Did You See That? More Importantly, Did You Diagnose It? Bradford Edgren, DDS, MS

Data from a single CBCT scan can be viewed as images in the axial, coronal and sagittal planes and sliced in any direction. The CBCT scan completely eliminates the superimposition of normal anatomical structures, allowing proper diagnosis of tooth position and pathology. Being able to view existing pathology and ruling out non-existing pathology, can avoid unnecessary oral maxillofacial surgery.

Case 1
This patient had received Phase I treatment, and we were patiently waiting for the second permanent molars to erupt prior to initiating Phase II treatment. By the time three of the four second molars had fully erupted on this 13-year-old male patient, the decision was made to take progress records. As part of this patient's progress records, an i-CAT CBCT scan was taken. The scan revealed the cause for the lack of the eruption of the maxillary right second molar. A lingually impacted third molar was impeding the eruption path of the maxillary right second molar. Previous "standard" 2D pans did not show the fourth third molar because it was perfectly superimposed behind the second molar. This second molar might never have erupted, or worse, could have been presumed to be ankylosed and scheduled for removal. Fortunately for this patient, he had all four of his third molars removed, and the second molar erupted normally.

Case 2
This eight-year-old female came to our office because of the delayed eruption of her central incisors. Her panoramic radiograph demonstrated a severely impacted left maxillary central incisor and a potentially impacted maxillary left canine. Due to the nature of the panoramic radiograph, it was impossible to determine both the anatomy of the crown and root, as well as the true orientation of maxillary left central. Phase I treatment was initiated, and space was created for the impacted central incisor. An i-CAT scan was taken to determine the orientation of the central incisor and to evaluate the tooth's anatomy. The scan revealed that the central incisor was horizontally oriented with normal crown and root anatomy. The i-CAT scan aided the oral surgeon in properly placing the gold loop and chain on the facial aspect of the central incisor. The central incisor was then guided into proper position. Consequently, the maxillary left canine also impacted; the oral surgeon placed a gold loop and chain on the canine, and it too was brought into proper position.

Case 3
This 17-year-old male presented with significant lower anterior crowding. He already had all four third molars previously extracted, and his pre-orthodontic treatment panoramic radiograph was unremarkable. Orthodontic treatment was completed, and retention records were taken including an i-CAT scan. The scan revealed a supernumerary third molar just lingual to the maxillary right second molar. The previous panoramic radiograph did not reveal this additional molar prior to treatment. It could only be detected by a 3D CBCT scan. The patient was referred to an oral surgeon who used the scan to locate and extract the previously undiagnosed supernumerary without any further complications.

Case 1 3D scan


Case 1 2D pano


Case 2 2D pano


Case 2 3D scan


Case 3 2D pano


Case 3 3D scan