Some of our readers might not be acquainted with Anatomage. Can you give us a little history? Chenin: Anatomage is now five years old. We are a 3D
imaging software company that is expanding the potential of 3D
imaging in all fields of dentistry with cone beam computed
tomography (CBCT). We are by definition a 3D CBCT software
service and solutions company and our ultimate goal is to
expand the potential as much as possible. The whole industry is
pretty much focused only on implant planning, with little concern
for other specialties or even inter-specialty communication.
We were one of the first to branch out and get into orthodontic
applications. We are not focused on just implants, but all dental
specialties. Some of the new updates really bring home that we
have the ability to do everything in the same platform; orthodontics,
implants, periodontal assessment, TMJ assessment, 3D
photography, hard- and soft-tissue simulations and more. It’s
the most complete “virtual patient” available.
I understand you have some new developments
in the works. Chenin: We’ve launched the first next-generation of CBCT
imaging, called Dynamic CBCT. It has the ability to simulate
hard- and soft-tissue movements and also compares pre/post
treatment results via superimposition. This was a huge developmental
advancement from mere static CBCT imaging. We are
now releasing another generation of digital imaging – Cosmetic
CBCT – which has the ability to combine intraoral photography
data, as well as a digital model data, into the patient’s scan.
All three of those elements are combined on one platform,
which is again, the CBCT scan, the patient digital model and
intraoral photography. It brings cosmetics into the realm of radiology,
which is very interesting and unique, and it advances
computer-guided treatment to a whole new level. Having accurate
information about gingival height, contour, health, color,
and so on, can really help in treatment planning a case for
implants or orthodontics, or a combination of the two.
Are you saying that you can actually see gingiva
with CBCT and that you can actually define the
gingival margins around teeth?
Chenin: Exactly! We will scan the digital model as well, and
that gives us the data that was missing from the CBCT scan,
which provides the patient’s hard tissues. CBCT shows internal
soft tissue, but does not distinguish well between the gingiva,
cheeks or tongue, nor does it show critical aspects like gingival
margins. We have three elements, one is the cone beam data set – that is a rough outline of the soft tissue and a very good outline
of the hard tissue, then the stone model scanned and the
photo, which we add to provide us with color. So you really get
the CT scan as the basis of everything. The stone model scans
give you gingival data and the photo essentially gives you true
patient colorization on it.
Are you are able to produce a virtual model that
shows the gingival line around the teeth?
Chenin: Yes, as a result of the combination of these several
data sets. We combine the CBCT scan of the patient, which is
the platform for all the data, with a scan of the stone model of
the patient and that is where the gingival data is brought in.
Normally with a cone beam data set, the gingival lines are not
distinct from the cheeks or the tongue. But with the incorporation of the model scan, the gingival line is very distinct and very
clear. Also, the intraoral photos are fused to the model so we
have the actual color and the actual intraoral photo in there as
well. So, three unique data sets come together for the first time – the cone beam scan of the patient, the scanned stone model
and the intraoral photography.
What is going to be the orthodontic benefit of
this type of thing?
Chenin: Orthodontists are using cone beam as a record for
treatment plans and having that gingival data from the start is
a great initial record. I think it will also help as the case goes on
as a record of where the gingival data is at the end. What is
greatly enhanced is temporary anchorage device (TAD) treatment
planning. With CBCT it is possible but previously,
because we didn’t know where the gingiva was, it was hard to
accurately place or see how it was going to appear. Now you can
virtually place these TADs and know exactly how it is going to
look from the gingiva, so you can plan more accurately how
that is going to happen. In terms of the dental team quarterbacking
with the surgeon or implantologist who is placing the
implant, if you are doing the ortho first and the implant second
you can take the gingival aesthetics into consideration as well.
So rather than just using the hard tissue, we now have a complete
cosmetic layer as well.
Will this enhance the application of this technology
to creating bracket placements or doing
Invisalign without PVS impressions?
Chenin: I believe so. Cone beam, in general, is going
towards therapeutic devices such as indirect treatments, brackets
and other aligners. One of the challenges of just pure CBCT
data is you don’t have that gingival line, so our enhanced, cosmetic
CBCT gives you those boundaries. If you are planning
brackets, you would be able to plan them in consideration with
the gingival line, which would be absolutely necessary. The last
thing you want to do is place some brackets on the CBCT scan
and then, when you get the patient in the chair, realize that you
have placed those brackets on top of gingiva. The cosmetic
model has the stone model scan fused to the CBCT scan so you
can take both things into consideration. This is a procedural step
that can help make that leap of orthodontic therapeutic devices
from conebeam easier. So, in computer-guided orthodontic
treatment this step can definitely help both the process and the
treatment planning. This is all going back to the idea of the virtual
patient; that the more complete our picture of the virtual
patient is, the better all treatments will be. In some cases it is a
necessity. I think this is the most complete virtual patient that is
possible. Again, it has the 3D CBCT scan which has the soft and
hard tissues (a scan of the stone model which has an accurate
presentation of the gingival) and it has the intraoral photography
fused to provide that as well.
If I wanted to use this service what would you
need from my office to make this work?
Chenin: We would want a CBCT scan of the patient,
a CBCT scan of the stone model and regular series intraoral
photographs.
When you say a composite of the stone model if
we were doing electronic models like OrthoCAD
models, for example, would that digital information
work for you?
Chenin: It would. However those companies have their
own proprietary formats. If they had a non-proprietary format
such as an STL file, it would work. There is just that proprietary
barrier. If you have your own digital scanner, you can send us
that data because it is non proprietary. The easiest way is to scan
the model with your CBCT machine.
If we did a stone model in the office would it
make any difference what kind of impression we
would take?
Chenin: Definitely! The quality of the model is going to be
a concern. We recommend PVS and good quality stone or good
quality plaster – but you could use just regular stone. I think the
higher grade you use, especially like PVS, it will definitely make
an impact on the overall quality.
I’ve seen some studies showing that intraoral
scans produce more detailed images than you
could get from a PVS impression.
Chenin: We can also fuse intraoral scans with that data. The
categories would be a CBCT scan, intraoral scan and then oral
photography. It doesn’t necessarily have to be a stone model
scan in a CBCT machine.
Once we can achieve a virtual patient that has
all of the information including soft tissue, then
this can be used for any specialty. This one data
file can be shared by orthodontists, implant doctors,
surgical doctors and anyone like that, is
that correct?
Chenin: Yes, and that is the idea behind the virtual patient.
Everybody should be on the same page. With this, you’re working
with the same file that can be shared with anyone. The
treatment planning is facilitated, the combination therapy is
facilitated, communication is facilitated – everything. Records
are simplified. The software allows you to press an upload button;
the file is then uploaded to our secure server, where you can
then share with whoever you then specify. It reduces the hassle
of having to track down records from different offices. You can
have the orthodontic simulation programmed into that file, the
implant simulation programmed into it and everybody is using
the same file.
Once this virtual patient data file is all put
together, how would an orthodontist or oral surgeon
look at this? Is that done through your
Web site?
Chenin: Within the software there is a button that they can
upload to our Web site, which has a secure sign-in and where the
other collaborating doctors would access it. They can download
that file and then open it up with 3D viewing software. Even if
they don’t have the full version of the software, they will be provided
with a free viewer. Essentially, any number of collaborators
would have access to the file and the software to view it.
What can you tell us about the cost involved
with doing this?
Chenin: It is less than $100 per case. You’re getting the ability
to collaborate with your colleagues to a level that far exceeds
anything that has come out before. On top of that, your diagnostic
data is more sophisticated and exceeds anything that we
have seen before. If you’re doing an orthodontic, orthognathic,
implant case what is $75 - $100 to make sure everything is done
right and everyone is on the same page.
What is the difference between a virtual patient
and a cosmetic CBCT scan? Are they the same?
Chenin: Everybody has a piece of the virtual patient or a lot
of companies try to portray a virtual patient. Something such as
a digital stone model can be called essentially a virtual patient.
But what the cosmetic CBCT does is to provide the most “complete”
virtual patient. I think almost any type of digital file that is
a patient record could be technically called a “virtual patient” but
the real question is: how complete is it? I think our cosmetic
CBCT is the most complete because it has the full 3D hard and
soft tissue from the cone beam scan, it has the gingiva from the
stone model and it has intraoral photography as well. In addition,
it has everything that you can do with cone beam such as TMJ,
airway, ortho, etc. So really, Cosmetic CBCT is really the next
generation of CBCT and it is the most complete virtual patient.
Doug, thank you so much for this interesting
and informative discussion of the next level of
sophistication in the CBCT technology. |