We live in a busy world and every software / protocol / app that make life easier is most welcome in my daily routine.

As orthodontist we are taught to trace lateral cephalograms during our post-graduate education. We need to get a keen understanding of skull anatomy in order to complete our diagnostic armamentario through well drawn tracings. Boards exams also asks for proficiency in tracing and mastering of superimposition. When school / board is over, it’s hard to think that we routinely put the same effort and attention into tracing and superimposing (even if it’s one of the most effective method for self-learning).

Here in Switzerland where I live and work, we are obliged to trace every single patient in order to determine if he can be good candidate for the Invalidity Insurance, that covers expenses for the most extremes CLII, CLIII, open and deepbites (a sort of IOTN5 grade index but more severe). I thus felt the need of looking for something effective and fast to allow me a fast and precise tracing.

I discovered a minor software house based in Slovenia, called Audax. They actually exist since 15 years and have been involved into software developing for management of digital patient records. I discovered their former software AXCeph six years ago, and fell in love with simplicity.

In fact, it allowed to scale and move around a cloud of points and lines to fit the actual lateral ceph of your patients. Once scaled and dropped more or less in the correct position, a fast manual adjustment of points and structures allowed you to get a tracing in a time that could vary between 2 and 4 minutes, according to the difficulty of the tracing. For me it was already a good point to love their software.

Furthermore, superimpositions can be obtained with a “apple-like” simplicity, that is a simple drag’n’drop of the newest tracing on the oldest tracing in order to obtain classical superimpositions on the cranial base, or on the maxilla or on the mandible. This allowed me to superimpose much more before and after tracing than before, both for self-learning and didactic purposes.

A little more than one year ago they launched a revolutionary sub-program that they called TINA (that stands for Tracing Is Now Automatic). They developed a protocol of automatic recognition of anatomic reference points and structures, together with the University of Manchester.

I admit videos have a strong power on me and when I saw the TINA module in action I was just astonished and was willing to test it.

I thus bought* the module and started to apply it consistently on each of my patients. I admit in the beginning, having had some doubts if my money was well invested as I love technology but I have also a cautious skeptic approach (derived by many years of being an enthusiastic early adopter, not that often very deceived). Well, the module worked out exactly like in the video. The precision of points and structures recognition is really impressive. Of course I am not that lazy (and crazy) to completely trust the software. There are some points that needs minor adjustments, that are the same points that are sometimes difficult to identify with the evergreen ball-eye method. For instance A point deserve a look each time, with B it works better.

Let’s say that the net time of the tracing, once the image is ready is 5 to 15 seconds for having the tracing ready, plus a 30 to 40 seconds of check and adjusting of critical points. It rarely take more than 1 minute. I personally do not know many software that allows you get these results in such a small time.

To conclude I am really thankful to those people who developed such a sharp and brilliant tool to make my life as an orthodontist a lot easier! If any of my colleagues want to feel the same freedom of/from tracings, I warmly invite you to give it a try!


* Important note. This is not a paid post. I regularly bought the license for the AudaxCeph software (the full one allowing superimpositions) + the TINA module. I am just an enthusiastic customer of the Audax group who’s willing to share his enthusiasm for something that as maid my life easier. Furthermore, I guess that if they were US based they could have a much more larger audience, serving much more colleagues. But they are a small Slovenian company and I personally have a weakness for outsider and small promising teams, as long as in the major Italian footbool League (Serie A) I have always been (and will always be) a fan of Atalanta FC, the promising little team of Bergamo, my hometown.


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