When one of my colleague’s staff members had concerns about her orthodontics and upcoming orthognathic surgery, he asked me if I would consult with her. During her appointment, we took comprehensive records”including a 3D CBCT image”and spoke at great length about her concerns, which included the length of treatment time, difficulty of closing lower bicuspid extraction space, and general questions on orthognathic surgery. At this point, I had only had my CBCT unit for one month. While I was focusing on the conventional full orthodontic records during the appointment, which appeared to be fairly normal, it wasn’t until later that day until I had more time to review the CBCT images.
Even though bone levels around the lower anteriors appeared normal in the panorex and cephalometric 2D radiographs, I was shocked to find out that the lower anteriors had been pulled through the lingual plate of bone and only one-third of the root had bone on the facial surface. I had never seen any results like this before, but I realized there was no other way I could clinically without a CBCT view.
Because I was so focused on the lower anterior bone”as most orthodontists are”I naturally happened to notice the maxillary anterior teeth, which had no palatal bone coverage on the root surfaces. There is no other way I know of that an orthodontist could diagnose these problems without a CBCT. I have found my 3D imaging system to be an invaluable aid.
CBCT has had a large impact on my practice with not only the initial diagnoses of my patients, but also their continual review and treatment. Because of its important place in my daily work, I have made it available to other healthcare professionals and retained a board-certified radiologist for comprehensive review and provide implant positioning services to alleviate liability concerns.