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Conversations and Literature about 3D in orthodontics

List of literature for diagnostic model technologies:

The DDS-Pro program is compatible with the DDP-Ortho program
Read more at: www.ddp.systems


Sphenoid sinuses’ volume and area analysis of Brazilian individuals’ CBCTs, related to sex, age, skin color, and nutritional status using DDS‑Pro™ software

Franciéllen de Barros, Mônica da Costa Serra, Barbara Kuhnen, José Scarso Filho, Marcelo Gonçalves, Victor Gonçalves, Clemente Maia da Silva Fernandes

Forensic Science, Medicine and Pathology

The purpose of this study was to analyze the volume and area of sphenoid sinuses of Brazilian individuals’ cone-beam computed tomography (CBCT) images using the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland), to assess a potential correlation to sex, age, skin color, and nutritional status, and to evaluate differences between the right and left sides. Three-dimensional volume and area measurements were made with the software using CBCT images of 113 living Brazilian individuals of both sexes (67 females and 46 males). TEM, rTEM, and R were used to assess the reproducibility of inter- and intra-examiner measurements. The measurement means were estimated with 95% confidence intervals according to sex and age group.

There were no significant differences between the left and right sides for both volume and area and between the sexes and black and white individuals. Volume and area were significantly higher in 18 years or older (p < 0.05) and in individuals with normal body mass index (BMI) (p < 0.05). The obtained results do not allow indicating the use of sphenoid sinuses volume and area measurements to estimate sexual dimorphism, and the same occurred for skin color. However, such measures can help to estimate age. Further studies are suggested with a larger sample, especially for the nutritional status variable.

Maxillary sinuses’ height/width/depth of Brazilian subjects and influence of sex, age, skin color, and nutritional status: A CBCT study

Franci´ellen de Barros, Clemente Maia da Silva Fernandes, Barbara Kuhnen, Jos’e Scarso Filho, Marcelo Gonçalves, Mˆonica da Costa Serra

ELSEVIER Forensic Imaging – 08.09.2022

The purpose of this study was to perform linear (two-dimensional) measurements of maxillary sinuses (MS) using cone-beam computed tomography (CBCT) images, analyze the influence of sex, age, skin color, and nutritional status, and verify differences between the right and left sides. The sample consisted of CBCT images of 238 living Brazilian subjects (139 women and 99 men). Linear measurements of maximal height, width, and depth of the right and left MS were performed with the DDS-Pro® 2.12.0_2021 software (DPP Systems, Czestochowa, Poland). All data were submitted to the statistical analysis to validate potential significant differences (p > 0.05) for sex and age and correlation to skin color and BMI. The TEM, rTEM, and R were used for intra- and inter-examiner assessments. There were differences between the sides, with significantly higher measurements on the right side for MS height and on the left side for width and depth. The MS width was only greater (p > 0.05) in men. Adult individuals (18 years or older) had higher MS height measurements than the other age groups. The measurements for skin color and BMI did not show significant differences, and it was impossible to confirm a relationship between the parameters measured. The measurements of MS height and width showed significant differences between the right and left sides and anatomic variability between the sexes for MS width, which can help analyze sexual dimorphism. There were also significant differences between the age groups. There was no significant difference in the measurements for skin color and nutritional status.

The results of the present study showed that the measurements of MS maximal height and width had significant differences between the right and left sides, and there was anatomic variability between the sexes for MS maximal width. Men showed greater MS width than women, which may help analyze sexual dimorphism. However, height and depth measurements did not show significant differences between the sexes. There were significant differences between age groups. There was no significant difference in the measurements for skin color and nutritional status. The findings of this study may help in the creation of a protocol in the field of Forensic Sciences, particularly in Forensic Anthropology, helping in the estimation of the biological profile of Brazilian individuals, and in processes of human identification, helping Justice and society.

Finding Better Ways to Perform Graftless Full Rehabilitation
of a Compromised Maxilla: New Platform-Switched
Zygomatic Implants Placed Extra-Sinus Improve Prosthetic
Restoration—A Preliminary Study of 25 Cases and 85 Implants

Paweł Aleksandrowicz, MD, DDS, PhD1/Marta Kusa-
Podkańska, DDS, PhD1/Andrea Borgonovo, MD, PhD2/Witold Tomkiewicz, MD3/Bartłomiej Szczodry, DDS4 Lidia Kotuła, MD, PhD5/Wojciech Popowski, DDS, PhD3 Joanna Wysokińska-Miszczuk, DDS, PhD2

The International Journal of Periodontics & Restorative Dentistry 1_2022

The presented clinical work was performed using the DDS-Pro software.

Standard treatment for full rehabilitation of compromised maxillae with regular implants includes sinus elevation grafting, a minimum of two to three surgeries, and a minimum treatment time of 9 to 15 months. Zygomatic implants are a viable alternative. However, prosthetic restorations have been compromised due to abutments emerging on the palate. The purpose of this study was to find ways that abutments will emerge on the ridge (occlusal surface). The presented results show it can be done if zygomatic implants are placed in the sinus wall (extra-sinus) and use an internal, conical connection with platform switching and 45-degree abutments. Thus, marginal tissue prognosis and primary stability may also be improved by adding coronal threads to an implant design. These improvements, if confirmed in longer follow-ups and further studies, may encourage more graftless rehabilitations of severely compromised maxillae, reducing the number of surgeries and overall treatment time.

New zygomatic implants with extra-sinus placement may present abetter, graftless option than regularimplants in graftless full rehabilitationof compromised maxillaewithout compromising prosthetics.Short- and long-term stability of zygomaticimplants are at less risk ofperi-implantitis at the crest becausetheir main anchorage is deep in thezygomatic bone. Adding a platformswitched,internal, conical connectionand utilizing a machined surfacecoronally may better preserve marginalbone, as has been reported onregular implants.Further follow-ups and studiesare needed. Development of surgicalguides may further facilitate theprocedure to become a standardtreatment of choice for full rehabilitationof compromised maxillae.

Platform switch hybrid zygoma implants improve prosthetics and marginal bone protection after extra-sinus placement

Paweł Aleksandrowicz PhD, MD, DDS1, Marta Kusa-Podkańska PhD, DDS1, Witold Tomkiewicz MD2, Lidia Kotuła PhD, MD3, Jan Perek DDS2, Joanna Wysokińska-Miszczuk PhD prof. DDS1

Wiley Periodical, 2020;22;186-192

The presented clinical work was performed using the DDS-Pro software.


The aim of our studdy is clinical evaluation of Platform switch hybrid
zygoma implants.

Results: Bone quality and quantity are the prerequisite for successful implant treatment. Zygomatic implants are intended for patients with severely resorbed maxilla that cannot accommodate conventional implants without prior extensive bone grafting. Such regenerative procedures, like sinus lifts, prolong implant rehabilitation
to several months (12–18). Furthermore, extensive grafts are less predictable showing varying degrees of graft resorption. Zygoma implants enable full, often immediate, reconstruction of the upper dental arch without the need for sinus lift treatment. The original zygoma protocol runs the implants through the sinus, requires general anesthesia, and positions the prosthetic platform of the implants on the palate, which
makes prosthesis cumbersome. It also induces risk for post-op sinusitis. Extra-sinus approach with novel zygoma hybrid implants bypasses sinuses and positions the implant prosthetic platform on the crest allowing for same good prosthetics as on
conventional dental implants. Furthermore, crestal threads and a platform-switch, of the novel zygoma design, increase implant anchorage and minimize marginal bone loss. The study presents evolution of zygoma implant rehabilitation protocol and zygoma implant design in our clinical practice over 15 years (2004-2019).

Conclusion: Extra-sinus zygomatic implant placement lowers the risk of post-op sinusitis and makes procedure possible to be done in local anesthesia.

Three-dimensional analysis of the maxillary sinus according to sex, age, skin color, and nutritional status: A study with live Brazilian subjects using cone-beam computed tomography

Franciéllen de Barros, Clemente Maia da Silva Fernandes, Barbara Kuhnen, José Scarso Filho, Marcelo Gonçalves, Victor Gonçalves, Mônica da Costa Serra

ELSEVIER, Archives of Oral Biology, Volume 139, July 2022


To perform three-dimensional measurements (volume and area) of the maxillary sinus, from cone-beam computed tomography (CBCT) images, and to assess potential differences between the left and right sides and a correlation of the measurements to sex, age, skin color, and nutritional status.


CBCT images of 161 living Brazilian subjects of both sexes (89 women and 72 men) were used, and three-dimensional measurements of volume and area were made with the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland). The inter- and intra-examiner reproducibility of measurements was evaluated with TEM, rTEM, and R.


Both maxillary sinus volume and area did not show significant differences between the left and right sides and between the sexes. Volume and area were significantly lower in the age group from 6 to 11 years than in the other two groups (p < 0.05). The measurements obtained for maxillary sinus volume and area were significantly higher in white individuals (p < 0.05), but they did not show significant differences (p > 0.05) regarding nutritional status (considering the body mass index – BMI).


There were no statistically significant differences between the sexes, which does not allow recommending the use of maxillary sinus volume and area measurements to analyze sexual dimorphism, and the same occurs for BMI. However, such measures can help to estimate the age and skin color of individuals.

In-House Hybrid Technique for Customization of Guides
and Miniplates in Orthognathic Surgery

Jonathas Daniel Paggi Claus, PhD, Matheus Spinella Almeida, DDS, and Federico Hernandez-Alfaro, MD, DDSy

The Journal of Craniofacial Surgery, Volume 31, Number 4, June 2020 

The use of customized plates in Orthognathic surgery offers precision in the repositioning of the jaws, according to the virtual planning performed, with the great advantage of avoiding the need for intermediate occlusal splints. However, the conventional customization process takes time to manufacture, present high cost and still involve legal issues with insurance companies.
Moreover, a technical disadvantage is that the systems available for customized plates require large incisions, with large detachment of soft tissues for insertion of the guides and plates. The objective of this paper is to present the in-house hybrid technique for customization of guides and miniplates in orthognathic surgery using minimally invasive approaches.

See Pictures with descriptions:

Recent reports have demonstrated the use of customized miniplates for orthognathic surgeries with promising results allowing the oral and maxillofacial surgeons to perform bimaxillary surgeries without the need for intermediate splints (waferless surgery). However, the evidence remains unclear and the technology too new to recommend use on a daily basis.5,8
Most of the customization systems described in the literature for orthognathic surgeries are a company-made process, in association with engineers. These processes involve high costs and is time consuming. Also, most of these publications used large incisions to allow the introduction of cutting guides and customized plates. The authors of this paper strongly prefer to work with small incisions according to these new concepts of minimally invasive orthognathic surgery.9,10
Further studies are necessary to evaluate the overall impact. In our experience, the hybrid technique for customization of guides and miniplates is a feasible method for orthognathic surgeries that allows surgeons to decrease incisions, increase precision and reduce operating time with a low-cost process.

Comparison of guided and
non – guided implant placement
In vitro study with 3D printing (Part 2)
Marta Czajkowska, Dr Łukasz Zadrożny, Zbigniew Bartosik & Dr Leopold Wagner, Poland
CAD/CAM 1_2019 

Proper 3D implant positioning is a crucial factor for predictable implant and prosthodontic treatment. Guided osteotomy preparation and placing implants through a guide may contribute to more precise implant placement in accordance with the prosthodontic plan.
…The implantation procedure was planned in DDS-Pro software (www.dds-pro.com.pl) on the basis of the CBCT scan and the optical scan of the cast model and of the model with wax-up of the future prosthesis.

The initial conclusion of the study are consistent with the conclusion of scientific research analysis and confirm greater compliance with treatment plan for implants placed in guided procedures. The comparison methods used and the research material selection in the form of STL files allowed us to analyse the procedure effect adjustment relative to the treatment plan.

Comparison of guided and
non – guided implant placement
In vitro study with 3D printing (Part 1)
Dr Łukasz Zadrożny, Marta Czajkowska & Dr Leopold Wagner, Poland
CAD/CAM 1_2019

The procedure of implantation is becoming an increasingly
popular method for replacing teeth. The critical factor
in the achievement of a therapeutic and aesthetic
long-term effect is the accuracy and precision of implant
placement, being the support for the future prosthetic work.Methodology
Based on the CBCT examination of the patient, who underwent
implantation in the mandible, a 3D model corresponding
to the actual bone and mucosal conditions
before implantation was created in DDS-Pro software
(www.dds-pro.com.pl). It was then reprinted 20 times. The
print was produced with selective laser sintering technology
using polyamide powder in the TPM Elite 3600 SLS
System printer (Solveere). It yielded ten identical pairs
of mandibular models.

The use of three-dimensionally printed models allows implantological procedures to be performed under conditions
spatially corresponding to the potential clinical situation. The models printed for this study were
tough though. The material cut during bed preparation was deposited on the drill and in the implant thread, making it difficult to install.
insertion to the full depth of the prepared bed. This forced the use of a much larger one than was used
clinically, forces to insert the implant.
When preparing the bed next to the preserved tooth, attention was paid to the need to use a drill extension,
to avoid the contra-angle resting on the template/tooth. This tool is missing from the Osstem Guide Kit navigation cassette, more on that
Please remember when using this set clinically and always have a standard cassette at your disposal
implantology. The use of a template shortens the time needed to complete the implant procedure compared to the procedure
performed free-hand.

The Easy Driver for Placement of Palatal Mini-Implants and a Maxillary Expander in a Single Appointment
Journal of Clinical Orthodontics – 11.2017

This digitally produced insertion guide simplifies one-visit placement of a Hybrid Hyrax expander for early orthopedic treatment of Class III malocclusion. Alternating maxillary and expansion and constriction are followed by a protraction facemask in the example shown by the authors.

Trends in the use of digital study models and other technologies among practicing orthodontists-
Dr.Park, Dr.Laslovich
JCO/July 2016

The authors evaluate the use of digital study models in daily orthodontic practice. They sent 31 questions to a random selection of 2,300 orthodontists, using SurveyMonkey.com; about 9% responded…
The rospondents would also be more likely to use intraoral scanners, cone-beam computed tomography (CBCT), and digital study models.
(OrthoCAD, SureSmile, Ortho Insight 3D, DigModel, emodel, O3DM)

Thet said, I found the information to be fascinating. Various methodods used to capture the data needed for digital study models are explored, and the results of the survey are reported in self-explanatory graphs and flow charts. I encourage you to spend some time with this article, looking fopr the underlying trends as much as the raw numbers.W.Ronald Redmonds, DDS, MS

Diagnostic accuracy and measurement sensitivity of digital models for orthodontic purposes: A systematic review
G.Rossini, S.Parrini, T.Castroflorio, A.Deregibus, C.debernardi
AJODO February 2016

Our objectives was to assess the accuracy, validity and reliability of measurements obtained from virtual dental study models compared with those obtained from plaster models. Abstract:

  • Digital models are as reliable as plastetr models for orthodontic purposes.
  • Lack of accuracy of measurements on digital models is not clinically significant.
  • Digital models should be considered the new gold standard in orthodontics.

Digital models are as reliable as traditional plaster models, with high accuracy, reliability, and reproducibility. Landmark identification, rather than the measuring device or the software, appears to be the greatest limitation. Furthermore, with their advantages in terms of cost, time, and space required, digital models could be considered the new gold standard in current practice.

„Digital casts in orthodontics: A comparison of 4 software systems”Anna Westerlund, Weronika Tancredi, Maria Ransjo, Andrea Bresin, Spyros Psonis, and Olof Torgersson
Gothenburg SwedenAm J Orthod Dentofacial Orthop 2015;147:509-16

The introduction of digital cast models is inevitable in the otherwise digitized everyday life of orthodontics. The introduction of this new technology, however, is not straightforward, and selecting an appropriate system can be difficult. The aim of the study was to compare 4 orthodontic digital software systems regarding service, features, and usability. Methods: Information regarding service offered by the companies was obtained from questionnaires and Web sites. The features of each software system were collected by exploring the user manuals and the software programs. Replicas of pretreatment casts were sent to Cadent (OrthoCAD; Cadent, Carlstadt, NJ), OthoLab (O3DM; OrthoLab, Czestochowa, Poland), OrthoProof (DigiModel; OrthoProof, Nieuwegein, The Netherlands), and 3Shape (OrthoAnalyzer; 3Shape, Copenhagen, Denmark).

The usability of the programs was assessed by experts in interaction design and usability using the “enhanced cognitive walkthrough” method: 4 tasks were defined and performed by a group of domain experts while they were observed by usability experts. Results: The services provided by the companies were similar. Regarding the features, all 4 systems were able to perform basic measurements; however, not all provided the peer assessment rating index or the American Board of Orthodontics analysis, simulation of the treatment with braces, or digital articulation of the casts. All systems demonstrated weaknesses in usability. However, OrthoCAD and 03DM were considered to be easier to learn for first-time users. Conclusions: In general, the usability of these programs was poor and needs to be further developed. Hands-on training supervised by the program experts is recommended for beginners.

“Comparison of Bolton analysis and tooth size measurements obtained using conventional and three-dimensional orthodontic models.”Nalcaci R1, Topcuoglu T2, Ozturk F3.Eur J Dent. 2013 Sep;7(Suppl 1):S66-70. doi: 10.4103/1305-7456.119077

The aim of this study was to compare the accuracy, reproducibility, efficacy and effectiveness of measurements obtained using digital models with those obtained using plaster models. Digital models were produced by the Ortho Three-dimensional Models (O3DM) Laboratory and their software (O3DM version 2) was used to obtain measurements. Identical plaster models were used to obtain measurements of teeth with a vernier caliper. All measurements were repeated at least 1 month later by the same operator for both digital and manual methods. The data were analyzed using Cronbach α, Wilcoxon signed rank test and the McNemar test.

Use of O3DM software is an acceptable alternative to the traditional vernier caliper method in orthodontic practice.

“Assessment of dental arches in patients with Class II division 1 and division 2 malocclusions using 3D digital models in a Syrian sample.”
Hajeer MY
Eur J Paediatr Dent. 2014 Jun;15(2):151-7

3D digital models (O3DM) with a dedicated programme were used to measure dental arch variables. Significant differences were observed between the two groups in the mesiodistal widths of some teeth but not in the dental arch widths.

3D digital models enabled fast, accurate and reliable measurements of dental arch characteristics in patients with Class II malocclusion. (2) Insignificant differences between Cl II1 and Cl II2 patients were observed regarding Bolton’s ratios and transverse arch measurements.

„From alginate impressions to digital virtual models: accuracy and reproducibility”
Michel Dalstra, Birte Melsen
School of Dentistry, University of Aarhus, Denmark
Journal of Orthodontics, Vol. 36,2009,36-41

It has been shown that there are no differences in the measurements between plaster models cast immediately after taking impressions in relation to the models cast 3-5 days of collection impression and obtained from them digital models, which ensures the correct measurements even after sending the impression to a professional lab by mail in order to prepare 3D models.

Making models (digital models) in one lab provides greater repeatability diagnostic material to carry out further measurements.

“Can digital models replace plaster models?”
Lene Rosbjerg, Emilie Neumann,Michel Dalstra, Birte Melsen.„
Moja Praktyka” the magazine for orthodontists published in Poland 1999 – 2014

Studies have shown that there were no statistically significant differences between measurements taken at the digital models and plaster. The authors also noticed greater security of patient records in digital form (models basically can not be lost or be damaged or been manipulated).

It has been proved that the measurements of digital models have better repeatability particularly when they make those with less experience clinical since the possibility of measurement inaccuracies related only to the determination of measurement points and does not occur due to the way of applying the measuring apparatus and the precision of the measurement reading.

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