Making the Case for 3D Imaging: Orthodontics

by Dr. John Dorsch

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.

dorsch_cs_9300_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.

About John Adrian Dorsch, D.D.S., M.S.

A published author and noted speaker on various orthodontic topics and part-time Associate Professor of Orthodontics at UMKC School of Dentistry, Dr. Dorsch, of Creekwood Orthodontics, holds a Bachelor of Science degree from Westminster College, a Doctorate of Dental Surgery degree from University of Missouri, Kansas City, and a Master of Science in Orthodontics from the University of Iowa.

Dr. Dorsch is a Diplomat of the American Board of Orthodontics and has held offices and current memberships with the Greater Kansas Dental Society, Missouri Dental Society, American Dental Association, Greater Kansas City Orthodontists, Missouri Orthodontic Society, Midwest Society of Orthodontists, American Association of Orthodontists, World Federation of Orthodontists and the Tweed Study Club.

One thought on “Making the Case for 3D Imaging: Orthodontics

  1. This is no surprise. As an oral surgeon, I have seen this quite often in patients that were post ortho referred for implant placement or other surgery. My pet peeve is maxillary expansion in the early teens that makes it almost impossible to remove impacted, symptomatic upper third molars. Very little access and the thirds wind up relatively palatal to the seconds which don’t have a lot of bone support on the buccal. Bicuspid extractions could have prevented a lot of these problems. Hopefully CBCT will allow orthodontists to do needed 3d diagnosis.

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