4 trends OrthO tribunE | OctObEr 2009 Fig. 2: Scan saves the patient unnecessary surgery. Fig. 3: Precise position of an impacted central incisor. Fig. 4: Patient educated on pathology. f OT page 1 My cone-beam system has even revealed supernumeraries, cysts and foreign objects hidden within standard radiographs. When evaluating for implants, 3-D imaging allows the clinician to determine the height and width, as well as the quality, of the bone in the implant area. Moreover, 3-D provides the ability to precisely evaluate the distance and angulation between roots of adjacent teeth to avoid damaging said teeth during implant placement. Because implants are generally the preferred restoration for the missing single tooth, an orthodontist can scan a patient prior to debanding to determine exactly how the teeth are aligned within the bone and make any necessary corrections. It would be very disappointing for a patient to anticipate receiving an implant and crown only to realize later that the orthodontist didn’t create enough space for the implant. Three-dimensional imaging provides for more precise measurements than 2-D panoramic radiographs, which can be unreliable because of distortion and superimposition. Cone beam offers true 1:1 anatomical measurements, eliminating geometric errors of projection and supporting accurate linear measurements. AD Fig. 2 Fig. 4 included panoramic X-ray and lateral and frontal cephalograms. Now, with one scan, I gain the panoramic, lateral and frontal images, as well as everything in between. Skeletal asymmetries that may not be clearly visible on 2-D head films are more evident with a cone-beam scan. 3-D makes it easier to determine the buccal, lingual and vertical position of impacted teeth. Cone-beam imaging also helps with informed consent. 3-D scans reveal pathologies that may have become lost in 2-D images because of distortion, magnification and the superimposition of anatomical structures. I discovered a horizontal root fracture on a patient and subsequently referred him to an endodontist for evaluation. This patient needed to be aware of the likelihood that the tooth could be lost because of previous trauma. Without this insight, foreshortening of the root, or even tooth loss, may have been blamed on the orthodontic treatment. For TMJ disorders, with one scan that takes just a couple of minutes, I get panoramic, frontal and lateral views as well as corrected tomographs that would have taken me an hour or more with 2-D methods. After implementing cone beam, I discovered some interesting cases. In one case, we were waiting patiently for the second permanent Fig. 3 All of this improves surgical predictability for orthognathic surgery cases. With 3-D, I don’t have to calculate for magnification errors when determining the amount of surgical correction on these cases. Prior to 3-D imaging, my orthodontic diagnostic records always