Preparation for bone graft | Digital Workflows

Preparation for bone graft

Orthodontic preparation for alveolar bone graft

The main objectives of orthodontic treatment of patients with cleft during mixed dentition are:

1. To align the dental arches and establishing a functional occlusion, favoring a more normal growth tendency.

2. To prepare the area of the alveolar cleft to receive the bone graft that must be carried out before the eruption of the permanent canine.

Collapsed maxillary arch with severe crowding

Fixed palatal expander before activation

Fixed palatal expander before activation maxillary arch after tooth alignment and palatal expansion

Digital records

Intra/extraoral photographs

Digital records - X-rays and cephalometric analysis

Orthodontists are increasingly adding digital technology to their orthodontics records.

These include the use of digital photography, digital radiography as well as e-models.

Number of software are available to do 2D and 3D cephalometry on radiographic or CBCT data.

Digital X-rays and cephalometric analysis

Digital records - Cone beam computed tomography

CBCT images to compare with digital x-rays

Cone beam computed tomography

Intraoral scan

Intraoral scan images

In-office Intraoral Scanning procedure

Path A - Digital Treatment simulation

Video display of the virtual treatment plan showing the sequence of tooth movements needed to correct the patient’s malocclusion.

Virtual Treatment Plan

Digital design/manufacture (aligners)

3D printed models

Thermoforming process

Finished sequential aligners

Path B - Appliance design/manufacturing

Digital appliance design/manufacture (expansion)

Initial patient scan

Digitally designed appliance (c.a.d.) 3d structure (dark blue) with welded expansion screw (light blue)

Digitally manufactured appliance (c.a.m.)

Appliance delivery

Cemented palatal expander

Following cementation, the patient is asked to get used to the appliance for a week, after which he/she is educated regarding the expansion protocol, which is carried out at home.

Removable plastic aligners

The patient is trained in the use of sequential removable aligners that are to be changed every 2 weeks, at home.

Remote monitoring

What is remote monitoring?

It is the use of digital technologies to monitor and capture medical and other health data from patients and electronically transmit this information to healthcare providers

Ways of remote monitoring?

Devices that track heart rate, blood pressure, oxygen levels, sleep quality, etc. These are collected from the patient’s location, then analyzed, interpreted, and transmitted to the caretaker at another location.

Self reported photographs can reveal lack of tracking of the orthodontic aligner, defining when the patient must travel to the treatment center for in-person appointment with the specialist.

Cellphone-based, at-home, self reported photographs

Remote cellphone-based consultation

In-person appointments

REQUIRED WHEN:

Loss of “tracking” or improper fit of appliance (re-scanning is required), sometimes due to exfoliation of deciduous teeth..
Re-training in oral hygiene.
Re-training in use/activation of appliances.
Fractured or loss of appliances.
In cases of appliance-induced ulcers or irritation.