TURKISH JOURNAL of

DOI: 10.5152/TurkJOrthod.2018.18027

REVIEW

Reverse Engineering in Orthodontics

Hajra Ghafoor

Private Practice, Hyderabad, India

ORCID ID of the author: H.G. 0000-0002-6194-4617.

Cite this article as: Ghafoor H. Reverse Engineering in Orthodontics. Turk J Orthod 2018; 31(4): 139-44.

ABSTRACT
Three-dimensional (3D) imaging has advanced greatly and is used extensively in orthodontics. It is worth outlining and reviewing the develop-
139
ments of reverse engineering (RE) as its applications are growing more widespread and diverse. Data from an existing object are used to create
a digital model. A traditional RE process is usually performed in these stages: (1) obtaining data, (2) restructuring the surfaces, and (3) creating a
useful model. They are classified as (1) laser projection based and (2) fringe projection based. This digital technology has been used in creating
3D model scanning, 3D digital model superimposition, diagnostic setup, volumetric assessment of tooth wear, soft tissue facial analysis, incor-
poration of digital model to 3D facial image, lip position and smile reproducibility, analysis of tooth position after orthodontic treatment, and
anthropometric measurements. This system has proven itself to have a varied probability of applications and researches in the field of orthodon-
tics. Similar to every single system, even RE has its own benefits and shortcomings. The complexity of the process and high cost are the major
disadvantages reported so far. Rapid advancement of this technology possibly will rapidly inverse the negative results that emerged previously.
As a future work, innovative use of RE technology is necessary to make this system triumph in the field of orthodontics.
Keywords: Digital technology, reverse engineering, three-dimensional imaging, orthodontics

INTRODUCTION

It is worth outlining and reviewing the developments of reverse engineering (RE) as its applications are growing
more widespread and diverse. The term “reverse engineering” can be interpreted as copying from an original.
Data from an existing object are used to create a digital model. RE shows promise in emerging applications in
the field of orthodontics (1).

Reverse engineering systems were classified as (1) laser projection based and (2) fringe projection based. Intra-
oral scanning systems made appearance in the last decade but are scarcely used in practice (2). To be efficacious-
ly executed in our global commercialized society, a high degree of automation will be required in these areas (1).
Three-dimensional (3D) imaging grew significantly in the past few years and established abundant uses in the
field of orthodontics. Diagnostic imaging is used to obtain the anatomical data that are processed by a computer
and then presented on a two-dimensional screen. Depth perception causes the image to appear in 3D (3).

The quality of service, in terms of improvement of patient’s satisfaction, is an increasingly important objective
especially imperative in orthodontics. Digital design tools can significantly influence to enhance these proce-
dures. However, computer-aided design/computer-aided manufacturing (CAD/CAM), RE, and rapid prototyping
(RP) systems were conceived and developed for industrial applications; they should be evaluated, studied, and
customized with a view to use in medicine (4). Table 1 lists several advantages and disadvantages of RE.

Orthodontics is a field that has evolved significantly within the past. 3D technology has remodeled this field,
leading to a more practical and patient-friendly treatment results. Today, orthodontic clinics are loaded with

Address for Correspondence: Hajra Ghafoor, Private Practice, Hyderabad, India Received: 2 April 2018
E-mail: drhajraghafoor@[Link] Accepted: 5 August 2018
©Copyright 2018 by Turkish Orthodontic Society - Available online at [Link]
 Ghafoor H. Reverse Engineering in Orthodontics Turk J Orthod 2018; 31(4): 139-44

high technical school, progressive instrumentation designed to actness and decrease technique sensitivity and chair side time in
boost the patient expertise by delivering quicker and additional addition to providing high accuracy to the treatment.
economical treatment, whereas this technology has advantages
to all patients, it is largely effective for complicated cases. There are several studies that have used 3D imaging method-
ologies in the past; however, they have not analyzed knowl-
This technology is not inevitable, but it improves a valuable insight edge with this technology. It might be unwise to mention that
at the time of diagnosis and treatment planning and enhances the the study or its results would be different if they had used this
standard of treatment effects. Historically, fitting an orthodontic technology as each study is exclusive in its own sense; however,
appliance on a patient was not a precise science. Similar to shoes, for sure, innovative use of this technology can undoubtedly im-
braces were designed based on standard average. This technolo- prove the future of orthodontia.
gy allows us to tailor the appliances that match specifically to the
patient’s teeth. Every patient’s jaw is formed and sized otherwise. History
Therefore, brackets and wires are formed and sized to match every The history of RE dates back to World War II and Cold War. It was
patient. This makes the patient more comfortable since the treat- primarily employed by the military to duplicate rival’s weapons,
ment is more predictable as changes are not required throughout devices, and technology. In the past few years, advances within the
the course that brings the results quicker and attain a smile per- field of computers have hugely taken an enormous leap to develop
sonalized to the form of one’s face and jaws. this technology. RE had gained prime importance in automotive
production and aviation business to accommodate the speedy rate
The information obtained within the past in sort of two dimen- of reinvention of contemporary instruments and machinery.
sions had few drawbacks. Teeth are physical objects and have
six degrees of freedom; move in x, y, and z directions; and also The engineering originality of the organic structure of the hu-
140 have roll, pitch, and yaw. It is humanly impossible to address all man body has placed RE in an exceedingly distinctive place with-
six degrees at a time. Different softwares are designed to report in the bioscience and medical device industries significantly in
these components each and every time. RE allows duplicating implementing artificial elements into the organic structure. The
the complete patient morphology and at the same time manu- overview of the literature was based on the applications of RE
facturing the appliances and templates that might increase ex- in automobile industry, automotive industry, medical life sci-
ences, and software industries. RE is employed in many medical
Table 1. Advantages and disadvantages of reverse engineering fields, including manufacture of individual surgical templates;
process fabrication of individual surgical implants and prostheses, such
Advantages Disadvantages as artificial knees, hip and spine implants; fabrication of hearing
Rapid fabrication Difficult to acquire meaningful details, aids; made-to-order surgical tools; medical coaching models;
such as curve and edges and medical devices. It has vast applications within the field of
Minimal time Complexity of process dentistry as well. Manufacturing customized dental abutments
Minimal radiation exposure CAD modeling skills necessary and dental implants, surgical templates, computer-aided dental
prostheses, customized bridges and crowns, digital dental mod-
Easy handling High cost
els, and customized removable appliances (5). Various applica-
Better visualization Difficult to evaluate accuracy and
usability
tions of RE in orthodontics include the following:
Reuse of design
• 3D model scanning,
Repeated verification
• 3D model superimposition,
• digital diagnostic setup,
• volumetric valuation of tooth wear,
• 3D soft tissue facial analysis,
• lip position and smile reproducibility,
• anthropometric measurements.

Process of RE
The procedural steps involve data acquisition, preprocessing
(noise filtering and merging), triangulation, feature extraction,
and segmentation and surface fitting (Figure 1). The whole
method of RE should to be computer aided (6).

Data Acquisition
This part is meant to collect the information regarding the geo-
metric facet of the physical half through scanning. There are sev-
eral different approaches by which product surface data can be
acquired. They can be classified into two broad categories: contact
Figure 1. a, b. Flow of reverse engineering process
and non-contact methods. Contact scanners are those that con-
Turk J Orthod 2018; 31(4): 139-44 Ghafoor H. Reverse Engineering in Orthodontics

tain a contact probe that moves on the silhouette of the physi- tion of options, or image characteristics, which can most expe-
cal half. A common example of such a scanner is the coordinate ditiously represent the knowledge that is necessary for analysis
measuring machine, whereas non-contact scanners are ones that and classification.
do not have a contact probe instead they use lasers, optics, and
charge-coupled device sensors to capture the information. Segmentation, Surface Fitting, and Solid Modeling
Segmentation is the most crucial step in RE. This section of the
Preprocessing process involves rending a triangular mesh into submeshes to
Data are obtained as a result of scanning and are then processed which an appropriate single surface can be fitted. This seriously
so as to eliminate noise and to scale back the quantity of points. affects the standard of the ensuing CAD model. New RE modules
This part of the process additionally offers us the advantage to or separate software packages are commonly required for point
merge multiple scan data sets. A number of commercial soft- processing.
wares are available for point processing.
Application of RE in Orthodontics
Triangulation and Feature Extraction
Triangulation is a process of formation or division of point data 3D model analysis
into triangles. Feature extraction is the next step during this pro- The accuracy and authenticity of digital study models are evalu-
cess that is outlined because of the method of shaping a collec- ated by linear, surface, and volumetric parameters, surface scan-
ning devices that are used to record the surface detail of such
Table 2. Description of superimposition points models, and its genuineness is renowned from the literature. 3D
Superimposition points Description orthodontic study model superimposition system for evaluating
Point 1 Left lateral canthus tooth movements was concluded to be consistent and depend-
able (7) after comparison of cephalometric superimposition with 141
Point 2 Left medial canthus
Point 3 Soft tissue nasion
3D digital model superposition. INUS dental scanning solution
was used for 3D scanning of dental casts, and surface-to-surface
Point 4 Right medial canthus
matching was used to perform the superimposition. Keating et
Point 5 Right lateral canthus
al. (8) assessed the precision of surface details of plaster study

Table 3. Different RE applications in orthodontics are compared on their mode of modeling software and RE software
Author Application Scanning technique Reverse engineering software
Cha (7) Superimposition of INUS dental scanning solution Rapidform 2002; INUS Technology Inc.,
tooth movement Seoul, South Korea
Choi et al. (13) Maxillary expansion and 3D optical scanner; Orapix; Orapix Co., Rapidform 2002; INUS Technology Inc.,
protraction Seoul, South Korea Seoul, South Korea
Duran (14) Molar distalization Dental scanner; Activity 850; Smart Optics, Rapidform; INUS Technology Inc., Seoul,
Bochum, Germany South Korea
Kihara (16) Digital models 3D surface scanner; RexcanDS; Solutionix, Rapidform 2006; INUS Technology Inc.,
Seoul, South Korea Seoul, South Korea
Park (20) Tooth wear Laser surface scanning system; KOD300, Rapidform XOR3; INUS Technology Inc.,
accuracy 50 mm, Orapix Co., Ltd., Seoul, Seoul, South Korea
South Korea
Yook (28) Volume changes of lip at Rexcan III 3D scanner; Solutionix Corp., Rapidform XOR/REDESIGN 3; INUS
bonding and debonding Seoul, South Korea Technology Inc., Seoul, South Korea
Dindaroglu (29) Lip position 3dMD Flex; 3dMD, Atlanta, GA, USA Geomagic Control 3D Systems, Rock
Hill, SC, USA
Dindaroglu (30) Smile reproducibility 3dMD; Flex System; 3dMD, Atlanta, GA, USA Geomagic Control, 3D Systems Inc.,
Cary, NC, USA
Deli (31) Soft tissue Five high-definition digital single-lens reflex PhotoModeler™ Scanner version 6; Eos
cameras with flash; Canon 40D, 10 Mpx Systems Inc., Vancouver, BC, Canada
Kau et al. (32) Growth changes Minolta Vivid VI900 3D; Osaka, Japan Rapidform™ 2004; INUS Technology Inc.,
Seoul, South Korea—RF4
Djordjevic et al. (33) Facial asymmetry Two Minolta Vivid 900 laser scanners; Rapidform 2006; INUS Technology Inc.,
Konica Minolta, Tokyo, Japan Seoul, South Korea
Elnagar et al. (34) Maxillary protraction Facial Insight 3D Scanner; Motion View Geomagic Control 14; Geomagic,
Software, Chattanooga, TN, USA Research Triangle Park, NC, USA
Ivanov et al. (35) Soft tissue changes after RME Roland LPX-250 laser scanner; Roland DG, Roland DG, Hamamatsu, Japan
Hamamatsu, Japan
Yu et al. (36) Nasoalveolar molding Vivid 910; Konica Minolta Holdings, Inc., Rapidform 2006; INUS Technology Inc.,
Tokyo, Japan Seoul, South Korea
 Ghafoor H. Reverse Engineering in Orthodontics Turk J Orthod 2018; 31(4): 139-44

models recorded using a 3D optical laser scanning device. It was Visualization of tooth roots was also possible in digital models
concluded that capturing the surface details using Minolta Vivid by registering exact crown prototypes to cone beam computed
900 is consistent and is aimed at capturing the details of plas- tomography (CBCT) scans (16). The process for visualizing tooth
ter models with high accuracy. Data obtained from such reliable roots in a digital model was created by a non-contact 3D surface
scans are subjected to RE software for further analysis. scanner of each patient’s dentition.

i) 3D digital model superimposition v) Integration of 3D digital cast and 3D facial photo

Assessments of treatment results are possible only by the su- 3D setup greatly helps an orthodontist in various stages of di-
perimposition of before and after lateral cephalograms. They agnosis along with determining several treatment possibilities;
are currently the most extensively used means for evaluating it assists in monitoring the changes after treatment and records
various tooth movements despite its inherent errors. Its major the predicted and final treatment outcomes (17).
drawbacks are difficulties in the identification of inherent land-
marks, high costs, tracing errors, frequent radiation exposure, Rangel et al. (18) presented practicality of the integration of a
technique sensitivity, and head position variation between serial digital dental cast into a 3D facial picture. A digital dental mod-
radiographs (9, 10). el was matched to place on a 3D photograph of the patient in
the precise anatomical location. These images can improve the
Progress technically during this technology permits superim- preciseness of diagnosis and treatment planning along with pro-
position of the maxillary dental arch with the help of a 3D digital viding a scope for future investigation about non-cephalometric
model scanning software. This technique was established for the analysis or superimpositions.
superposition of digital orthodontic models, and it allowed de-
tailed amounts of movements in all the dimensions (11). 3D digital vi) 3D assessment of volumetric tooth wear
142 orthodontic model superposition techniques were declared to be Loss of occlusal surface by attritional wear disturbs the vertical di-
clinically as dependable as cephalometric superimposition for eval- mensions of dentition and may cause tooth interferences; it was
uating orthodontic tooth movement (7), and it was verified that the also reported that the increased activity of the masticatory system
superposition of the dental arch digitally was repeatable (12). executed increased stress on the underlying structures (19).

ii) 3D model analysis after rapid palatal expander (RME) and Park et al. (20) suggested appraisal of tooth wear that emerges in
protraction headgear the course of orthodontic management by using the digital su-
Choi et al. (13) assessed the validity of the digital models three di- perimposition method. They concluded that recording the teeth
mensionally in patients who received treatment with rapid max- in 3D models remains valuable and can be intended for the as-
illary expansion and protraction headgear. Maxillary dental casts sessment of tooth wear in orthodontic patients.
were scanned using a non-contact 3D optical scanner. Rapid-
form 2002, a reverse modeling software, was used to perform 3D Soft Tissue Facial Analysis
reconstruction and superimposition. 3D models were superim- Appraisal of facial morphology is vital in the field of orthodontics
posed using the palate to measure various tooth movements. right from the diagnosis to the effective treatment planning (21).
They concluded that this 3D model superimposition method Medical CT or CBCT has replaced the traditionally used lateral
was reliable as cephalometric superimposition for assessing radiographs earlier used for facial analysis (9).
anteroposterior movements. Cases managed with orthopedic
appliances, such as maxillary protraction headgear and rapid i) Soft tissue superimposition
maxillary expansion, can also be assessed in a similar manner. Advances in technology led to the development of many procedures,
including laser scanners (22), stereophotogrammetry (23), and struc-
iii) 3D model analysis after miniscrew-supported molar dis- tured light systems (24), which are used to obtain the digital images
talization of the dentition and craniofacial structures. Simplicity and rapidity in
Duran et al. (14) evaluated the dentoalveolar effects of minis- usage has made the laser scanner system, which is also known as op-
crew-supported molar distalization by 3D RE method. The dental tical surface scanner, the most extensively used system, and therefore
casts were scanned by an optical dental scanner (Activity 850; it has various possibilities of scientific uses and researches (22,25,26).
Smart Optics, Bochum, Germany). The scans were converted into Its principle application is to monitor growth and treatment-related
digital data, and data were imported into the RE software (Rapid- changes in all the different planes of space (26). Superimposition is
form). The authors of these studies concluded that the method is possible by the registration of analogous regions on two different
clinically reliable, and with this method, the movement of each overlapped images (27,28). Moss et al. (27) combined five anatomical
tooth over the arch can be analyzed in all three planes of space, landmarks as shown in Table 2 together with five fabricated points
and measurements can be performed frequently since digital on the forehead. The forehead was suggested to be a stable area for
models do not involve radiation. superimposing 3D images of the face (12).

iv) Digital diagnostic setup ii) Volumetric changes in the lip after placement and remov-
Virtual surgical splint was fabricated in virtual articulator (15); it al of fixed appliance
consumed less time than to perform the mock surgery of dental Yook et al. (28) evaluated volumetric change in the lips after
casts for the fabrication of the surgical splint. placement or removal of labial fixed orthodontic appliances us-
Turk J Orthod 2018; 31(4): 139-44 Ghafoor H. Reverse Engineering in Orthodontics

ing a 3D surface scanning system. 3D facial scanning was per- vii) Maxillary protraction
formed before placement, immediately after placement of the 3D facial soft tissue changes in growing patients with maxillary
labial orthodontic appliances, before removal, immediately after jaw deficiency associated with maxillary jaw protraction were
removal, and 3 to 6 months after removal of the appliances. They performed using an innovative approach consisting of 3D ste-
established that the upper and lower lips are immediately pro- reophotogrammetry and sophisticated RE software (34). Facial
truded after bonding and retruded after debonding them. images were scanned and imported to RE process package for
additional analysis. The 3D analysis of the soft tissue changes
iii) Lip position and smile reproducibility showed vital favorable changes including advancement of the
Dindaroglu et al. (29) evaluated the reproducibility of the lip soft tissues of the upper lip; significant changes were observed
position at rest in three dimensions using the RE software and in the middle face. Additionally, redirection of soft tissue growth
stereophotogrammetric images. The outcome of the study sug- was evident within the lower lip and mandible areas.
gests that the rest position can be replicated both on the same
day and between the sessions in a small range. viii) Soft tissue changes after RME
Visualization and evaluation of transverse palatal soft tissue
Dindaroglu et al. (30) used the 3D stereophotogrammetry and RE changes were performed following maxillary expansion treat-
technology to assess social smile reproducibility. Social smile images ment in 33 Caucasian children with posterior crossbite. They
of White adolescents were obtained. Sixteen social smiles were re- were treated with tooth-borne Haas-type expander. Colored
corded on each individual at 3-minute breaks. They stated that there palatal maps were generated that clearly showed the change in
exists individual variability in duplication of social smile, and that this width of palatal soft tissues following RME. This method allowed
discrepancy was not noticeable under routine clinical observation. to measure and present correlation between intermolar widths
measured on the plaster models, to width changes on soft tissue
iv) Anthropometric measurements palatal surface. The expansion appliance in children resolved the 143
Deli et al. (31) conducted a study with the objective to describe crossbite and led to palatal widening that was clearly visualized
a procedure that is perfect, accurate, repeatable, quick, and ben- by creating mathematical morphometric models (35).
eficial for soft tissue analysis of anthropometric characteristics.
A new clinical procedure was used to perform this investigation. ix) Nasoalveolar molding (NAM) for cleft lip and palate
It involved four separate stages: setting up of a portable equip- A novel technique of presurgical NAM was developed based on
ment on which field analysis could be achieved, scanning of dis- a computer-aided RE and RP technique in infants with unilateral
similar expressions, preparation of the subject and spatial posi- cleft lip and palate. The upper denture casts were recorded using
tioning, and treatment and processing of data. They established a 3D laser scanner, and a digital model was constructed that was
that this innovative protocol for the attainment of anthropomet- analyzed to simulate the NAM procedure with RE software. The
ric measurements is quick, repeatable, reliable, and precise. appliances were fabricated based on the RP technique. With this
innovative approach, the treatment design and appliance fabri-
v) Soft tissue growth changes cation was simplified (36).
As children behave differently from adults in front of laser scan-
ning devices, a study (32) was performed prospectively to define Different RE applications in orthodontics are compared on their
the changes that occur when attaining a set of laser scans from mode of modeling software and RE software used as illustrated
children and adults and to determine if children could be appro- in Table 3.
priate subjects for the study of facial morphology employing a
laser scanning technique. Laser scans were performed, and the CONCLUSION
obtained information was transferred to reverse modeling soft-
ware for analysis. It was concluded from this study that children Quick advancement of CAD/CAM technology and persistent prog-
are reliable candidates for laser-based studies of facial morphol- ress in 3D imaging systems facilitate a clinician not only to diag-
ogy, and the laser scanning system employed in this study has nose but also to view the effects of treatment from several perspec-
great potential in the capture and study of facial morphology. tives. RE projects require amalgamation of the finest approaches
and technologies from different alternatives available, making it a
vii) Facial asymmetry daunting task. An increasing number of scanner service bureaus
Quantification of facial symmetry in healthy adolescents and ex- offers RE services, making it effortlessly reachable. Experts point
ploration if there is any gender variations were administrated with their opinion that RE is destined to persist as a market niche. This
the assistance of the RE process. The surface matching between advanced methodology is readily accessible, and efforts should be
the first face and its likeness was measured for the full face, upper, made by each and every practitioner to avail the most out of it.
middle, and lower facial thirds. Additionally, three angular and 14
linear parameters were measured. The faces of 15-year-old male
Peer-review: Externally peer-reviewed.
adolescents were less symmetric than those of female adoles-
cents, however the distinction within the quantity of symmetry. Conflict of Interest: No conflict of interest was declared by the author.
The upper, middle, and lower thirds of the face did not differ in the
amount of 3D symmetry. Angular and linear parameters of facial Financial Disclosure: The authors declared that this study has received
symmetry did not show any gender distinction (33). no financial support.
 Ghafoor H. Reverse Engineering in Orthodontics Turk J Orthod 2018; 31(4): 139-44

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