Virtual reconstruction of orbital floor defects using a statistical shape model.

PURPOSE: The current standard in reconstructing defects of the orbital floor, by using the concept of mirroring, is time-consuming and ignores the natural asymmetry of the skull. By using a statistical shape model (SSM), the reconstruction can be automatized and improved in accuracy. The present study aims to show the possibilities of the virtual reconstruction of artificial defects of the orbital floor using an SSM and its potentials for clinical implementation. METHODS: Based on 131 unaffected CT scans of the midface, an SSM was created which contained the shape variability of the orbital floor. Nineteen midface CT scans, that were not included in the SSM, were manually segmented to establish ground truth (control group). Then artificial defects of larger and smaller sizes were created and reconstructed using SSM (Group I) and the gold standard of mirroring (Group II). Eventually, a comparison to the surface of the manual segmentation (control group) was performed. RESULTS: The proposed method of reconstruction using an SSM leads to more precise reconstruction results, compared with the conventional method of mirroring. Whereas mirroring led to the reconstruction errors of 0.7 mm for small defects and 0.73 mm for large defects, reconstruction using SSM led to deviations of 0.26 mm (small defect) and, respectively, 0.34 mm (large defect). CONCLUSIONS: The presented approach is an effective and accurate method for reconstructing the orbital floor. In connection with modern computer-aided design and manufacturing, individual patient-specific implants could be produced according to SSM-based reconstructions and could replace current methods using manual bending techniques. By acknowledging the natural asymmetry of the human skull, the SSM-based approach achieves higher accuracy in reconstructing injured orbits.

Accuracy of intraoral scans: An in vivo study of different scanning devices.

STATEMENT OF PROBLEM: The accuracy of intraoral scanners is a prerequisite for the fabrication of dental restorations in computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry. While the precision of intraoral scanners has been investigated in vitro, clinical data on the accuracy of intraoral scanning (IOS) are limited. PURPOSE: The purpose of this clinical study was to determine the accuracy of intraoral scanning with different devices compared with extraoral scanning. MATERIAL AND METHODS: An experimental appliance was fabricated for 11 participants and then scanned intraorally and extraorally with 3 different intraoral scanners and a reference scanner. Intraoral and extraoral scans were subdivided into complete-arch and short-span scans and compared with the reference scan to assess trueness. Repeated scans in each group were assessed for precision. RESULTS: Precision and trueness were higher for extraoral scans compared with intraoral scans, except for complete-arch scans with 1 intraoral scanner. The median precision of short-span scans was higher (extraoral: 22 to 29 µm, intraoral: 23 to 43 µm) compared with complete-arch scans (extraoral: 81 to 165 µm, intraoral: 80 to 198 µm). The median trueness of short-span scans (extraoral: 28 to 40 µm, intraoral: 38 to 47 µm) was higher than that of complete-arch scans (extraoral: 118 to 581 µm, intraoral: 147 to 433 µm) for intraoral and extraoral scanning. CONCLUSIONS: Intraoral conditions negatively influenced the accuracy of the scanning devices, which was also reduced for the complete-arch scans.

Creating an anatomical wax-up in partially edentulous patients by means of a statistical shape model.

PURPOSE: Creating wax-ups of missing teeth for backward planning in implant surgery is a complex and time-consuming process. To facilitate implant-planning procedures, the automatic generation of a virtual wax-up would be useful. In the present study, the reconstruction of missing teeth in partially edentulous patients was performed automatically using newly developed software. The accuracy was investigated in order to test its clinical applicability. MATERIALS AND METHODS: This study presents a new method for creating an automatic virtual wax-up, which could serve as a basic tool in modern implant-planning procedures. First, a statistical shape model (SSM) based on 76 maxillary and mandibular arch scans from dentally healthy individuals was generated. Then, artificially generated tooth gaps were reconstructed. The accuracy of the workflow was evaluated on a separate testing sample of 10 individuals with artificially created tooth gaps given as a median deviation, in millimeters. Scans of three clinical cases with partial edentulism were equally reconstructed using the SSM and compared with the final prosthodontic work. RESULTS: The reconstruction of the artificial tooth gaps could be performed with the following median reconstruction accuracy: gap 21 with 0.15 mm; gap 27 with 0.20 mm; gap 34 with 0.22 mm: gap 36 with 0.22 mm; gaps 12 to 22 with 0.22 mm; gaps 34 to 36 with 0.22 mm. A scenario for an almost edentulous mandible with all teeth missing except teeth 33 and 43 could be reconstructed with a median reconstruction accuracy of 0.37 mm. The median tooth gap deviation of the SSM-based reconstruction in clinical cases differed from the final inserted prosthodontic teeth by 0.49 to 0.86 mm in median. CONCLUSION: A first feasibility of creating virtual wax-ups using an SSM could be shown. Artificially generated tooth gaps could be reconstructed close to the original with the proposed workflow. In the clinical cases, the SSM proposes an anatomical reconstruction, which does not yet consider prosthodontic aspects. To obtain clinical use, contact with antagonist teeth must be considered and more training data must be implemented. However, the presented method offers a fast and viable way for the approximate placement of missing crowns. This could be used in a digital planning workflow when implant position must be determined. (Int J Comput Dent 2022;25(4):349-0; doi: 10.3290/j.ijcd.b2599407).

Quantifying differences in hominin flaking technologies with 3D shape analysis.

Genetic and climate-driven estimates of past population dynamics are increasingly influential in broader models of hominin migration and adaptation, yet the contribution of stone artifact variability remains more contentious. Scientists are increasingly recognizing the potential of unretouched stone flakes ('flakes') in exploring existing models of hominin behavioral evolution. This is because flakes (1) were produced by all stone tool manufacturing groups in the past, (2) are abundant from the inception of the archaeological record up into the ethnographic present, and (3) preserve under most conditions. The statistical tools of 3D geometric morphometrics capture detailed approximations of flake form that are challenging to document with conventional artifact analyses. We analyze a collection of 717 3D scans of experimentally produced flakes from 5 production strategies that were practiced by hominins through large parts of the Pleistocene and that scientists have drawn on also to make demographic arguments about past human behavior (n = 45 reduction sequences, n = 3 knappers naive toward the study objectives). First, as a proof of concept, we demonstrate that we can estimate the strategies used to produce these flakes at a high success rate even when flakes from early stages of core reduction are included. We frame the significance of this finding against archaeological classifications from several key Middle Paleolithic assemblages in France (n = 4 sites, n = 28 layers, n = 16,467 flakes). Second, we show that 3D geometric morphometrics captures subtle differences in these strategies that influence flake formation on a flake-by-flake basis and that reflect decisions made by knappers about platform selection, preparation, and core-surface management. We explore the broader potential of our model with a cross-validation approach, and we describe a means of assessing flake form on a continuum wherein variability among assemblages separated by large expanses of space and time can be meaningfully explored.

Troubles in Tuva: Patterns of perimortem trauma in a nomadic community from Southern Siberia (second to fourth c. CE).

OBJECTIVES: Warfare is assumed to be one of the defining cultural characteristics of steppe nomads in Eastern Eurasia. For the first-centuries CE, a period of political turmoil in Northern China and Southern Siberia, relatively few data are, however, available about the degree and variability of violence in these communities. Here, we provide new data on violence among steppe nomads during the first-centuries CE by analyzing the type, anatomical distribution, and demographic distribution of perimortem trauma at Tunnug1 (Tuva, Southern Siberia-second to fourth c. CE). MATERIALS AND METHODS: Perimortem traumas were assessed on 87 individuals representing both sexes and different age classes. The timing of the lesions was assessed based on morphological criteria, including the absence and presence of bone reactive processes and the relative plasticity of the bone at the moment of impact. The distribution by age, sex, and anatomical location of trauma was analyzed by means of logistic models, Fisher's exact tests, and 3D visualizations. RESULTS: A total of 130 perimortem traumas, including chop marks, slice marks, penetrating lesions, and blunt traumas were identified on 22 individuals. Chop marks were mostly at the level of the skull and vertebrae and were likely caused by bladed weapons. Slice marks were found on the cervical vertebrae and cranium and may be the result of throat slitting and scalping by means of smaller bladed implements. Traumas were more frequent in males, and their presence is not correlated with age. DISCUSSION: This study adds new data to the few available regarding violence among steppe nomadic cultures and provides new insights about the effects of political instability on the life of the people inhabiting Eastern Eurasia during the early centuries CE.

Three-dimensional geometric morphometrics of thorax-pelvis covariation and its potential for predicting the thorax morphology: A case study on Kebara 2 Neandertal.

The skeletal torso is a complex structure of outstanding importance in understanding human body shape evolution, but reconstruction usually entails an element of subjectivity as researchers apply their own anatomical expertise to the process. Among different fossil reconstruction methods, 3D geometric morphometric techniques have been increasingly used in the last decades. Two-block partial least squares analysis has shown great potential for predicting missing elements by exploiting the covariation between two structures (blocks) in a reference sample: one block can be predicted from the other one based on the strength of covariation between blocks. The first aim of this study is to test whether this predictive approach can be used for predicting thorax morphologies from pelvis morphologies within adult Homo sapiens reference samples with known covariation between the thorax and the pelvis. The second aim is to apply this method to Kebara 2 Neandertal (Israel, ∼60 ka) to predict its thorax morphology using two different pelvis reconstructions as predictors. We measured 134 true landmarks, 720 curve semilandmarks, and 160 surface semilandmarks on 60 3D virtual torso models segmented from CT scans. We conducted three two-block partial least squares analyses between the thorax (block 1) and the pelvis (block 2) based on the H. sapiens reference samples after performing generalized Procrustes superimposition on each block separately. Comparisons of these predictions in full shape space by means of Procrustes distances show that the male-only predictive model yields the most reliable predictions within modern humans. In addition, Kebara 2 thorax predictions based on this model concur with the thorax morphology proposed for Neandertals. The method presented here does not aim to replace other techniques, but to rather complement them through quantitative prediction of a virtual 'scaffold' to articulate the thoracic fossil elements, thus extending the potential of missing data estimation beyond the methods proposed in previous works.

Assessing thoraco-pelvic covariation in Homo sapiens and Pan troglodytes: A 3D geometric morphometric approach.

OBJECTIVES: Understanding thoraco-pelvic integration in Homo sapiens and their closest living relatives (genus Pan) is of great importance within the context of human body shape evolution. However, studies assessing thoraco-pelvic covariation across Hominoidea species are scarce, although recent research would suggest shared covariation patterns in humans and chimpanzees but also species-specific features, with sexual dimorphism and allometry influencing thoraco-pelvic covariation in these taxa differently. MATERIAL AND METHODS: N = 30 adult H. sapiens and N = 10 adult Pan troglodytes torso 3D models were analyzed using 3D geometric morphometrics and linear measurements. Effects of sexual dimorphism and allometry on thoraco-pelvic covariation were assessed via regression analyses, and patterns of thoraco-pelvic covariation in humans and chimpanzees were computed via Two-Block Partial Least Squares analyses. RESULTS: Results confirm the existence of common aspects of thoraco-pelvic covariation in humans and chimpanzees, and also species-specific covariation in H. sapiens that is strongly influenced by sexual dimorphism and allometry. Species-specific covariation patterns in chimpanzees could not be confirmed because of the small sample size, but metrics point to a correspondence between the most caudal ribs and iliac crest morphology that would be irrespective of sex. CONCLUSIONS: This study suggests that humans and chimpanzees share common aspects of thoraco-pelvic covariation but might differ in others. In humans, torso integration is strongly influenced by sexual dimorphism and allometry, whilst in chimpanzees it may not be. This study also highlights the importance not only of torso widths but also of torso depths when describing patterns of thoraco-pelvic covariation in primates. Larger samples are necessary to support these interpretations.

A 3D Morphometrical Evaluation of Brow Position After Standardized Botulinum Toxin A Treatment of the Forehead and Glabella.

BACKGROUND: Botulinum toxin treatment for forehead wrinkles has been extensively studied and found to be a safe and reproducible procedure. However, the effect on the position of the eyebrows, which relies on the dynamic positioning of the treated muscles, has received less attention and has not been studied with 3-dimensional (3D) technology. OBJECTIVES: The authors sought to evaluate the changes of eyebrow position after standardized botulinum toxin treatment of glabella or glabella and frontalis muscles with 3D imaging. METHODS: In a prospective study, 2 groups of adult females were treated with botulinum toxin A at the glabella only (G) or at the glabella and the frontalis muscle (F/G). The brow position was measured at 5 positions with 3D photography before injection and 2 weeks, 3 months, and 6 months after injection. Results were statistically analyzed and related to patient age. RESULTS: In the F/G group, the brow descended significantly almost across the whole brow length after 2 weeks. The descent lessened after 3 months and moved medially. No clear trend was evident in the G group. There was no significant change attributed to patient age in both groups. CONCLUSIONS: Botulinum toxin treatment of the glabella and frontalis muscle impacts the position and configuration of the eyebrow. The degree of change is affected by the amount of frontalis weakening rather than by treatment of the glabella. While age in general is not a reliable predictor, individual factors play the major role in how pronounced a change of the brow can be expected.

Site fragmentation, hominin mobility and LCT variability reflected in the early Acheulean record of the Okote Member, at Koobi Fora, Kenya.

From its initial appearance at ∼1.7 Ma, the Acheulean was prevalent through a vast chronological span of hominin behavioural evolution that lasted nearly 1.5 million years. The origins and production patterns of large bifacial cutting tools ('LCTs') - the marker of the Acheulean techno-complex - and the systematic changes in this behaviour through time are gaining increasing interest in paleoanthropology. Here we provide a synthesis of early Acheulean LCT variation in a landscape context by analysing assemblages from four different quasi-contemporaneous (∼1.4 Ma) sites from the Koobi Fora Formation. We characterize this variation using both 3D geometric morphometric and descriptive approaches. The expansive lateral exposures of fluvial and lacustrine sediments, as well as the associated tephrostratigraphy of the Koobi Fora Formation provide the landscape context that enables these comparative analyses. Our study demonstrates that when multiple contemporaneous early Acheulean localities are analysed together, a broader picture of LCT variability is elucidated. Four sites at Koobi Fora appear to represent a single system of lithic economy, characterized by a discrete trajectory of changes in LCT size and shape. These sites have ranges of LCT forms which appear to represent different but overlapping stages on a single reduction trajectory. Certain sites exhibit the full reduction trajectory while others exhibit only fragments of this trajectory. Other inter-site lithic proxies further complement these patterns in LCT variability. We explore patterns of site function, mobility and hominin landscape use, all of which may be suggestive of a depth of planning in early Acheulean hominins wherein technological activities were undertaken in substantial anticipation of future needs.

Reproducing the internal and external anatomy of fossil bones: Two new automatic digital tools.

OBJECTIVES: We present two new automatic tools, developed under the R environment, to reproduce the internal and external structures of bony elements. The first method, Computer-Aided Laser Scanner Emulator (CA-LSE), provides the reconstruction of the external portions of a 3D mesh by simulating the action of a laser scanner. The second method, Automatic Segmentation Tool for 3D objects (AST-3D), performs the digital reconstruction of anatomical cavities. MATERIALS AND METHODS: We present the application of CA-LSE and AST-3D methods to different anatomical remains, highly variable in terms of shape, size and structure: a modern human skull, a malleus bone, and a Neanderthal deciduous tooth. Both methods are developed in the R environment and embedded in the packages "Arothron" and "Morpho," where both the codes and the data are fully available. RESULTS: The application of CA-LSE and AST-3D allows the isolation and manipulation of the internal and external components of the 3D virtual representation of complex bony elements. In particular, we present the output of the four case studies: a complete modern human endocast and the right maxillary sinus, the dental pulp of the Neanderthal tooth and the inner network of blood vessels of the malleus. DISCUSSION: Both methods demonstrated to be much faster, cheaper, and more accurate than other conventional approaches. The tools we presented are available as add-ons in existing software within the R platform. Because of ease of application, and unrestrained availability of the methods proposed, these tools can be widely used by paleoanthropologists, paleontologists and anatomists.

Prospective 3D analysis of facial soft tissue augmentation with calcium hydroxylapatite.

BACKGROUND: Facial rejuvenation is an expanding field with an increasing number of treatment modalities. Several non-autologous filler materials are available for soft tissue augmentation. Calcium hydroxylapatite (CaOH) is aimed at increasing collagen neosynthesis and thereby producing long-term augmentation effects. Despite a multitude of observational reports, the field is suffering from lack of quantitative morphometric evaluation methods. OBJECTIVE: The objective of this proof-of-principle study was to investigate whether the effects of facial tissue augmentation with CaOH (RADIESSE™) can be quantified and followed up using 3D surface scanning. METHODS: 3 female subjects received augmentation of the mid and lower face with CaOH. The faces were recorded prior, directly after, and two weeks and six months after the injection using standardized photos and 3D scanning. Computational analysis allowed quantifying the change in volume and displacement of the facial surface. Additionally, a patient satisfaction questionnaire was administered. RESULTS: In all subjects, increase in facial volume could be quantified and was present after two weeks and six months. CONCLUSIONS: 3D surface scanning is an adequate tool for objective quantification of changes after facial augmentation with filler materials. Persistent volume augmentation after CaOH injections could be quantified after two weeks and six months. Evidence level: IV.

Phylogeny and adaptation shape the teeth of insular mice.

By accompanying human travels since prehistorical times, the house mouse dispersed widely throughout the world, and colonized many islands. The origin of the travellers determined the phylogenetic source of the insular mice, which encountered diverse ecological and environmental conditions on the various islands. Insular mice are thus an exceptional model to disentangle the relative role of phylogeny, ecology and climate in evolution. Molar shape is known to vary according to phylogeny and to respond to adaptation. Using for the first time a three-dimensional geometric morphometric approach, compared with a classical two-dimensional quantification, the relative effects of size variation, phylogeny, climate and ecology were investigated on molar shape diversity across a variety of islands. Phylogeny emerged as the factor of prime importance in shaping the molar. Changes in competition level, mostly driven by the presence or absence of the wood mouse on the different islands, appeared as the second most important effect. Climate and size differences accounted for slight shape variation. This evidences a balanced role of random differentiation related to history of colonization, and of adaptation possibly related to resource exploitation.

Analysis of the human osseous nasal shape--population differences and sexual dimorphism.

OBJECTIVES: In this study, the shape of the outer osseous nose in a German and a Chinese sample is analyzed using a dense set of semi-landmarks. Shape differences related to population and sex as well as directional and fluctuating asymmetry were statistically evaluated and also visualized. MATERIALS AND METHODS: Shape differences in the bony nose were investigated between a large sample of CT scans of German (140 ♀, 127 ♂) and Chinese (135 ♀, 132 ♂) crania. We used semi-automatic methods to represent the shape of this region as a dense point-cloud, consisting of 370 three-dimensional bilateral coordinates. Both the symmetric and asymmetric modes of shape variation were addressed. RESULTS: Strong differences in nasal shape were found between the two populations, while sex was found to play a minor role in explaining the observed shape variation. The expression of sexual dimorphism was similar in both populations. Differences attributed to population affinity and to sexual dimorphism were both found to affect the shape of the ossa nasalia and the projection of the spina nasalis. The correlation with population/sex was weak for directional asymmetry, but strong for fluctuating asymmetry. The nasal region is more asymmetric in Germans than in Chinese, with males displaying more asymmetry than females in both populations. DISCUSSION: While the bony nose is well suited for predicting population affinity, regarding the populations under investigation, its value for sexing unknown individuals is rather moderate. The similar expression of sexual dimorphism in those otherwise very dissimilar populations indicates common factors responsible for these differences.

Orbital reconstruction: prefabricated implants, data transfer, and revision surgery.

External impact to the orbit may cause a blowout or zygomatico-maxillary fractures. Diagnosis and treatment of orbital wall fractures are based on both physical examination and computed tomography scan of the orbit. Injuries of the orbit often require a reconstruction of its orbital walls. Using computer-assisted techniques, anatomically preformed orbital implants, and intraoperative imaging offers precise and predictable results of orbital reconstructions. Secondary reconstruction of the orbital cavity is challenging due to fractures healed in malposition, defects, scarring, and lack of anatomic landmarks, and should be avoided by precise primary reconstruction. The development of preformed orbital implants based on topographical analysis of the orbital cavity was a milestone for the improvement of primary orbital reconstruction.

Reconstruction of dental roots for implant planning purposes: a retrospective computational and radiographic assessment of single-implant cases.

PURPOSE: The aim of the study was to assess the deviation between clinical implant axes (CIA) determined by a surgeon during preoperative planning and reconstructed tooth axes (RTA) of missing teeth which were automatically computed by a previously introduced anatomical SSM. METHODS: For this purpose all available planning datasets of single-implant cases of our clinic, which were planned with coDiagnostix Version 9.9 between 2018 and 2021, were collected for retrospective investigation. Informed consent was obtained. First, the intraoral scans of implant patients were annotated and subsequently analyzed using the SSM. The RTA, computed by the SSM, was then projected into the preoperative planning dataset. The amount and direction of spatial deviation between RTA and CIA were then measured. RESULTS: Thirty-five patients were implemented. The mean distance between the occlusal entry point of anterior and posterior implants and the RTA was 0.99 mm ± 0.78 mm and 1.19 mm ± 0.55, respectively. The mean angular deviation between the CIA of anterior and posterior implants and the RTA was 12.4° ± 3.85° and 5.27° ± 2.97° respectively. The deviations in anterior implant cases were systematic and could be corrected by computing a modified RTA (mRTA) with decreased deviations (0.99 mm ± 0.84 and 4.62° ± 1.95°). The safety distances of implants set along the (m)RTA to neighboring teeth were maintained in 30 of 35 cases. CONCLUSION: The RTA estimated by the SSM revealed to be a viable implant axis for most of the posterior implant cases. As there are natural differences between the anatomical tooth axis and a desirable implant axis, modifications were necessary to correct the deviations which occurred in anterior implant cases. However, the presented approach is not applicable for clinical use and always requires manual optimization by the planning surgeon.

Precision of intraoral digital dental impressions with iTero and extraoral digitization with the iTero and a model scanner.

INTRODUCTION: Digital impression devices are used alternatively to conventional impression techniques and materials. The aims of this study were to evaluate the precision of digital intraoral scanning under clinical conditions (iTero; Align Technologies, San Jose, Calif) and to compare it with the precision of extraoral digitization. METHODS: One patient received 10 full-arch intraoral scans with the iTero and conventional impressions with a polyether impression material (Impregum Penta; 3M ESPE, Seefeld, Germany). Stone cast models manufactured from the impressions were digitized 10 times with an extraoral scanner (D250; 3Shape, Copenhagen, Denmark) and 10 times with the iTero. Virtual models provided by each method were roughly aligned, and the model edges were trimmed with cutting planes to create common borders (Rapidform XOR; Inus Technologies, Seoul, Korea). A second model alignment was then performed along the closest distances of the surfaces (Artec Studio software; Artec Group, Luxembourg, Luxembourg). To assess precision, deviations between corresponding models were compared. Repeated intraoral scanning was evaluated in group 1, repeated extraoral model scanning with the iTero was assessed in group 2, and repeated model scanning with the D250 was assessed in group 3. Deviations between models were measured and expressed as maximums, means, medians, and root mean square errors for quantitative analysis. Color-coded displays of the deviations allowed qualitative visualization of the deviations. RESULTS: The greatest deviations and therefore the lowest precision were in group 1, with mean deviations of 50 µm, median deviations of 37 µm, and root mean square errors of 73 µm. Group 2 showed a higher precision, with mean deviations of 25 µm, median deviations of 18 µm, and root mean square errors of 51 µm. Scanning with the D250 had the highest precision, with mean deviations of 10 µm, median deviations of 5 µm, and root mean square errors of 20 µm. Intraoral and extraoral scanning with the iTero resulted in deviations at the facial surfaces of the anterior teeth and the buccal molar surfaces. CONCLUSIONS: Scanning with the iTero is less accurate than scanning with the D250. Intraoral scanning with the iTero is less accurate than model scanning with the iTero, suggesting that the intraoral conditions (saliva, limited spacing) contribute to the inaccuracy of a scan. For treatment planning and manufacturing of tooth-supported appliances, virtual models created with the iTero can be used. An extended scanning protocol could improve the scanning results in some regions.

Automated detection of cephalometric landmarks using deep neural patchworks.

OBJECTIVES: This study evaluated the accuracy of deep neural patchworks (DNPs), a deep learning-based segmentation framework, for automated identification of 60 cephalometric landmarks (bone-, soft tissue- and tooth-landmarks) on CT scans. The aim was to determine whether DNP could be used for routine three-dimensional cephalometric analysis in diagnostics and treatment planning in orthognathic surgery and orthodontics. METHODS: Full skull CT scans of 30 adult patients (18 female, 12 male, mean age 35.6 years) were randomly divided into a training and test data set (each n = 15). Clinician A annotated 60 landmarks in all 30 CT scans. Clinician B annotated 60 landmarks in the test data set only. The DNP was trained using spherical segmentations of the adjacent tissue for each landmark. Automated landmark predictions in the separate test data set were created by calculating the center of mass of the predictions. The accuracy of the method was evaluated by comparing these annotations to the manual annotations. RESULTS: The DNP was successfully trained to identify all 60 landmarks. The mean error of our method was 1.94 mm (SD 1.45 mm) compared to a mean error of 1.32 mm (SD 1.08 mm) for manual annotations. The minimum error was found for landmarks ANS 1.11 mm, SN 1.2 mm, and CP_R 1.25 mm. CONCLUSION: The DNP-algorithm was able to accurately identify cephalometric landmarks with mean errors <2 mm. This method could improve the workflow of cephalometric analysis in orthodontics and orthognathic surgery. Low training requirements while still accomplishing high precision make this method particularly promising for clinical use.

Cranial reconstruction evaluation - comparison of European statistical shape model performance on Chinese dataset.

Purpose: Morphological variability of the skull is an important consideration for cranioplasty and implant design. Differences in morphology of the skull based on the ethnicity are known. In a previous study we could show the accuracy and benefits of virtual reconstructions based on a statistical shape model (SSM) for neurocranial defects. As the SSM is trained on European data, the question arises how well this model fares when dealing with patients with a different ethnic background. In this study we aim to evaluate the accuracy and applicability of our proposed method when deploying a cranial SSM generated from European data to estimate missing parts of the neurocranium in a Chinese population. Methods: We used the same data and methods as in our previous study and compared the outcomes when applied to Chinese individuals. A large unilateral defect on the right side and a bilateral defect were created. The outer surface of the cranial table was reconstructed from CT scans, meshed with triangular elements, and registered to a template. Principal component analysis together with Thin Plate Spines (TPS) deformation was applied to quantify modes of variation. The mesh to mesh distances between the original defects´ surfaces and the reconstructed surface were computed. Results: Comparing the Chinese test group with the European control group, regarding the entire defect the analysis shows no significant difference for unilateral defects (test vs. control group/0.46 mm ± vs. 0.44 mm). Reconstruction of bilateral defects exhibited only in slightly higher prediction errors than those of unilateral defects (0.49 mm ± vs. 0.45 mm). Conclusion: The proposed method shows a high accuracy that seems to be ethnical independent - with low error margins for virtual skull reconstruction and implant design.Clinical relevance: Metallic objects may severely impact image quality in several CBCT devices.

A Novel Method for Digital Reconstruction of the Mucogingival Borderline in Optical Scans of Dental Plaster Casts.

Adequate soft-tissue dimensions have been shown to be crucial for the long-term success of dental implants. To date, there is evidence that placement of dental implants should only be conducted in an area covered with attached gingiva. Modern implant planning software does not visualize soft-tissue dimensions. This study aims to calculate the course of the mucogingival borderline (MG-BL) using statistical shape models (SSM). Visualization of the MG-BL allows the practitioner to consider the soft tissue supply during implant planning. To deploy an SSM of the MG-BL, healthy individuals were examined and the intra-oral anatomy was captured using an intra-oral scanner (IOS). The empirical anatomical data was superimposed and analyzed by principal component analysis. Using a Leave-One-Out Cross Validation (LOOCV), the prediction of the SSM was compared with the original anatomy extracted from IOS. The median error for MG-BL reconstruction was 1.06 mm (0.49-2.15 mm) and 0.81 mm (0.38-1.54 mm) for the maxilla and mandible, respectively. While this method forgoes any technical work or additional patient examination, it represents an effective and digital method for the depiction of soft-tissue dimensions. To achieve clinical applicability, a higher number of datasets has to be implemented in the SSM.