The diagnostic benefits of 3D imaging using cone beam digital imaging units is now well established and have even become run of the mill in certain aspects of dentistry, for example impantology, and are now starting to enter other areas of dentistry such as facial rejuvenation.
During his most recent facial rejuvenation two day hands-on course, Nick Mohindra introduced delegates to the new Vectra H1 3D camera. It enables clinicians to take 3D images of their patients’ facial features in order to assess and demonstrate the physical
changes resulting from Oralift therapy.
Sometimes the facial adjustments resulting from Oralift therapy can be subtle and it can be difficult for patients to appreciate all the changes that have occurred simply by looking in a mirror. Similarly, using just a couple of before and after images can be equally difficult to interpret because there can be changes in angulation, lighting, distance from camera, size of image, patient’s clothes, hair, makeup and so on. Therefore, in order to facilitate an accurate assessment of the changes it is important that all of the images are precisely standardised so that the conditions of the first image are perfectly reproduced in all the subsequent images.
Consequently, Nick has established a photography area where he has marks on the floor indicating where the patient must stand, marks on the walls indicating where the patient should look in order to get a reproducible angulation of the head, and standardised external illumination so that the lighting effect remains constant. Essentially he ensures he controls and standardises all the peripheral factors he can, leaving only changes in the patient’s appearance as a variable.
In Nick’s opinion the best room to take these photographs in should have no windows, so that there is no alteration in the ambient light. The clinician should also use a white or black background so that there is no visual confusion from a ‘busy’ background.
When taking the images the operator should use standardised settings, Nick uses ISO 100, shutter speed 8 and aperture 160 for all of his pictures. You cannot simply use the automatic settings because otherwise you will get ‘red-eye’, harsh shadows and so on.
If you have not got an external light source, like Nick, you can use a shoe-mounted light on a manual setting, with the light bounced off the ceiling, but this is not as reproducible as a dedicated external light-source integrated with the camera.
The final images can then be cropped to achieve like-forlike presentations and put into Powerpoint presentations for comparison. However the images must be exactly the same size for an accurate comparison. Obviously the bigger the picture the more detail you can see compared with a smaller image.
Nick takes a series of four to six images. These include a ‘biggest smile’ picture from directly in front, a frontal image without a smile, and left and right profiles, again without a smile. Ideally you should also take left and right profiles from further away. Nick also recommends that you take two 45 degree shots.
Even lighting gives a much better image and makes it easier to compare like-for-like images too.
If images are cropped correctly it makes it easier to identify changes and assess changes in posture.
Up until recently Nick was still reliant on using a standardised digital SLR camera for taking individual images, which could then be used as before and after pictures to assess and demonstrate the results of his Oralift therapy on a patient’s facial features.
However, he now has a Vectra H1 3D digital camera which enables him to take accurate and reproducible 3D images which can be superimposed, using appropriate software, so that both Nick and the patient can identify volume changes and other
developments associated with the patient’s Oralift therapy.
Nick uses the 3D camera because it simplifies the procedure of comparing images, and standardises results without the need to worry about lighting or position. Images can be taken standing up in any room. One 3D image is all that is needed because it can be viewed from the side, 45 degrees, above and below. The contours of the face can be viewed from any of these angles. The 3D camera has a simple focusing mechanism, yet is the same size as an ordinary SLR camera.
The 3D images need to be taken on all visits in order to have a complete record of before, during and after treatment images.
When taking the pictures it is important to make sure the patient does not clench their teeth together. You must ensure that they bring their lips together, but remain relaxed so that they adopt a natural pose for the picture.
The Vectra H1 3D camera is a handheld imaging system which is lightweight, easy-to-handle and suitable for any small-to-medium field imaging, including the face. Completely self-contained and incorporating an integrated flash and focusing lights, it is ready to go with minimal training required. Photographs can be captured to the camera’s SD card or, when tethered to a PC, directly into a patient’s records. The associated Sculptor software offers a comprehensive set of aesthetic simulation tools.
Advantages of 3D
Images taken using a 3D camera show much more detail than images taken with a conventional 2D camera because it throws wrinkles and so on into relief. The images can also be rotated so that you can really assess the patient properly. You can also
superimpose one image over another, enabling you to measure volume changes in a colour coded relief map and demonstrate the changes to your patients too.
The volume changes could be attributed to muscle hypertrophy or be due to oedema within the muscle, increased muscle tone, increased muscle length or muscle tone correcting facial asymmetry. Some volume changes can occur even if there has been no treatment, but the changes that result from Oralift therapy are greater and last, rather than being simply transient.
The clinician can also use the software to calculate the number of spots and wrinkles on each image. These results can be compared from one image to another, enabling the clinician to monitor the treatment and look out for signs of overuse.
What are Oralift appliances?
They are thermoplastic mandibulary mouthguard-type appliances incorporating 3, 5 or 7mm bite blocks which, when moulded to the teeth, only contact in the molar region. Oralift appliances only take two minutes to fit. They are only worn during the day, never at night, and because they are only worn for a maximum of two hours per day (two sessions of one hour each), every third day, there is no risk of changes to the occlusal scheme.
Oralift appliances are worn in a cycle of two months worn, four months not worn, two months worn, four months not worn and so on. However, even when they are not being worn they still seem to be having an effect on the ageing process because of the long-term results Nick has observed. It is like having a personal trainer for the face.
Simple facial exercises can help fight the ageing process too, but the Oralift differs in two ways. First, the muscles being affected by Oralift seem to be all the head and neck muscles, including the muscles involved in breathing and swallowing. The second difference is that the muscles are having to adapt to the new mandibular position, and the increased volume in the mouth. This process of adaptation is not necessarily the same as exercise.
There are a number of theories as to how the Oralift works. The most plausible one seems to be that, when it is in the mouth, the muscles of the head and neck are activated to create an increased free way space and this activity generates new chemistry and adjustments within the musculature.