Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Move Treatment in the Right Direction with 3D CBCT Imaging by Dr. Yan Razdolsky

Start Discussion More by this author (1)


In orthodontics, many materials and methods are needed to efficiently move the teeth into the proper position. Specialists must make decisions about various types of wires, brackets and springs, and integrate those into the many complex methods of tooth movement. One of the most important tools that helps orthodontists make easier decisions is cone beam 3D imaging. While panoramic radiographs can offer some of the information, many patients can benefit from the additional data shown on a 3D scan which might not be apparent on a 2D radiograph. 3D imaging can show unerupted teeth, supernumeraries, impacted teeth and root position — details that, if undetected, can impede the progress of tooth movement.

Case Study

In this case, a patient presented with bilateral impacted cuspids. The cuspid on the left has approximately a 70-degree impaction. For that tooth, it was apparent that if I put the braces on and opened the space, the tooth would drop right into position. The tooth on the right, however, was in a horizontal position. Here is where 3D imaging made all the difference in my treatment planning. On the panoramic image, the cuspid appears to be impacted mesio-distally, so tooth #6 seems to go from west to east (Fig. 1).

After capturing an i-CAT scan, I could see that, in reality, the tooth was actually impacted labio-palatally (Fig. 2). The panoramic X-ray, because of its 2D nature, gave the wrong impression of the tooth position. Especially for an orthodontist, this information is imperative to my decision of how to properly bring the tooth into position. Before I had 3D imaging, I used panoramic X-rays. I would start the tooth movement and expected the tooth to move into proper position. In some cases, due to the limitation of information available in the pan X-ray, it was only after the tooth did not move properly that I would discover it was impacted or in a different position than expected.

At this point, armed with all of the information needed to continue on a path to successful treatment, I utilized Dr. Vince Kokich's research on surgical and orthodontic management of impacted maxillary canines. He said that enamel, unlike cementum, cannot resorb bone. So it was important to send this patient to an oral surgeon to remove all the bone around the tooth.

After the oral surgery, I made a special spring to exert the force on the tooth in the labial direction. At first, the tooth was pointed to the labial, and eventually it moved down to perfect position (Fig. 3). At the debond appointment, the patient and I were both delighted to see that both cuspids had moved parallel to the rest of the teeth (Fig. 4).


The value of a 3D scan for orthodontics is very apparent in this case. The information from the scan allowed me to determine the correct direction in which to properly move the teeth. I would have found out later about the true tooth position with a panoramic X-ray, which would have resulted in more treatment time and frustration for both the patient and myself.

Additionally, when scanning with an i-CAT FLX CBCT, I can feel confident that I am working within as low as reasonably achievable (ALARA) parameters. I can control the radiation dose and size of the scan, depending upon the needs of the patient. For an impacted cuspid, I do not have to scan the whole face. The scan can be taken only on the maxilla, considerably reducing the radiation. Reducing the radiation even further is the low dose setting called a QuickScan+, where I can see the full dentition with a dose comparable to 2D panoramic X-ray.1 The 3D unit gives me many other choices as well, including adjustable cross-sectional views, volume renderings and cephalometric images. In addition to low radiation, this unit integrates with SureSmile robotic archwires and other CAD/CAM technologies.

For this case and many more like it each day, as I see the teeth moving in the right direction, it demonstrates to me that by using 3D technology, my practice is moving in the right direction as well.

References
  1. Ludlow JB, Walker C. Assessment of phantom dosimetry and image quality of i-CAT FLX cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2013;144(6):802-817.
Dr. Yan Razdolsky is a Diplomate of the American Board of Orthodontics. His professional affiliations include the American Association of Orthodontists, World Federation of Orthodontists, the Midwestern and Illinois State Societies of Orthodontists, the American Dental Association, the Illinois and Chicago Dental Societies, Academy of General Dentistry, and the Alpha Omega International Dental Fraternity.

Orthotown Magazine
September 2025
Orthotown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie® Poll
Do you have a dedicated insurance coordinator in your office?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Orthotown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450