which orientation is the ideal one becomes difficult without reference points. Figure 4 illustrates required references planes of inter- est for the rehabilitation of complex cases that require facial form as a reference for the predictable and successful fabrication of aesthetic prostheses. MaxAlign Given that it accurately and effi- ciently captures and documents important patient information for the laboratory, third party insur- ance, and patients, MaxAlign (Fig. 5) is a tablet-based technology that serves as a communication tool for clinicians.18, 19 The program is a modi- fied virtual facebow application that, unlike conventional facebows, ena- bles the accurate mounting of casts alongside a patient's image.18 Thus, MaxAlign presents a novel ap- proach to the virtual acquisition of records and communication. In three steps, the dentist can cap- ture a photograph of the patient’s teeth, document the width of the centrals (Fig. 6), and record the oc- clusion.20 The accurately mounted casts provide information that can be used for diagnoses and treatment planning and offers an easy refer- ence for the mounting of models.18, 19 Using MaxAlign with a LabStand, the Fig. 5: MaxAlign tablet software used for patient image acquisition Fig. 6: MaxAlign patient image modification lab can easily use photographic over- lays to mount the models, anatomi- cally referenced on the patient.20 Ul- timately, the increased accuracy and accessibility in patient data reduces lab guesswork on cases and delivers predictable results efficiently.20 As MaxAlign is a mobile, tablet-based technology, many barriers to utiliza- tion are eliminated. For instance, as the technology is mobile, it does not require any office space considera- tion. It is also cost-effective, possess- es negligible radiation concerns for the patient and has a gentle learning curve for the clinician and staff. Merging virtual technologies Recent research has investigated a new application utilizing MaxA- lign with the True Definition Scan- ner by merging and correlating the intraoral images (Fig. 7). MaxAlign provides the reference and frames the 3-D intraoral digital impression with the landmarks of the patient’s face, providing crucial information to the lab in anterior aesthetic and complex prosthodontic cases. Addi- tionally, early investigation has also merged images from digitized wax- up scans with the referenced patient image from Max-Align (Fig. 7). By applying the transparency control on MaxAlign, the patient and other third parties, can now have the abil- ity to immediately 'try-in' the pro- posed restorations and view a before and after effect within the context of the patient’s face. This can aid in patient communication and under- standing of planned treatment. Conclusion Records will continue to have a sig- nificant requirement in the diagno- ses, treatment planning and delivery of predictable and successful pros- theses. With the growing pressures on the dental profession, including economics, office space limitations, patient concerns and skill acquisi- tion, it is crucial to develop accurate and informative technologies to maximise patient information ac- quisition and communication. Al- though CBCT and virtual planning remain the ‘gold standard’, there are real patient and clinician limitations to the technologies. The utilisation of low-radiation, mobile, tablet-based technologies to merge patient in- formation, has become an exciting avenue that will continue to have an increasingly important role in im- plantology and dentistry. References 1. Arnett, GW, and Robert T. Bergman. 11 15.2 (2006): 23–128. Print. 3. Schulze, Ralf K.W. “Computed to- mography, cone beam computed to- mography and magnetic resonance imaging diagnostic possibilities in dentistry.” International Journal of Stomatology & Occlusion Medicine 4 (2011): 2–9. Print. 4. Brenner, David J, and Eric J Hall . “Computed tomography—an in- creasing source of radiation expo- sure.” The New England Journal of Medicine 357.22 (2007): 2277–2284. Print. 5. Brenner, David J. “Slowing the increase in the population dose re- sulting from CT scans.” Radiation Re- search 174.6b (2010): 809-815. Print. 6. Brenner, DJ. “David Brenner on the Radiation Exposure Risk of CT Scans.” ScienceWatch, March 2010 http:// webcache. googleusercontent.com/ search?q=cache:LrwO9gouHcUJ: sci- encewatch.com/inter/aut/2010/10- mar/10marBren/&num=1&hl=en& gl=ca&strip=1&vwsrc=0. Accessed Jan 20, 2017. 7. Canadian Agency for Drugs and Technologies in Health. “Radiation Emissions from Computed Tomog- raphy: A Review of the Risk of Cancer and Guidelines.” Rapid Response Report: Summary with Critical Ap- praisal (2014): 1–25. Pub Med Health. Web. 8. “What are the radiation risks from CT?” U.S. Food and Drug Administra- tion, 25 Mar. 2016. Web. 14 July 2016. 9. Rice, Henry E et al. “Review of radi- ation risks from computed tomogra- phy: Essentials for the pediatric sur- geon.” Journal of Pediatric Surgery 42 (2007): 603–607. Print. 10. Block, Josh. “Your guide to medi- cal imaging equipment.” Block Imag- ing, 9 Jan. 2014. Web. 15 July 2016. 11. U.S. Food and Drug Administra- tion. “Dental Cone-Beam Computed Tomography.” U.S. Department of Health and Human Services. N.p., 13 Apr. 2016. Web. 21 Sept. 2016. 12. “Dental Cone Beam CT.” Radiolog- ical Society of North America, Inc, 17 July 2015. Web. 21 Sept. 2016. 13. Machado, Genevive L. “CBCT Im- aging – A Boon to Orthodontics.” The Saudi Dental Journal 27.1 (2015): 12–21. Print. 14. Adibi, Shawn et al. “Cone Beam Computed Tomography for General Dentists.” Open Access Scientific Re- ports 1.11 (2012): n. pag. Print. 15. 3M. 3M True Definition Scanner Frequently Asked Questions. U.S.A.: 3M, 2016. Print. 16. 3M Unitek. “3M True Definition Scanner.” 3M Unitek, 2016. Web. 5 July 2016. 17. Dental Products Report. “3M True Definition Scanner information.” Dental Products & Reviews, n.d. Web. 5 July 2016. 18. Kalman, Les. “Cast mounting us- ing MaxAlign: The clinical compo- nent.” CAD/CAM International Mag- azine of Digital Dentistry 6.3 (2015): 6–10. Print. 19. “MaxAlign.” Whip Mix, n.d. Web. 3 July 2016. 20. DentistryIQ Editors, ed. “Whip Mix introduces MaxAlign app for capturing patient data.” DentistryIQ, 5 May 2015. Web. 3 July 2016. Fig. 7: 3M digitised wax-up scan merged and referenced with MaxAlign patient image “Facial Keys to Orthodontic Diagno- sis and Treatment Planning.” Ameri- can Journal of Orthodontics and Dentofacial Orthopedic 103.4 (1993): 299–312. Print. 2. Afsharzand, Zahra, Behnoush Rashedi, and Vicki C. Petropoulos. “Communication between the den- tal laboratory technician and dentist: Work authorisation for fixed partial dentures.” Journal of Prosthodontics Dr Les Kalman, DDS —Assistant Profes- sor, Department of Restorative Dentistry, Schulich School of Medicine and Den- tistry; and Chair of Dental Outreach Community Service Programme, Western University, London, Ontario, Canada. Mariana Capretz, BSc – Undergraduate Student, Faculty of Science, Western Uni- versity, London, Ontario, Canada.