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)