A QUALITATIVE AND QUANTITATIVE ANALYSIS OF SOFT TISSUE CHANGE EVALUATION BY ORTHODONTISTS IN CLASS II NON EXTRACTION ORTHODONTIC TREATMENT USING THE 3dMD SYSTEM

Abstract

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.