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Good Afternoon

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Three Dimensional

Cephalometrics,

Morphometrics and

other recent advances

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Introduction

Over the years, diagnosis and

treatment planning in orthodontics

and dentofacial orthopedics has relied

substantially on numerous

technological aids.

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The gold standard that these aids (imaging,

articulators, jaw tracking and functional

analyses) attempt to achieve is the accurate

replication or portrayal of the anatomic truth.

The anatomic truth is the accurate three-

dimensional anatomy, both static and

functional, as it exists in nature.

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The ultimate goal of the clinicians is to use

these technologies, either alone or in

various combinations, to delineate this

anatomic truth.

Imaging is one of the most ubiquitous tools

that orthodontists use to measure and

record the size and form of craniofacial

structures.

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Imaging has been traditionally used in

orthodontics to record the status quo of

limited anatomic structures.

While the use of imaging in orthodontics

has been relatively adequate, the fulfillment of

ideal has been limited by the available

technology & the quality of the database.

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These desired goals of craniofacial imaging

are closer to being achieved than ever before.

We will be seeing in detail about the Three

dimensional cephalometrics, Morphometrics

& other advances in imaging which takes us a

step closer to the realization of our goal.

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Three Dimensional Cephalometry

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Facial evaluation begins with a systematic,

three-dimensional assessment of the frontal

& profile views in three planes.

The deformities can then be described

three dimensionally in the frontal and profile

views as excessive, normal, or deficient.

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Earlier orthodontists paid little attention to the

PA view coz the clinical problems

encountered were symmetric & appeared to

be adequately recorded by the lateral view

alone.

Recently, as orthodontists have become

"craniofacial orthopedists" treating more

severe, often asymmetric craniofacial

anomalies; the limitations of the lateral

cephalogram have become obvious.

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The Broadbent-Bolton cephalostat produces

intrinsically three-dimensional information

about cranial form.

Yet in the clinical setting, this information

has been used primarily two dimensions at a

time in the separate study of lateral or

posteroanterior cephalograms.

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From the very first introduction of the

cephalostat, Broadbent and Bolton stressed

the importance of coordinating the lateral with

the PA films to arrive at a distortion-free

craniofacial form.

For this purpose they described the

Orientator,an exploitation of the geometry of

the cephalostat to simulate

stereophotogrammetry.

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Orientator, is an acetate overlay placed over

both cephalograms (LAT and PA) after they

were oriented jointly along their common

Frankfort horizontal plane.

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History

The earliest three dimensional

measurements of the skull were made by

researchers in anatomy & anthropology,

primarily on dried specimens.

The reference planes of Frankfort, His, and

Camper and most of the anatomic landmarks

that we currently employ were defined and

measured directly prior to 1900.

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The most widely known system for

measuring the spatial relationships between

the teeth and the skull in vivo was that of

P.Simon, during 1920s.

His system, like that of his predecessor Van

Loon; was essentially mechanical. It

included a maxillary clutch and a frame.

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By means of this

apparatus & a wax

check bite, it was

possible to locate the

dentition within the

skull anteroposteriorly,

vertically & with

respect to the occlusal

plane orientation.

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Simons conceptions of gnathostatic

measurement were essentially sound, but

the technical procedures were quite

demanding.

Simon's system is important in that it

focused sharply than did subsequent x-ray

methods upon the location of structures that

interest Orthodontists most the teeth &

alveolar process.

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In the exposure of a pair of cephalograms

the patient's head is not turned, but instead

the cephalostat itself. The LAT and PA films

would occupy positions at 90 to each other.

By keeping the films with respect to the

head, one can draw the rays connecting the

x-ray source to each landmark of either film

as threads in space.

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The result is a pair of pyramidal sprays of

thread, intersecting at approximately 90

throughout the interior of the space occupied

in reality by the patient's head.

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The films can be flattened into one plane by

unfolding them along the "corner", with each

bundle of threads (x-ray paths) flattened to

the side of the other film at the appropriate

distance.

The Orientator is the diagram of the

flattened threads. When superimposed over

the abutted pair of films, the points in each

film that correspond to any locus in the

other can be visualized.

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Broadbent & Bolton used Orientator to

correct for distortion inherent in the spread of

cephalometric x-ray beam.

In 3D cephalometry we are instead truly

reconstructing the location of landmarks in

space. The principle of the Orientator then is

identical with the ray intersection method, a

photogrammetric tool.

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For a radiographic landmark to be locatable

in the space of head, it must be connected to

the x-ray source in two different projections:

the LAT & PA views.

The best landmark candidates for such

points are structures defined by means of the

vertical coordinate, which is shared between

the two views.

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Many landmarks are conventionally defined

as the "top" or "bottom" points of structures:

menton, condylions, superior and inferior

orbital rims, and cusp tips.

Points uppermost or lowermost in the PA

ceph may not represent precisely the same

points in space uppermost or lowermost in

the lateral ceph.

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The typical lateral tracing includes eight

landmarks conventionally taken to lie on the

midsagittal plane: S,N, ANS, supradentale,

upper & lower incisal edge, menton, and

pogonion.

Of these, supradentale is visible in the PA

film, as are the averaged incisal edges and

menton.

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Sella, nasion, ANS, & pogonion have little

visibility, if any, in the PA film.

With two of their coordinates supplied by the

lateral film, the third may be taken to

correspond to the apparent position of the

midsagittal plane at the appropriate depth in

the frontal film.

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Any three-dimensional reconstruction will

proceed more accurately if the bilateral

landmarks on the lateral film have not been

averaged.

Instead they should be identified individually

by a careful consideration of study models,

dental landmarks, and auxiliary

cephalometric films.

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3D ceph

landmarks

x, y, & z

coordinates

found in the LAT

and PA

cephalogram

using which the

3D points are

reconstructed.

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Registration of the films

The theory of the cephalostat treats

projections of the head in a pair of views

precisely to the FH plane & separated by a

90 rotation about the vertical plane.

But the real data is more or less divergent

from the ideal.

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Practically heads cannot be placed precisely

in the FH plane, nor can the subject hold a

fixed orientation while rotated 90 within the

cephalostat.

In true Bolton system, the images at 90

simultaneously by are generated almost the

use of 2 x-ray systems that are themselves at

90. Modern cephalostats have lost this

crucial capability.

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In particular, there is usually some element

of rotation about the ear rods, away from the

FH plane in one or both images.

Modest amounts of such positioning error

may be routinely corrected by simple

computations before one proceeds to actual

3D reconstructions.

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The films corresponding to LAT and PA

projections of the same head are digitized

separately.

The digitized LAT cephalogram is rotated so

that the point midway between the two

porions lies on a horizontal line with the

midpoint of the two orbitales .

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The PA film is rotated so that the line

between the two porions is precisely

horizontal.

This film is then subjected to a computed

shear correcting for failure of the midorbitale

point to lie precisely on the horizontal line

between the two porions.

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Each landmark locatable on both films is

sheared by an amount corresponding to its AP

separation from porion as scaled by the AP

separation of midorbitale from midporion in the

LAT.

This is a satisfactory approximation to correct

the procedure, a three-dimensional rotation,

for all angles of rotation small enough to be

encountered in practice.

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The ray intersection

method

After this calibration step, we may imagine

that the landmark locations correspond

precisely to the nominal geometry of the

cephalostat.

Each lies on one of a pair of film planes in

precisely known spatial relation at 90 to

each other.

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The landmark images are at a known

distance from x-ray source whose central

rays are at 90 to each of the films & which

intersect in space, exactly halfway between

the pair of porions.

As in Orientator, each landmark location on

film is now replaced by the path in space that

the x ray must have followed to arrive there: a

thread connecting that digitized location to

the source.

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In this way the distortion

inherent in each

cephalometric projection is

corrected by the

combination of points from

both films.

This three-dimensional

constellation of landmarks

may be joined by straight

lines and rotated for

viewing in all directions.

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Advantages

The 3D method supports the usual

biometrics of landmark locations & takes

advantage of a normative data base that is

suited for semiautomatic analysis of

syndromic data.

In comparison with CT, it involves low

radiation dose, simpler to obtain, has an

available normative data base, & is more

practical for long-term serial analysis.

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When compared with conventional

cehalometrics, the 3D evaluation for one new

methodology, (Acuscape & Sculptor) was

more precise within approximately 1mm of

the gold standard.

The sculptor program was found to be 4 to

5 times better than the 2D approach.

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Disadvantages

The principal drawback of the method is its

inability to represent curving form in three

dimensions.

One fundamental difficulty is associated with

the assumption that "corresponding"

landmarks in LAT and PA films actually

pertain to the same three-dimensional point

on the skull.

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Some inherent flaws and errors of this

scheme include tracing and digitizing errors,

failure of the porions to superimpose in the

lateral film, and the finite size of the x-ray

source.

It is difficult to compensate for the differences

in enlargement (termed "projective

displacement'') of structures which lie at

different distances from the frontal and lateral

film surfaces.

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Empirical problems have prevented the

routine clinical use of this Broadbents

"biplanar" 3D method, notwithstanding its

obvious conceptual brilliance.

To overcome the problems Sheldon

Baumrind and colleagues at the University of

California devised another method, The

Three-dimensional x-ray stereometry from

paired coplanar images.

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The two basic and important problems faced

by the biplanar method of Broadbent were:

1.Difficulty in identifying the same landmarks in

both films with confidence.

and

2. Projective displacement.

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Since both the LAT & PA are taken at 90

o

to

each other i.e, biplanar the same anatomic

structures take up different size and shape,

making it difficult to precisely identify the

landmark.

This was overcome by this coplanar method

where both the films are taken more or less in

the same plane making landmark

identifications lot easier.

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It is difficult to

compensate for the

differences in

enlargement

("projective

displacement'') of

structures which lie at

different distances from

the frontal and lateral

film surfaces.

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That is to say that all the anatomic structures

lying in each "para-film" plane will have the

some magnification factor, no matter what

their anatomic nature.

Conversely, if two planes are at different

distances from the film surface, their

enlargement factors will be different, no

matter what the anatomy.

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Broadbent system is in essence a spatial and

temporal composite of the two views.

It follows that the enlargement factor for any

given anatomic landmark will differ from the

lateral projection to the frontal projection

unless by coincidence that the structure is at

same distance from both the film surfaces.

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In order to deal with the problem of

differential enlargement, a number of

investigators have constructed specialized

mechanical devices.

These include the "orientator" of Broadbent,

the "compensator" of Wylie and Elasser, and

the "modified compensator" of Vogel.

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This new method put forward by Baumrind to

overcome these difficulties was based on an

engineering tool called Photogrammetry.

Photogrammetry -- discipline devoted to

solving the problems of making 3D

measurements from paired 2D images, esp.

used for reconstructing terrestrial maps from

photos taken from space.

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The basic principle is the stereoscopic vision

used by eye to recognize the 3D information

of the object.

When we view points at some distance from

us, our eyes rotate slightly to align and focus

on the points.

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Line segments can

readily be drawn from

each point through

the optical center of

the lens of each eye.

The included angle

between the pair of

such lines is known

as the "parallactic

angle'' of the point.

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Points at different distances will have

different parallactic angles. Differences in

parallactic angle are interpreted by the brain

as differences in distance.

The alternative way of measuring the

parallax is by using linear rather than

angular measurement. The distance

between two points on the connecting lines

in the same plane will also depict the

parallax of the point.

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In other words viewing the points along the

line with each eye focusing only on one

points, the brain will perceive it to be a single

point at the actual depth.

Similarly, looking at a same point in two

pictures, with each eye concentrated on one

point, the brain will perceive the depth of the

structure.

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But this procedure puts extensive strain on

the eyes and though with dificulty the

clinician can assess the 3D info in mind, it is

not possible to quantify the information and

set up a database.

To overcome this, Photogrammetry uses

STEREOSCOPE for viewing the picture and

then by calculating the distance between the

points, i.e, parallex the depth information is

quantified.

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Each matched pair of photographs is called a

stereopair or a diapositive.

When this technique is used for quantitative

purposes, the distance between each

matched (or "conjugate") pair of points is

measured with a device known as a "parallax

bar.

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The focal spot of x-ray tube is equivalent to

the optical center of camera lens. In each

case, the radiation travels in straight line

between the object & the nodal point.

Thus, a conventional single x-ray film is the

geometric equivalent of a single conventional

photograph except that the subject lies ''within"

the camera instead of beyond it.

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Making of the stereopairs

The subject would be positioned in a head

holder; and an exposure would be made from

"camera station L1.''

The central ray would pass through the

porion-porion axis, the focal spot to

"midsagittal plane" would be maintained at 60

inches, and a length scale would be

incorporated upon the film surface.

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Immediately after exposure, the film would

be removed and a new film would be shifted

into the same position by some cassette-

changing device.

The second film would then be exposed from

"camera station L2.

This produces a stereopair, one of which is a

standard cephalogram. This procedure

produces a coplanar image.

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The advantage of the coplanar image over

the biplanar is that both x-rays are more or

less similar & hence landmark identification is

a lot easier & reliable.

Though the biplanar images have the

strongest mathematical correlation, its

advantage is offset by the projection error

and landmark identification.

As we will be seeing the coplanar images still

retain a strong correlation.

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A biplanar system

with rays orthogonal

and film in 2 planes.

B films placed in

single plane.

C head is rotated by

90

o

. Both are not

standardized films.

D orthogonal rays are

made to be acute.

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One of the systems dedicated for producing

coplanar images for 3D stereometry with 2

cassette holders.

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The following parameters must be known if

3D maps are to be made from pairs of two-

dimensional images:

1. The principal point of both the films.

2. The distance between the two stations (

L1 and L2 called base B).

3. The perpendicular distance from the film to

the source.

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1.Principal point -- The location on the film of

the point of contact of central ray from x-ray.

The principal point of L1 is needed to define

the origin of coordinate system. L2 is needed

to define X axis.

2.The perpendicular distance from each

exposure station to the film plane is

designated "H" (for height) & should, in

simple case, be equal for both x-rays.

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Knowing these values, by using simple

mathematical calculations the three

coordinates for the points are measured, and

using these coordinates a 3D wire diagram is

reconstituted.

The origin of the coordinates can be

controlled, and the reconstituted figure can

be standardized, for future comparison and

evaluation.

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Advantages

More precise than the Broadbent and Bolton

system.

Errors from patient movement can be

corrected by using reference landmarks,

whose definite relation we know.

The projective displacement is not there.

Can take use of the available normative

database.

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Disadvantages

Again cannot represent curving forms.

Needs a dedicated special x-ray apparatus

with precise calibration.

Needs complex patient positioning arrays to

avoid errors.

Without calibration the reliability degrades

rapidly.

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Morphometrics

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Introduction

Analysis of size and shape for diagnosis,

evaluation, comparison, and future reference

forms an integral part of orthodontic

diagnosis.

The methods currently available to evaluate

craniofacial from include Anthropometry,

Photogrammetry, Cephalometry, Computed

tomography, magnetic resonance imaging,

etc.

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Invariably cephalometry continues to be the

most versatile technique for investigation of

the craniofacial skeleton because of its

validity and practicability.

Despite the inherent distortion and

differential magnification, in comparison with

newer imaging techniques the cephalogram

produces a high diagnostic yield at a low

physiological cost

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There are 2 distinct groups of analytical

methods used in cephalometry:

Landmark based techniques and

Boundary outline methods.

Landmark-based techniques are dependent

on cephalometric landmarks.

Boundary outline techniques survey only the

perimeter of the structure.

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The use of algebraic measurements in

traditional ceph analyses is known as

conventional ceph analysis (CCA).

It is a landmark based technique.

Linear distance measurements between two

landmarks.

Angles,

Areas & ratios are the parameters used by

CCA.

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Limitations of CCA

Relies on the use of a reference structure for

orientation and superimposition: that is

assumed to be biologically constant but in

reality not so.

Measurements calculate the magnitude of

vectors between landmarks, ignoring their

direction.

Only size is measured, not the shape.

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To overcome all these, newer methods of

cephalometric analysis were developed in

place of CCA. Morphometrics is one such.

Morphometrics = morph + metrikos (Gr).

form + measurement.

Morphometrics = Measurement of form.

In reality it consists of procedures which

facilatate mapping of visual information into a

mathematical representation.

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Morphometrics is measurement of form.

What is form?

Form, fundamentally is the displacement of

space by area or volume due to an object

that is subject to scale difference.

Simply stated,

Form = Size + Shape + Structure.

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Types of morphometrics

Morphometrics in representation of form,

mapping of visual information into a

numerical representation, viable for statistical

analysis.

The different types are:

1. Multivariate Morphometrics.

2. Co-ordinate Morphometrics.

3. Boundary Morphometrics.

4. Structure Morphometrics.

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Multivariate Morphometrics

This type of morphometrics is applied to

datasets composed of distances, angles and

ratios.

Multivariate Morphometrics (MM) is defined

as the use of quantitative methods to

discover the structure of interrelationships of

multiple measurements.

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MM evolved to meet the need for procedures

aimed at measuring the degree of similarity

within and between two or more forms using

multiple measurements.

It is based on the concept that simultaneous

utilization of numerous variables provides

more information than a large number of

individual variables being assessed

seperately.

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Usually MM are based on measurement

system composed of distances, angles and

ratios, the Conventional Metric Approach

(CMA).

MM (CMA) does not quantify the form

boundary or textural considerations.

Used as an adjunct to Co-ordinate

Morphometrics.

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This method is extremely useful for gaining

insights about :

1. How variables are structured?

2. How the groups are related?

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Some applications include :

1. Establishing the similarity between different

forms.

2. Measuring the variation that is present

using set of uncorrelated variables.

3. Investigating the structure of measurements

used to describe form.

4. Identifying the components of size and

shape.

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Four commonly used methods for dealing with

form difference between groups are:

1. Discriminant functions.

2. Mahalanobis D

2

statistic.

3. Canonical variate analysis.

4. Cluster analysis.

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Discriminant functions

This assist in placement of unknown

specimens in to known groups.

This is done by increasing the discrimination

between groups based on a set of commonly

held measurements.

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Discrimination is achieved by finding a

transformation in form which maximizes

between group differences while minimizing

within group variation.

Group identity and membership within the

group must be known in advance otherwise

cluster analysis is indicated.

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The discriminants were computed to

maximize the between group variance

relative to the within group variance.

The discriminant function for the specimen is

the sum of all linear distance of how far apart,

each multiplied by a weighing co-efficient.

Each discriminant function score is

orthogonal with respect to all others.

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Mahalanobis D

2

statistic

The distance between groups is measure

and squared .

This squared distance between groups is

termed the generalized distance or D

2

statistic of Mahalanobis".

It describes the relatedness or similarity

between forms based on multiple

uncorrelated measurements.

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Canonical variate analysis

The form of an subject to be assessed is

taken, rotated through an axis so that within

group variation is minimized.

The image is rescaled, transformed and

deformed until within group variation is made

circular.

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The image or the form is rotated again

through an axis this time such that between

group variations is maximized.

Both the rotated & rescaled axis is called the

Canonical Axis for that image.

These axes are orthogonal to each other.

They are in fact the representation for the

image or the group.

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Cluster analysis

This method deals with the identification of

group structures.

That is given a collection of objects are there

recognizable subgroups?

More than one clustering method has to be

used to get a reliable result.

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There are two methods to find the difference

within groups:

1. Factor analysis.

2. Principal component analysis. (PCA).

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Both of these deals with differences and

interrelationships within the variables

themselves.

These give an idea about the structure of the

underlying variables and how they vary with

each other.

Identify which of those uncorrelated variables

are in turn the primary determinants of form

and reduce the statistical load.

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Procrustes superimposition

It is a variant of the landmark based

morphometric method, and a superimposition

method.

Procrustes a robber in Greek mythology,

belived his iron bed to be unique and as a

standard of length.

His victims if small were stretched, those taller

were chopped off their legs to fit the size of the

bed.

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His one size fits all concept was utilized in

the superimposition method.

Each form is represented by a series of

landmark co-ordinates forming a figure

known as configuration.

Each configuration is scaled first to the same

size.

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The Procrustes superimposition algorithms

translate the configurations to superimpose

the centroids and rotate the configurations to

minimize the differences.

This is essentially the position of best-fit.

After the superimposition, the mean

configuration called the consensus is

computed.

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For each land mark the Procrustes residual

is calculated as the diff between the location

of landmarks in each form, and its position in

the consensus.

These can be plotted to display the shape

variance.

Procrustes superimposition has been used

for evaluation of normal and syndromic

craniofacial growth.

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Co-ordinate morphometrics

Based solely on the data points composed of

2D or 3D co-ordinates, usually in the

Cartesian system.

It ignores the boundary of the form.

Most of these are based on DArcy

Thompsons Transformation grids.

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This includes the following methods:

1. Conventional Metric Approach (CMA)

including the Conventional Ceph Analysis.

2. Biorthogonal Grids (BOG).

3. Finite Element Method (FEM).

4. Thin Plate Spline Analysis (TPS).

5. Euclidean Distance Matrix Analysis

(EDMA).

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Conventional Metric Approach

Based on distances, angles and ratios.

Homologus points should be taken for

plotting.

CMA and its CCA both are incomplete

mapping, not describing the shape or shape

changes.

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Biorthogonal grids

The BOG is developed by Bookstein.

This also uses the homologus point

representation.

The foundation of the BOG method is

comparison between two 2D forms.

One form is designated as the base form and

the other as one which reflects the shape

changes from the base form.

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The shape changes are viewed as

deformations from the basic form.

The base form is constructed with landmarks

of our interest, whose shape change we are

going to study.

The base form is usually a triangle, though

any polygon can be used.

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The triangle is constructed and a circle is

drawn inside the triangle touching the

boundary.

Once this triangle transforms in to another

triangle, the circle gets transformed in to an

ellipse.

Base triangle Deformed triangle

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The major and minor axes of the ellipse and

the corresponding diameters of the circle are

the representations of shape changes.

They represent the principal dilatations or

estimates of maximum stretch or shrinkage

due to the deformation.

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The cross denoting the centre of the ellipse

with its major and minor axes represents a

tensor for that shape change.

The ratio of major axis to minor axis is

considered as the estimator of shape change.

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The BOG is used by Bookstein for studying

shape changes in craniofacial anomalies.

When BOG is used for biological subjects it

is called Tensor Biometrics.

The disadvantage is that it measures shape

change rather than the shape as such.

Like CMA it cannot represent curves.

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Finite Elements Method

This is similar to BOG if not identical.

It is also based on homologus landmarks and

is invariant with respect to the co-ordinate

system.

Very similar to BOG, but that many triangles

(Finite Elements) are constructed.

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The average shape change of all the

triangles is computed for the shape change

for the whole form.

The principal dilatations in BOG are called as

strain measures here.

The triangles are the basic forms used in 2D

FEM.

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The triangles are replaced by hexahedrons in

3D FEM.

Each cube is represented by 8 homologus

points in the Cartesian system.

The cubes are non-homogenous unlike

triangles and hence represent spatially

varying tensor fields.

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FEM on Face FEM on Tooth

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FEM based Ceph analysis

Discretization of the

craniofacial

complex in to finite

elements based on

the normal

biometric

landmarks.

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FEM depicting

size and

shape changes

using colour

coding for

easy

comprehension

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Thin Plate Spline Analysis

TPS analyze shape change using theory of

surface spline interpolations.

The TPS function colloquially known as

bending energy is visualized as an infinetely

thin metal sheet draped over a set of

landmarks, extending infinitely in all

directions.

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The configurations of two forms are matched

exactly to minimize the bending energy.

If two forms are identical bending energy is

zero.

The magnitude and location of bending

energy can be identified depending upon the

size and position of the deformation of the

plate.

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The thin plate

where shape

changes, i.e,

bending energy is

depicted by the

colour gradient.

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In affine transformations the parallel lines in

the plate remain parallel.

The bending energy of the affine

transformation is zero and only the tilting of

the plate may occur.

In non-affine transformations the there will be

local deformations, these are represented as

partial warps.

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Shape changes can be statistically analyzed

using multivariate statistical techniques, based

on partial warp scores.

TPS has been applied to three dimensions for

studying changes in cranial base.

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Euclidean distance matrix analysis

This was developed by Lele at the John

Hopkins.

Utilizes 3D Cartesian co-ordinates of the

homologus points to identify local areas of

shape change.

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Initially a mean form from distances of all

possible landmarks is computed.

These distances are the EDM

representations which is averaged to yield a

mean matrix for the sample.

Calculation of a distance difference matrix

using ratio of similarity between forms on pair

wise distances is calculated.

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This distance difference matrix is then sorted

to identify the areas of maximum and

minimum change.

These EDMA does not distinguish between

size and shape individually.

The results obtained are similar to FEM.

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Boundary morphometrics

These techniques takes boundary outlines,

and not points.

Very useful in assessing shape where

landmarks are scarce.

Indispensable if boundary outline is the

primary area of interest.

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The advantages of boundary outline methods

are that:

Recreation of the boundary precisely is

possible.

It is an information preserving method.

A combination of boundary outline form can

incorporate homologus points also.

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There are six boundary outline methods:

1. Median Axis Function.

2. Fourier Descriptors.

3. Eigen Shape Analysis.

4. Fourier Transforms.

5. Wavelets.

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Median Axis Function

It is also called as symmetric axis or line

skeleton.

MAF is defined as the locus of points which

lie in the interior of the form, exactly

equidistant from the border of the outline.

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It is a method of collapsing of a 2D outline in

to a curve or a line.

Consists of embedding a series of

overlapping circles or discs that touch the

outline such that they are tangential to the

borders of the outline.

The centers of those circles now define those

two points and when we join the centers we

get a stick figure.

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Stick figure of a mandible

using MAA

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The circle usually touches two points in the

periphery.

If it touches three points it encloses a

bifurcation.

The circles contains two variants

(determinants) :

The structure of the median axis (stick

figure).

Radius of the circle i.e, width of MAF at the

tangent points.

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Circles are used in a 2D structure, where as

it can converted to spheres and used in 3D

measurements.

MAF is not unique, it is possible for classes

of similar shapes to have an identical medial

axis.

The radius function must be computed

regularly to have an individual representation.

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Conventional Fourier Descriptors

The approach of Fourier analysis can be

viewed as a transformation of data from one

domain to another.

In biology it refers to the transformation from

spatial domain to the frequency domain.

www.indiandentalacademy.com

This is also termed as decomposition of the

spatial configuration (Boundary) in to

frequency components (amplitude & phase

relationships).

This procedure of decomposition is called

Fourier analysis or Harmonic analysis.

The inverse process of recreation of an image

from data is called Harmonic synthesis.

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Two types of FD approaches have been

widely used, both convert the data to polar co-

ordinates prior to analysis.

One is based on measurements from a center

within the form, preferably a centroid.

The other uses angular functions based on

points located on the outline.

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How many harmonics are needed to achieve

a satisfactory fit of the FD as an expected

function to the boundary outline (observed

form).

The residual of fit is calculated and is used

for comparison between FDs.

Elliptical Fourier Functions have now

superseded the conventional FDs.

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Eigen Shape Analysis

The use of ESA facilitates the reduction of

the morphological shape space to a

comparatively few dimensions that contain

most of the differences in shape.

So it is claimed to have reduced the

minimum number of factors necessary for

recognizing subtle shape differences.

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This utilizes Fourier functions using tangent

functions.

So basically uses angular measurements

when compared to Conventional FDs which

utilizes the sine and the cos data.

There is no need for centroid, and is

basically a single valued function.

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Elliptical Fourier Functions

EFF is also a type of pattern recognition.

The EFF technique was developed originally

for military aircraft identification and like

conventional Fourier functions is a curve-

fitting procedure.

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The basic principle involves embedding a set

of closely spaced observed measurements

on an objects boundary into a mathematical

function.

EFF is a parametric solution to shape

description, deriving a pair of equations as

functions of a third variable

www.indiandentalacademy.com

The first harmonic represents an ellipse, with

higher harmonics detecting increasingly

localized shape differences.

The accuracy of the procedure can be

determined by calculating a residual value-

the difference between the observed data &

the predicted values derived from the EFF.

www.indiandentalacademy.com

EFF is very loyal in representing the shape

and shape differences.

It is one of the most commonly used

boundary representation method.

Though currently it is used only for the 2D

data, it has been developed for use in 3 d

forms also.

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Fourier Transformations

These are the recent developments of the

Conventional Fourier descriptions.

There are 2 types of Fourier transformations

1. Discrete Fourier transform (DFT).

2. Continuous Fourier transform

(CFT).

www.indiandentalacademy.com

FTs are bit complicated in their calculations,

but software has developed to compute them

automatically.

They have the ability to reproduce even

minor details of shape changes.

To reduce the computer computation times,

newer tech like Fast Fourier Transform (FFT)

& Short Time Fourier transform (STFT) are

developed.

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Wavelets

These are similar to the FTs.

Unlike the FTs which are continuous

representations over the period - to +,

wavelets are limited duration.

Similarly they are of two types

1. Continuous wavelet transform (CWT).

2. Discrete wavelet transform (DWT).

www.indiandentalacademy.com

Though both FTs and the wavelets are the

currently developed geometric morphometric

methods which are highly versatile, their

regular use in biologic morphometrics is yet

to be realized.

Both can represent many functions and

characteristics of the object, rather than like

the primitive methods.

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Structural Morphometrics

These are techniques that numerically

describe the characterizing of the surface or

the internal structure of the form.

Structure is also that, which is inside the

boundary outline.

www.indiandentalacademy.com

It can be both internal or external structure of

the object.

It can be either surface texture or roughness,

or the internal structures like the bony

trabaculae, or the chemical structures the

crystal lattices.

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There are three approaches:

1. Fourier Transforms.

2. Wavelets.

3. Optical Data analysis/ Coherent

Optical Processing.

They are also yet to influence the field of

biologic morphometrics.

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Recent Advances

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Change is the only thing that does not

change.

Yes there are many recent advances in the

field of Orthodontics and especially in the

area of Craniofacial Imaging.

Few of them have really a great potential to

be developed especially for Craniofacial

imaging.

www.indiandentalacademy.com

Digital Imaging

The interest in digital imaging has resulted

due to a number of different reasons.

In terms of necessity, utilization of digital

imaging provides the ability for the computer

to manipulate data to allow complex

introduced techniques may reduce patient

radiation exposure.

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The elimination of hard-copy X-ray film may

decrease storage needs and enable

teleradiology, or the transmittance, of images

over the phone and internet.

The digital process is a collection of

information of binary form, resulting in the

construction of a computerized image.

www.indiandentalacademy.com

In most types of digital radiography,

electromagnetic energy (X-radiations) is

converted to an electrical charge by an X-ray

sensor.

These sensors include charge-coupled

devices (CCDs), amorphous silicon and

amorphous selenium chips are arranged in

an array when used in large X-ray

applications.

www.indiandentalacademy.com

Another method of converting the X-ray into

an electrical charge for digital use is the

storage based phosphor plate.

These plates are thin, wireless, flexible

plates similar to intensifying screens.

The re-usable phosphor plates store the

energy from X-ray beam, and are then read

by a laser scanner which detects the intensity

& location of the stored energy.

www.indiandentalacademy.com

Once the X-ray energy has converted to an

electrical charge, a computer with a frame-

grabber circuit board (digitizer) sample the

photosensor value (voltage) and converts

(digitizer) them into a picture element array

(pixels).

Since the information is in digital form, it can

be integrated together with other digital

information such as intraoral & extraoral

photographs & tomographs to form

composite profile.

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Teleradiology

Early 1982 marked the initial meeting of the

First International Conference and Workshop

on Picture Archiving and Communications

Systems (PACS) for Medical Applications.

This electronic transport of the images will

continue to meet challenges as new

technology surface

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3D CT

The CT images can be manipulated to

undergo a three-dimensional reconstruction

of the image.

The final image can be fed through a

computer aided design system and either

viewed on a computer screen or processed

into plastic via milling machines or laser

stereolithography.

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The technique is sophisticated enough to be

able to extract an element out of the image,

such as the mandible, and view it in isolation

from other structures.

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Microcomputed Tomography

MicroCT is principally the same as CT except

that the reconstructed cross sections are

confined to a much smaller area.

The future of microCT lies in being able to

sample data over a much smaller volume

than full body volume, thereby significantly

reducing the radiation exposure to the

patient.

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This technique can now measure bone

connectivity in all three dimensions and even

record anisotropy, both of which are not

possible even with histology.

This method has been used clinically to

evaluate osteoblastic/osteoclastic alveolar

remodeling as well as bone dehiscences and

root resorption.

www.indiandentalacademy.com

Tuned-aperture Computer

Tomography

TACT system is able to convert multiple two-

dimensional images created from multiple

arbitrary projection source positions into a

three-dimensional image.

The future of TACT will lie in its ability to

assist in the evaluation of alveolar bone &

detection of root resorption.

www.indiandentalacademy.com

MR Spectroscopy

MRI works by obtaining a resonance signal

from the hydrogen nucleus, and therefore is

essentially an imaging of water in the tissue.

MR spectroscopy works in a similar manner,

but allows the imaging of any molecule or

compound in the tissue.

www.indiandentalacademy.com

MR spectroscopy is useful for the study of

skeletal muscle physiology.

This approach has been applied for the study

of phosphate metabolism in muscles of

children with bruxism.

They have applications to a better

understanding of changes in muscle

functions.

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Structured Light

Structured light scanning enables the

topology of the face to be digitized simply,

and without ionizing radiation.

The result is a three-dimensional shell of

the patients face, viewable on a computer

monitor.

www.indiandentalacademy.com

The eventual goal of this technique is to

merge the facial shell and underlying X-ray

data from other sources to complete the 3D

structure for diagnosis, treatment planning

and assessment.

3D facial analyses are now a possibility, and

3D superimposition revealing treatment effect

& outcome will soon be a reality.

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Cone Beam Computerized

Tomography

It is a type of CT that is more or less similar

to the DPT in function.

This has tremendous potential to be used in

orthodontics, and is expected to replace all

other imaging modalities in the near future.

www.indiandentalacademy.com

In contrast to the CT it uses a low energy

fixed anode tube with a cone shaped X-ray

beam.

The image sensors used are solid state

image sensor or an amorphous silicon plate.

www.indiandentalacademy.com

CBCT uses 1 rotation sweep of the patient

similar to the DPT. Image data can be

collected for a complete maxillofacial volume

or limited areas.

The accuracy is very high coz the projection

is orthogonal and the rays are parallel with

each other. The object is also very near to

the sensor producing a 1 to 1 measurements.

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Picture of a CBCT image

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Discussion

What is an ideal imaging?

The underlying principle of ideal imaging is the

determination of anatomic truth in terms of

accurate portrayal of spatial orientation, size,

form, and relationship of desired structures of

features.

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The ideal imaging modality is the one

which maximizes the desired

information and minimizes the

physiological risk and economical

cost to the patient.

www.indiandentalacademy.com

c

o

n

c

l

u

s

i

o

n

www.indiandentalacademy.com

Despite the inherent distortion &

differential magnification, in comparison

with newer imaging techniques, the

cephalogram produces a high diagnostic

yield at a low physiological cost, the

ideal with the techniques available now.

www.indiandentalacademy.com

The newer techniques has to be simplified

for the practicing orthodontist to emerge as

an alternative to cephalmetrics.

For the every day clinician cephalogram will

continue to be the imaging tool, where newer

methods are useful for research and study of

ethnographical data.

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www.indiandentalacademy.com

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Thank You

www.indiandentalacademy.com

References

Morphometrics for the life sciences ----- lestrel.

AJO_DO OCT 1983 3D Ceph.

OCT 1988 3D Ceph.

MAY 2004 morphometrics.

SEPT 2004 3D imaging.

DEC 1981 Photogrammetry.

AO 1999 NO 6 review of imaging.

1994 NO 5 FEM based Ceph Analysis.

EJO 2003 25 size and shape

measurements.

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www.indiandentalacademy.com

Thank you

For more details please visit

www.indiandentalacademy.com

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