Integration of digital maxillary dental casts with 3D facial images in orthodontic patients.

Objective: To evaluate three-dimensional (3D) accuracy and reliability of nonradiographic dentofacial images integrated with a two-step method. Methods: 3D facial images, cone-beam computed tomography (CBCT) images and digital maxillary dental casts were obtained from 20 pre-orthodontic subjects. Digital dental casts were integrated into 3D facial images using a two-step method based on the anterior tooth area. 3D coordinate values of five dental landmarks were identified in both dentofacial images and CBCT images. The accuracy of the integration method was assessed with paired t-tests between dentofacial images and CBCT-based reference standards. Intraclass correlation coefficients (ICCs) were assessed for the reliability of dentofacial images and CBCT-based images. Analysis of variance and Kruskal-Wallis tests evaluated the accuracy of the method in different dimensions. Results: There was no statistical difference between dentofacial images and CBCT reference standards in both translational and rotational dimensions (P > .05). Translational mean absolute errors for full dentitions were within 0.42 mm and ICCs were over 0.998 in x, y, and z directions. Rotational mean absolute errors for full dentitions were within 0.92 degrees and ICCs over 0.734 in pitch, yaw, and roll orientations. Integration errors were significantly greater in the first molar, z-translation, and pitch rotation (P < .05). Conclusions: Integrating 3D dentofacial images with the two-step method is precise and acceptable for clinical diagnostics and scientific purposes. Errors were greater in the molar region, z-translation, and pitch rotation.