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 treatment.
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 whole person.
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 same time.
Author's Bio:
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.
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