No one wants to practice dentistry in the dark. Cone beam 3D imaging sheds the
necessary light on a patient’s craniofacial anatomy and offers precise details that allow me
to produce diagnostic records that illustrate the images of the teeth, along with the supporting
bones, jaws, jaw joints and other bony structures so that I can truly practice evidence-
based orthodontics. I realized how important 3D CBCT was to me first hand,
when I sold one of my offices about two years ago, and along with the office, the new
owner also bought my i-CAT Next Generation. My original office in Buffalo Grove did not have CBCT imaging capabilities, but it soon became very apparent that I was not
equipped with the necessary information I needed to practice orthodontics as more than
just a “wire bender.” Fortunately for me, at that time, the i-CAT FLX became available.
This cone beam 3D imaging system gave me the details that I needed for more exact
diagnosis, but also at a significantly lower radiation dose.
An example of a case where 3D imaging greatly affected my treatment plan and outcome
was when a 10-year-old boy came to me for an orthodontic evaluation. I took a
scan as part of my orthodontic protocol and sent it to a maxillofacial radiologist for evaluation.
The scan volume showed an aneurysmal bone cyst in the anterior mandible.
While these types of cysts can sometimes be resolved on their own in children, it was better
not to procrastinate and to send this child to an oral surgeon.
Besides the aneurysmal cyst, the child also had a
supernumerary tooth—mesiodens behind the central
incisor, directly posterior to tooth #9. As an
orthodontist, this information was extremely valuable.
We can’t just start moving teeth without
knowing what potential problems lie hidden within
the anatomy. If I had treated the patient without
sending him for treatment of the cyst, the orthodontic
treatment could have been stalled, and there
would be risk of a jaw fracture. The supernumerary
tooth could have caused root resorption. If I had retracted the incisor, I would have been right up against the supernumerary tooth.
Instead of being surprised by these complications during orthodontic treatment, the
oral surgeon could remove the cyst beforehand so that the bone could calcify again.
And, he can also remove the supernumerary tooth. An aneurysmal cyst needs six
months to heal properly, and then the child could be evaluated for proper orthodontic
Having 3D data for this patient allowed me to educate the patient’s parents
about the details of his dental condition, and to communicate the need for treatment
by the oral surgeon. Seeing the dental anatomy in three dimensions facilitated
understanding and built trust. It showed I cared about the patient as a
Regarding the lower dose radiation of the i-CAT FLX, a recent study released at
the end of 2013 by Drs. John Ludlow and Cameron Walker addressed concerns
regarding CBCT use in orthodontics. The study noted, “The increasing use of
cone-beam computed tomography in orthodontics has been coupled with heightened
concern about the long-term risks of X-ray exposure in orthodontic populations.
An industry response to this has been to offer low-exposure alternative
scanning options in newer cone-beam computed tomography models.” The industry
response from Imaging Sciences International resulted in the development of
the i-CAT FLX. Ludlow’s study found that “QuickScan+ effective doses are comparable
with conventional panoramic examinations.” It continued, “We have shown
that the QuickScan+ protocol provided a substantial 87 percent reduction in dose
compared with the standard exposure protocols in both child and adult phantoms.
Thus, when QuickScan+ protocols can be used, they will provide a clinically meaningful
reduction in dose.” i-CAT FLX has many exposure protocols, and with a
slightly greater exposure setting the resolution of 3D image can be increased substantially.
Various areas of the cranio-facial region can be selected, further reducing
the radiation exposure.
With less radiation exposure I can obtain much more clinical information to
light my way to a successful outcome of my treatment plan. Informed patients are
more compliant patients, and an informed orthodontist has the data needed to
move teeth responsibly and efficiently. This capability for more precise diagnosis
and treatment planning enables me to produce the healthiest relationship between
the jaw joints and the teeth, while producing the most harmonious smile at the