Clinical Pearl

Instant Virtual Treatment Outcome Using PowerPoint

Abstract Fayyaz Ahamed,

The aim of this article is to introduce a faster and even simpler method where the patient can readily Kavitha S. Iyer1,
visualize the treatment outcome than the currently available methods. This article demonstrates how Amey J. Rathi2,
PowerPoint software can be used to generate instant virtual treatment outcomes (IVTOs) at the
chairside using the patient’s digital photographs. The generated two‑dimensional skeletal and dental Goutham Kalladka3
IVTO provides the necessary communication aid in patient motivation and education. Furthermore, it Department of Orthodontics and
serves as making a tremendous leap forward, toward informed consent. Dentofacial Orthopedics, Sri
Ramakrishna Dental College
and Hospital, Coimbatore,
Keywords: Dental virtual outcome, patient counseling, surgical outcome, treatment outcome, 1
Department of Orthodontics
virtual treatment outcome and Dentofacial Orthopedics,
Ragas Dental College and
Hospital, Chennai, Tamil Nadu,
Introduction FDA‑Cleared Class II medical devices 2
Department of Dentisty, MGM
such as Dolphin imagining software Medical College and Hospital,
Orthodontic imaging software is designed
(Dolphin Imaging and Management Aurangabad, Maharashtra,
for use by specialized dental practices 3
Department of Orthodontics
Solutions, Eton Ave., Chatsworth, CA,
for capturing, storing, and presenting and Dentofacial Orthopedics,
USA) have been used for over a decade by Bangalore Institute of Dental
patient images and assisting in treatment
many practitioners as an effective tool for Science, Bengaluru, Karnataka,
planning and case diagnosis. The speed of
aiding in virtual treatment and to measure India
computerized cephalometric programs has
the outcomes. This software can provide
helped streamline the laborious manual
possible treatment outcome, simulate
measurement of patient cephalograms
surgical results, and allow the operator,
and has also hastened the creation of
completely refine predicted treatment
the visualization treatment objective.[1]
results. The soft‑tissue outline can be
Informed consent has taken a tremendous
easily detailed in the image with a drawing
leap forward with the screen view of the
tool (blend brush) for image smoothness.
end result provided by treatment planning
Recently, SureSmile (OraMetrix, Inc.,
software to the patient that is far more
Hillcrest, Dallas, TX, USA) technology
aptly illustrative than the old wax setup.
has allowed the practitioner to perform
No longer does the final result exist only
accurate, 3D treatment simulations based on
in the mind of the orthodontist, or as a
data supplied by its handheld OraScanner
comparison with samples of previously
(OraMetrix, Inc., Hillcrest, Dallas, TX,
treated cases.[2]
USA). This state‑of‑the‑art technology has
Imaging software effortlessly manages taken patient education, treatment planning,
patient pictures and X‑ray images with and appliance to newer dimension.[4,5]
a set of powerful and user‑friendly tools However, the results produced by these Address for correspondence:
Dr. Kavitha S. Iyer,
for conveying treatment plans. They software’s diagnostic and treatment planning Department of Orthodontics and
help easily communicate ideas through tools are dependent on the interpretation of Dentofacial Orthopedics, Ragas
a more colloquial and less technical trained and experienced practitioners.[6] A Dental College and Hospital,
language with greater patient realization cheaper, faster, and even simpler method Chennai, Tamil Nadu, India.
E‑mail: drkavithaiyer@gmail.
and acceptance for treatment. Treatment where the patient can readily visualize the com
visualization approach is classified as image treatment outcome was needed.
editing systems and photo‑cephalometric
Use of PowerPoint  (Office 2016, Microsoft
treatment visualization systems, and it Access this article online
Corporation, Redmond, WA, USA) to
can be depicted in two‑dimension (2D) or Website:
manage digital photographs and case
three‑dimension (3D).[3] [Link]
presentations and create customized
DOI: 10.4103/apos.apos_10_18
documents for the orthodontic office has Quick Response Code:
This is an open access journal, and articles are been well reported in the literature.[7‑12] It
distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which has a myriad of features that can enhance
allows others to remix, tweak, and build upon the work
non‑commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms. How to cite this article: Ahamed F, Iyer KS, Rathi AJ,
Kalladka G. Instant virtual treatment outcome using
For reprints contact: reprints@[Link] PowerPoint. APOS Trends Orthod 2018;8:175-8.

© 2018 APOS Trends in Orthodontics | Published by Wolters Kluwer - Medknow 175

 Ahamed, et al.: Instant virtual treatment outcome

the delivery of content with proper meaning and enable Generating the Instant Virtual Treatment
the user to customize their presentations. Its ability to Outcomes
incorporate multimedia files and portability of records
Case 1
has become the de facto presentation software for the
Information Age.[13] This article presents a fast method to Surgical IVTO was done for a 24‑year‑old  male patient
develop a 2D dental and skeletal virtual treatment outcome with skeletal Class  III profile. Three treatment plans
using patient photographs with PowerPoint during the were incorporated in the skeletal IVTO. Extraoral digital
patient’s consultation visit. photograph of the patient was imported at chairside into
the PowerPoint 2016 software. First, for the mandibular
Procedure setback and maxillary advancement, two copies of
Any computer operating system installed with Microsoft the extraoral profile photograph were cropped, one in
Office PowerPoint 2007 or higher version software the lower two‑third face at the level of lip commissure
is required for rendering instant virtual treatment extending below for mandibular setback, and in
outcome (IVTO). Digital images stored within the another photograph, the cropping for upper one‑third
operating system or from an external device/cloud storage of lower face was done at lip commissure extending
can be imported into the operating system for generating above to the subnasale for maxillary advancement. The
IVTO. cropped pictures were superimposed based on profile
improvement. In the second treatment plan for only
1. The image to be converted to IVTO is imported into the
the mandibular setback, the previous setback cropping
PowerPoint software using insert option in the view tab
was superimposed on the mandibular segment without
on the toolbar or by simple drag and drop option from
maxillary advancement.
the file folder into a PowerPoint slide [Figure 1]
2. Additional geometric references such as the ruler, In the third treatment plan of reduction and setback
gridlines, and guides can be added from the view genioplasty, only the chin part of the photograph was
tab in the toolbar into the slide to help with image cropped and superimposed superiorly and posteriorly.
orientation The chairside generated IVTO helped the patient to go
3. Use diagonal stretching to increase or decrease with the first treatment plan of maxillary advancement
the size of the picture without changing the image and mandibular setback surgery [Figure 2]. The patient
magnification was informed that a further evaluation was needed
4. Make copies of the image by clicking CTRL‑C to finalize the treatment objectives and final surgical
and CTRL‑V (for Windows operation system) or planning.
Command + C to copy, then Command + V to Case 2
paste (for Mac OS) in the same slide. Use the image
copies to crop, stretch, rotate, or flip it horizontally An IVTO was done for a  19‑year‑old female  patient
from the format tab in the view option of the toolbar who presented with missing maxillary bilateral lateral
as per the superimposition requirement over the original incisors and over retained maxillary deciduous canines.
image to make the desired virtual treatment outcome Intraoral frontal occlusion photograph of the patient was
5. Once the image is finalized, select all the images to be imported at chairside into the PowerPoint 2016 software.
merged into a single IVTO image Two copies of the photograph were made followed by
6. Generated dental and skeletal IVTO images are cropping of one side maxillary right central incisor
compared with the pretreatment image for easy and maxillary right canine separately. To replicate the
communication with the patient for treatment outcome orthodontic treatment plan of orthodontic distalization
visualization and acceptance. of the maxillary canines after extraction of deciduous
canines and opening space for lateral incisor replacement,
the cropped canines were superimposed in a distal
position over retained deciduous canines and rotated to
match the inclination. The cropped canines from that
position were copied and pasted to the other sides with a
simple horizontal flip.
For the bilateral lateral incisors replacement, the cropped
upper central incisor was shrunk diagonally to replicate
the lateral incisors and rotated to mimic lateral incisor
angulation. Finally, the cropped image was positioned
between upper canines and central incisors. The model
wax setup was performed and compared to the generated
Figure 1: Image imported into Powerpoint IVTO [Figure 3].

176 APOS Trends in Orthodontics | Volume 8 | Issue 3 | July-September 2018

 Ahamed, et al.: Instant virtual treatment outcome

a b

c d

a e f
Figure 3: Dental IVTO for bilateral missing maxillary lateral incisors with
transpositioned canines. (a) Imported Pretreatment image, (b) Image copied
and pasted for cropping individual tooth, (c) Maillary central incisor cropped
and image resized to resemble lateral incisor, (d) transpositioned maxillary
canine cropped and moved distally, (e) Final positioning of cropped images
overlapped bilaterally to mimic lateral incisor replacement, (f) Dental IVTO
compared with pretreatment and model setup

familiar PowerPoint software to create the instant dental

and skeletal treatment outcome visualizations which can be
shared with the patient at chairside. PowerPoint software
b comes preinstalled on most computers and can easily be
Figure 2: (a) Skeletal IVTO for mandibular setback and maxillary installed in any computer system.
advancement. A. Extra oral profile photograph imported. B. Mandible
cropped around chin. C. Cropped image moved back to mandibular setback Compared to Microsoft Paint and other photo editing
position . D. IVTO compared with pretreatment photograph. E. Maxilla
cropped below subnasale. F. Cropped maxilla advanced with mandibular
software, PowerPoint offers simplicity and versatility
setback. (b) Skeletal IVTO for setback and vertical reduction genioplasty. in editing. Exporting images in portable document
G. Chin cropped. H. Chin repositioned vertically up. I. Chin cropped from format, PowerPoint slide show, other image formats,
frontal image. J. Chin repositioned vertically up on the frontal image for
vertical reduction genioplasty
and portability to other devices are easily carried out
with the help of PowerPoint. When compared to other
commercially available software dedicated to imaging
Discussion
and visual treatment planning, which uses modern‑day
In the digital era, many orthodontists routinely use technology of digital image warping to transform the
cephalometric software for case diagnosis, treatment image pixels to smoothly blend at the edges of the image
planning, and formulation of computer‑generated visual into a simulated posttreatment image, IVTO made with
treatment objectives. Morphing and warping of the images PowerPoint software produces superimposition images
have been utilized for predicting orthodontic treatment which do not blend in the edges. This does not prove
outcome.[14,15] Now, the commercially available programs to be a limitation, as the gross nonblended edges in
allow superimposition of the profile images, use 3D records IVTO during superimposition can be precisely blended
for simulating treatment outcome in all three dimensions of to smooth contoured image with Photoshop (Adobe
space, and provide multiple treatment options.[16] Systems Incorporated, Park Avenue, San Jose, CA, USA).
The recent introduction of 3D scanners and cone‑beam However, this might require additional photoshop training.
computed tomography has added to the accuracy of IVTO provides the necessary communication aid in patient
3D diagnosis and treatment planning in real time. education to help patient contemplate dental and skeletal
Unfortunately, this technology needs an exorbitant treatment results to match their desire and thus increasing
investment and specialized training. An orthodontist has treatment acceptance.
to regularly communicate with a technologist through a
Conclusion
remote server to plan the virtual treatment outcome.[17]
Generating IVTO in PowerPoint does not require complex • Instant virtual treatment outcome is an efficient,
technical skills in using imaging software, as a simple economical, and simple method for generating a precise
diagnostic digital photograph is imported into a more treatment outcome
APOS Trends in Orthodontics | Volume 8 | Issue 3 | July-September 2018 177
 Ahamed, et al.: Instant virtual treatment outcome

• A digital photograph can be utilized for generating Orthod 2009;43:161‑74.

IVTO, proving its simplicity 5. Sachdeva RC, Aranha SL, Egan ME, Gross HT, Sachdeva NS,
• Instant chairside visualization for dental and skeletal Currier GF, et al. Treatment time: SureSmile vs conventional.
Orthodontics (Chic.) 2012;13:72‑85.
treatment planning, hence, serves as an excellent patient
6. Peterman  RJ, Jiang  S, Johe  R, Mukherjee  PM. Accuracy of
education tool.
dolphin visual treatment objective (VTO) prediction software
Declaration of patient consent on class III patients treated with maxillary advancement and
mandibular setback. Prog Orthod 2016;17:19.
The authors certify that they have obtained all appropriate 7. Halazonetis  DJ. Advanced powerPoint animation techniques:
patient consent forms. In the form the patient(s) has/have Part II. Am J Orthod Dentofacial Orthop 2000;118:236‑40.
given his/her/their consent for his/her/their images and 8. Swartz  ML. Managing digital images. Am J Orthod Dentofacial
other clinical information to be reported in the journal. The Orthop 2000;118:354‑8.
patients understand that their names and initials will not 9. Halazonetis  DJ. Why does the file get too large when I paste
be published and due efforts will be made to conceal their a picture in powerPoint? Am J Orthod Dentofacial Orthop
identity, but anonymity cannot be guaranteed. 2004;125:753.
10. Swartz  ML. Digital photographs and powerpoint. Am J Orthod
Financial support and sponsorship Dentofacial Orthop 2004;126:639.
11. Halazonetis  DJ. How can I convert my slides to digital images?
Nil. Am J Orthod Dentofacial Orthop 2004;126:640.
Conflicts of interest 12. Elfarssi S. Inserting a flash movie into a powerPoint presentation.
Am J Orthod Dentofacial Orthop 2007;131:285‑7.
There are no conflicts of interest. 13. Sarver DM. Use of on‑line digital image services to create
customized documents for the orthodontic office. Am J Orthod
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