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Three-dimensional imaging is now being used for various orthodontic and maxillofacial assessments: 3D
treatment planning, preorthodontic and postorthodontic
evaluations, preoperative and postoperative evaluations,
3D prefabricated archwires, research, distinction between
syndromes involving craniofacial deformities, and more.4-6
Soft-tissue prediction software has also been used
successfully in patients with skeletal Class III
malocclusion treated with bimaxillary surgery.7
Three-dimensional imaging with a laser scanning system has proven to be reliable, with accuracy within
0.85 mm.8 A study with a photogrammetric tool for
3D acquisition showed a lower system error: within
0.2 mm.9 On the other hand also, a recent study
showed that the 3D cone-beam computerized tomography measurements were statistically significantly
different from measurements performed on ex-vivo
skulls in two thirds of the measurements, but the
authors concluded that this statistical significance
was probably not clinically relevant.10
Despite the favoring trends in 3D imaging, 2-dimensional diagnostic methods are still the main tools (lateral
and frontal cephalograms, dental panoramic tomograms,
intraoral and extraoral photographs) in maxillofacial
surgery and orthodontics. This might be a direct result
of the lack of 3D evaluation tools to accompany newer
imaging modalities.
A Class III malocclusion is a common condition
that, along with Class I and Class II malocclusions,
has physical, psychological, and social effects on
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Table I.
Subject/coordinate
1
2
3
4
5
6
7
8
9
10
11
12
12
14
15
Average*
Mean
AvF
Mean direction
quality of life.11 Class III patients most common features are retrusive maxilla, protrusive maxillary incisors, retrusive mandibular incisors, protrusive
mandible, and long lower facial height.12 Facial asymmetry is a 3D problem that often accompanies other facial deformities. Many analyses compare right and left
measurements with a constructed midline reference
plane for the estimation of asymmetries.13 This method,
however, has raised concerns, and new methods of
asymmetry evaluation are still emerging.14
The aim of this study was to evaluate 3D facial
shells by incorporating a population-specific average
template with a group of Class III subjects preparing
for orthognathic surgery. To date, 3D data of such nature
have not been used to determine differences between
Class III patients and a normative data set.
MATERIAL AND METHODS
px
1.68
8.70
0.13
5.49
2.56
6.72
4.33
0.23
4.07
1.18
2.70
9.78
1.51
1.85
6.53
3.83
1.92
1.18
Left
py
pz
103.98
2.01
103.35 0.45
97.18
4.50
99.47
5.73
100.79
0.90
100.88
0.59
93.23 0.14
103.04
2.18
86.81
5.78
103.33
0.08
98.15 1.28
97.67 2.53
104.79 0.34
97.70 0.88
103.65 1.77
99.60
1.95
99.60
0.96
95.21 4.09
Down Forward
ax
0.89
1.24
0.81
0.44
1.24
0.90
0.31
2.22
0.59
0.64
0.76
0.71
2.35
1.64
1.37
1.07
0.58
1.54
Left
ay
az
51.15
3.64
56.14
0.98
50.74
4.80
48.94
4.03
54.17 2.04
48.47 1.07
52.03
0.44
54.04
3.17
50.24
2.24
59.73
0.34
48.49
0.76
51.64
1.39
59.80 0.49
52.89 0.57
56.87
0.28
53.02
1.75
53.02
1.19
55.05
2.83
Down Forward
examination was performed to exclude them), (4) normal body mass index of 18.5 to 25, and (5) no gross craniofacial anomalies.
The inclusion criteria for the Class III group were (1)
white descent, (2) normal body mass index of 18.5 to 25,
(3) diagnosed Class III condition that required combined
orthodontic and surgical treatment, and (4) no other
forms of pathology (eg, condylar hypolasia). The Class
III group was further divided into subgroups by sex.
The study was approved by the Slovenian National
Medical Ethics Committee. It was conducted according
to the principles of the Helsinki-Tokyo declaration.
Informed consent was obtained from all subjects.
The laser scanning system consisted of 2 highresolution Vivid VI900 3D cameras (Konica Minolta,
Tokyo, Japan) with a reported manufacturing accuracy
of 0.1 mm, operating as a stereo pair. Each camera emits
an eye-safe Class I laser, 690 nm at 30 mW, with an
object-to-scanner distance of 600 to 2500 mm and
a fast mode scan time of 0.3 seconds. The system uses
a one half frame transfer charged couple device and
can acquire 307,000 data points. The scanners output
data are 640 3 480 pixels for 3D and red, green, and
blue color data. The data were recorded on a desktop
workstation, and, for surface capture, a medium-range
lens (Konica Minolta) with a focal length of 14.5 mm
was used. The cameras were placed 1350 mm from the
subjects. The scanners were controlled with multi-scan
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Table III.
Subject
Subject
Diff px
Diff py
Diff pz
Diff ax
Diff ay
Diff az
1
1.27 105.54
5.52 0.24 55.93
5.81
2
1.90 102.43 0.85
0.70 52.41 2.38
3
1.28 102.23 10.81
0.47 58.73
1.12
4
2.04 115.68 8.69
1.03 56.48 3.81
5
1.89 111.53
6.15
0.72 58.40
6.66
6
2.41 129.64
2.08
0.81 71.47
4.83
7
2.15 112.53 0.62
0.00 58.60 5.03
8
0.40 103.14 0.47
1.90 64.58 2.45
9
2.16 103.66
2.86
0.86 60.43 1.48
10
5.48 114.50 1.93
3.32 61.00
3.36
11
2.52 114.14
2.57
1.77 58.82
4.98
12
7.12 108.13
0.09
2.27 55.57
2.08
13
2.01 114.58 3.60
0.99 64.42
0.42
14
4.48 97.94 4.48
3.16 54.33 2.35
Average*
2.65 109.69
3.62
1.30 59.37
3.34
Mean
2.32 109.69
0.67
1.27 59.37
0.84
0.37 55.60
3.33
Value on AvM 0.83 103.96 5.49
Mean direction Left Down Forward Left Down Forward
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Average*
Mean
Direction
0.50
9.88
1.32
6.68
1.38
5.54
3.15
0.96
2.89
0.01
1.51
8.59
0.32
0.67
5.34
3.25
0.74
Left
8.77
8.14
1.97
4.26
5.57
5.67
1.99
7.83
8.40
8.11
2.94
2.46
9.58
2.48
8.44
5.77
4.39
Down
6.10
3.64
8.59
9.82
4.10
4.68
3.95
6.27
9.87
4.17
2.81
1.56
3.75
3.21
2.32
5.05
5.05
Forward
2.43
2.78
2.35
1.98
0.31
0.65
1.85
0.67
0.96
0.90
0.79
0.84
0.81
0.10
0.17
1.17
0.96
Right
3.89
1.09
4.31
6.11
0.88
6.58
3.02
1.00
4.81
4.69
6.56
3.41
4.76
2.16
1.82
10.90
2.03
Down
0.81
1.85
1.97
1.20
4.87
3.90
2.40
0.34
0.59
2.49
2.07
1.45
3.32
3.40
2.55
2.21
1.64
Back
Diff, Difference.
*Represents the average of absolute differences.
Table IV. The difference of Pog (px, py, and pz) and
subspinale (ax, ay, and az) of the average male template
and the male Class III subjects
Table II.
px
py
pz
ax
ay
az
Subject
Diff px Diff py
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Average*
Mean
Mean direction
2.10
1.07
2.11
2.87
2.72
3.23
2.98
0.43
2.99
6.31
3.35
7.95
2.84
5.31
3.30
3.15
Left
Diff pz
1.57 11.02
1.54
4.64
1.74 16.31
11.71
3.19
7.57 11.65
25.68
7.58
8.57
4.87
0.83
5.02
0.30
8.35
10.54
3.57
10.18
8.06
4.16
5.58
10.62
1.89
6.02
1.02
7.22
6.62
5.73
6.17
Down Forward
0.33
3.19
3.13
0.88
2.80
15.87
2.99
8.98
4.83
5.40
3.21
0.03
8.81
1.28
4.41
3.77
Down
2.49
5.71
2.20
7.14
3.34
1.51
8.36
5.77
4.81
0.04
1.66
1.25
2.91
5.67
3.77
2.49
Back
Diff, Difference.
*Represents the average of absolute differences.
an average female (AvF) shell. The steps required to produce an average face have already been described and
are summarized as follows: (1) the images are
prealigned to determine the principal axes of rotation;
(2) manual corrections are made to positioning;
(3) best-fit alignment is done with the built-in algorithm
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761
Fig 2. Coordinates px (Pog) of the male and female Class III (MCIII and FCIII) patients compared with
the px of the average female (AvF) and male (AvM) patients.
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Bozic et al
Fig 3. Coordinates py (Pog) of the male and female Class III (MCIII and FCIII) patients compared with
the py of the average female (AvF) and male (AvM) patients.
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763
Fig 4. Coordinates pz (Pog) of the male and female Class III (MCIII and FCIII) patients compared with
the pz of the average female (AvF) and male (AvM) patients.
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Fig 5. Coordinates ax (point A) of the male and female Class III (MCIII and FCIII) patients compared
with the ax of the average female (AvF) and male (AvM) patients.
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765
Fig 6. Coordinates ay (point A) of the male and female Class III (MCIII and FCIII) patients compared
with the ay of the average female (AvF) and male (AvM) patients.
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Bozic et al
Fig 7. Coordinates az (point A) of the male and female Class III (MCIII and FCIII) patients compared
with the az of the average female (AvF) and male (AvM) patients.
Female subject
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Average
Similarity (%)*
Male subject
Similarity (%)*
30.83
47.69
27.18
52.02
26.66
49.05
52.64
28.72
38.46
34.42
41.81
39.26
34.81
23.71
47.84
38.34
1
2
3
4
5
6
7
8
9
10
11
12
13
14
27.15
39.59
36.10
34.29
38.78
21.43
32.47
34.44
21.30
25.93
35.98
35.85
30.56
46.07
32.85
CONCLUSIONS
2.
3.
4.
Bozic et al
Fig 8. A Slovenian female Class III face superimposed on an average Slovenian female face showing
a protruded mandible, with the upper two thirds mostly within the accepted 0.85-mm tolerance. Note
the asymmetry of the mandible.
Fig 9. A Slovenian male Class III face superimposed on an average Slovenian male face showing
mandibular prognathism and maxillary retrognathism, with the upper facial third mostly within the
accepted 0.85-mm tolerance.
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Bozic et al
Fig 10. A Slovenian female Class III face superimposed on an average Slovenian female face where
the mandible is protruded, the maxilla is retruded, and there is also a significant difference from the
average face in the upper third: the area around the eyes and forehead.
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