Tuncay, Orhan C.; Godel, Jeffrey H.; Yang, Jie (Temple University. Libraries, 2013)
      With the advent of cephalometrics in the 1930s, numerous studies have focused on the profile of a face to achieve a more esthetic orthodontic treatment outcome. With such heavy emphasis on facial esthetics, a shift in focus from the profile view to the oblique view has become necessary as the smile in the oblique view is what the general public evaluates. The purpose of this pilot study was to determine whether the current tools for diagnosis and treatment evaluation are sufficient. Currently, 2-dimensional composite photographs are utilized in evaluating the soft tissue. At Temple University, 3-dimensional images, which show all sides of the patient's face, are used adjunctively to 2-dimensional composite photographs. In this study, faculty members at the Temple University Department of Orthodontics were asked to complete surveys after viewing two different image modalities, 2-dimensional images and a 3-dimensional video of the same patient. They were asked to fill out the soft tissue goals for specific facial landmarks. Patient photos were in the smiling view as current literature lacks studies on this view. Faculty members' responses from analyzing the 2-dimensional images and 3-dimensional video for each patient were compared to determine which areas had frequent discrepancies from using two different image modalities. During the survey, a voice recorder captured any comments regarding the images. The ultimate goal of this qualitative pilot study was to identify when 3-dimensional imaging is necessary in treatment planning and evaluation, with an added hope to further advance research in 3-dimensional imaging and its vast possibilities to advance the field of orthodontics. Based on the data collected, the following conclusions were made: 1. The qualitative data highlighted that 3-dimensional imaging would be necessary in cases with skeletal deformities. 2. In the oblique view, 3-dimensional imaging is superior than 2-dimensional imaging by showing more accurate shadow, contour, and depth of the soft tissue. 3. Further improvement is necessary to create a virtual patient with treatment simulation abilities. 4. The comfort level among orthodontists of 2-dimensional imaging was higher than 3-dimensional imaging. With more widespread use of 3-dimensional imaging, more orthodontists may gradually reach a higher comfort level in using this relatively new technology. 5. Faculty members expressed high willingness to use 3-dimensional imaging if improvement in new technology could allow for more manipulation and accurate soft tissue prediction. 6. 3-dimensional imaging is superior in its efficiency, quick capture time, and lack of need for multiple images. Implementation of 3-dimensional imaging could streamline the records process and help with practice efficiency without compromising the image quality. 7. Both patients and orthodontists may benefit from using 3-dimensional imaging. Patients can see an accurate representation of themselves and possibly view their own treatment simulation upon further improvement in current technology. Orthodontists would benefit with much more accurate images that may serve as the virtual patient. 8. Besides the exorbitantly high cost, faculty members thought that more advances were needed and the current benefit was not great enough to justify the investment. The results were consistent with other studies that used the oblique view in that the 2-dimensional oblique view lacks depth and does not provide adequate information. With further improvement in current 3-dimensional imaging, this technology can benefit orthodontists in visualizing their patients. In addition, patients can benefit by hopefully seeing a live and accurate simulation of themselves instantly as a virtual patient. With these benefits of 3-dimensional imaging, it may one day be the new standard in patient records in the field of orthodontics.
    • Retrospective Three-dimensional facial soft tissue analysis in skeletal Class I malocclusions with premolar extractions

      Tuncay, Orhan C.; Godel, Jeffrey H.; Sciote, James J.; Doumit, Carmen (Temple University. Libraries, 2018)
      Objectives: Decreased volume and atrophy are hallmarks of aging facial soft tissues. In perioral region, a hallmark is deepening of nasolabial folds. It is unknown how extraction orthodontic treatment affects such tissues. This study describes nasolabial fold regional changes in premolar extraction cases. Methods: Pre- and post-treatment 3dMD images of 14 skeletal Class-I patients with 4 premolar extractions were studied for changes of tissue thickness in the nasolabial fold region. All subjects were treated at Temple University. The sample consisted of 10 females and 4 males aged 12 -26 years old and included three ethnicities: Asian, Hispanic, and African American. With the aid of 3dMD Vultus software, both qualitative and quantitative analyses were collected. Color histograms were created for qualitative analyses, and quantitative volumetric changes in cheek volume were correlated to 2-D cephalometric lip thickness, lip retraction, and incisor retraction. Data were analyzed by Spearman’s rho for lip thickness, lip retraction, and incisor retraction. Regression analyses were completed controlling for age, gender, and ethnicity. Results: In this sample of Class-I malocclusion patients with 4 premolar extraction treatment, quantitative results showed no significant correlations were found between 2-D soft tissue thickness and volumetric changes around the nasolabial fold region. Moreover, none of the other characteristics including, change in the upper lip in 2-D cephalometric measurements, age, and gender were factors that correlated with volumetric changes around the nasolabial fold. The qualitative findings showed changes in lips and commissures did not affect the soft tissues around the nasolabial fold areas. Overall, there were no significant correlations between the thickness of soft tissue, change in the lips in 2-D, age, ethnicity, and gender in volumetric changes. Conclusions: Data generated by this investigation did not imply any cause-and-effect relationship between measurements of lip thickness, lip retraction, and incisor retraction to the deepening of the nasolabial fold.