Accuracy of Dolphin visual treatment objective (VTO) prediction software on class III patients treated with maxillary advancement and mandibular setback

Progress in Orthodontics, Jun 2016

Background Dolphin® visual treatment objective (VTO) prediction software is routinely utilized by orthodontists during the treatment planning of orthognathic cases to help predict post-surgical soft tissue changes. Although surgical soft tissue prediction is considered to be a vital tool, its accuracy is not well understood in tow-jaw surgical procedures. The objective of this study was to quantify the accuracy of Dolphin Imaging’s VTO soft tissue prediction software on class III patients treated with maxillary advancement and mandibular setback and to validate the efficacy of the software in such complex cases. Methods This retrospective study analyzed the records of 14 patients treated with comprehensive orthodontics in conjunction with two-jaw orthognathic surgery. Pre- and post-treatment radiographs were traced and superimposed to determine the actual skeletal movements achieved in surgery. This information was then used to simulate surgery in the software and generate a final soft tissue patient profile prediction. Prediction images were then compared to the actual post-treatment profile photos to determine differences. Results Dolphin Imaging’s software was determined to be accurate within an error range of +/− 2 mm in the X-axis at most landmarks. The lower lip predictions were most inaccurate. Conclusions Clinically, the observed error suggests that the VTO may be used for demonstration and communication with a patient or consulting practitioner. However, Dolphin should not be useful for precise treatment planning of surgical movements. This program should be used with caution to prevent unrealistic patient expectations and dissatisfaction.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1186%2Fs40510-016-0132-2.pdf

Accuracy of Dolphin visual treatment objective (VTO) prediction software on class III patients treated with maxillary advancement and mandibular setback

Peterman et al. Progress in Orthodontics Accuracy of Dolphin visual treatment objective (VTO) prediction software on class III patients treated with maxillary advancement and mandibular setback Robert J. Peterman 0 Shuying Jiang 1 Rene Johe 0 Padma M. Mukherjee 0 0 Department of Orthodontics, Rutgers School of Dental Medicine , 110 Bergen Street, Newark, NJ 07103 , USA 1 Department of Institutional Assessment and Quality Improvement, Rutgers School of Dental Medicine , 110 Bergen Street, Newark, NJ 07103 , USA Background: Dolphin® visual treatment objective (VTO) prediction software is routinely utilized by orthodontists during the treatment planning of orthognathic cases to help predict post-surgical soft tissue changes. Although surgical soft tissue prediction is considered to be a vital tool, its accuracy is not well understood in tow-jaw surgical procedures. The objective of this study was to quantify the accuracy of Dolphin Imaging's VTO soft tissue prediction software on class III patients treated with maxillary advancement and mandibular setback and to validate the efficacy of the software in such complex cases. Methods: This retrospective study analyzed the records of 14 patients treated with comprehensive orthodontics in conjunction with two-jaw orthognathic surgery. Pre- and post-treatment radiographs were traced and superimposed to determine the actual skeletal movements achieved in surgery. This information was then used to simulate surgery in the software and generate a final soft tissue patient profile prediction. Prediction images were then compared to the actual post-treatment profile photos to determine differences. Results: Dolphin Imaging's software was determined to be accurate within an error range of +/− 2 mm in the X-axis at most landmarks. The lower lip predictions were most inaccurate. Conclusions: Clinically, the observed error suggests that the VTO may be used for demonstration and communication with a patient or consulting practitioner. However, Dolphin should not be useful for precise treatment planning of surgical movements. This program should be used with caution to prevent unrealistic patient expectations and dissatisfaction. Background One of the great challenges in orthodontics is the treatment planning and management of orthognathic surgical cases. These cases require a combination of both orthodontics and orthognathic surgery to achieve a wellbalanced occlusion, proper function, and harmonious facial esthetics. Depending on the type of skeletal imbalance, oral and maxillofacial surgeons perform orthognathic surgeries involving the maxilla and/or the mandible for these patients. Orthodontics, esthetics, and visual aids for soft tissue prediction have progressed since the early 1970s from the use of acetate tracing paper to computer-based line drawings to more modern technologies in the 1990s where computers could alter patient photographs in an attempt to predict surgical outcomes [ 1–5 ]. Visual treatment objective (VTO) images help the orthodontist to predict hard and soft tissue changes that may occur as a result of surgery and can be utilized to treatment plan orthognathic cases and to communicate with patients and surgeons. Seventy percent of prospective orthognathic surgery patients mention esthetics as their principle motivation, further highlighting the importance of soft tissue treatment planning [ 6 ]. It is the doctor’s legal, moral, and ethical responsibility to inform the patient of the risks versus benefits, options of camouflage versus surgery, and treatment versus no treatment [ 7 ]. However, VTOs might lead to unrealistic patient expectations causing dissatisfaction with postsurgical results [ 8 ]. This is a valid concern, as the errors of the prediction in two-jaw surgical cases are not well understood. Current literature is controversial with regards to the level of accuracy of the soft tissue predictions, and which areas of the face are best predicted by these software programs for two-jaw orthognathic cases [ 9 ]. Therefore, the primary objective of this study is to quantify the accuracy of Dolphin Imaging’s VTO soft tissue prediction software on patients treated with maxillary advancement and mandibular setback. Methods Patient sample After receiving IRB approval, records from the Rutgers University School of Dental Medicine, Departments of Orthodontics and Oral and Maxillofacial Surgery were reviewed. The inclusion criteria included non-growing patients, cervical vertebral maturation (CVM) stage 5; treated with comprehensive orthodontic treatment and orthognathic surgery involving both maxillary advancement and/or mandibular setback [ 10 ]. We excluded subjects with craniofacial anomalies, syndromes, history of trauma, patients who underwent any other surgical procedures, or poor quality records. Fourteen subjects (11 females and 3 males; mean age of 22.55; standard deviation 4.5714) were selected and determined to have complete (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1186%2Fs40510-016-0132-2.pdf

Robert J. Peterman, Shuying Jiang, Rene Johe, Padma M. Mukherjee. Accuracy of Dolphin visual treatment objective (VTO) prediction software on class III patients treated with maxillary advancement and mandibular setback, Progress in Orthodontics, 2016, pp. 19, Volume 17, Issue 1, DOI: 10.1186/s40510-016-0132-2