3D X-Rays in Orthodontics Are a Game Changer
Every once in a while a technology emerges that can be considered a “game changer” (an improvement that completely alters the status quo). Three-dimensional radiograph technology (3D x-rays) is such a technology. The ability to see a patient’s mouth in life-like three dimensions means less radiation, more accurate diagnosis, and better orthodontic treatment. Known officially as Cone Beam Computed Tomography (CBCT), three-dimensional x-rays have been around now for about ten years (2001). Only recently, however, have they been affordable enough to allow individual doctors to acquire them for use them in their private practices. Although similar to a medical CT scan, CBCT scans are much faster and require much less radiation. Medical CT scans of the head take between 3 and 5 minutes while CBCT scans provide their results in about 10 seconds and require up to 100 times less radiation!
The magic of CBCT technology is actually in the computer software. Nothing has changed with the actual x-rays used (except that today’s machines require much less of it). As the x-rays pass through the patient and reach the sensor, a computer records the “view” from every angle. Once all of the data has been collected, software then assembles all of the views into one three-dimensional model. The doctor can then manipulate this image to allow him to look at areas of interest from any vantage point.
Not only do 3D x-rays take less time and use less radiation, they also acquire enough data in a single scan that the need to re-expose a patient to get a better look at a specific object has been almost eliminated. From a single CBCT scan, a doctor can get a 3D model, a panoramic film, a lateral cephalometric film, a TMJ series, periapical films of every tooth, bitewings, and every other diagnostic survey that can be imagined… all without re-exposing the patient to more radiation.
Once an image has been obtained, the software can peel away overlying structures to give doctors an unimpeded view of any object. The 3D model can be tipped, turned, and sectioned so that doctors can get a much better idea of the location and size of an object that might influence their diagnosis and treatment plan. The software can also present the data in a series of “slices” which are sometimes better for evaluating some clinical conditions. In one study of impacted canines, doctors were given two-dimensional films and asked to diagnose and treatment plan 30 different cases. After viewing the three-dimensional scans of the same teeth, they changed their treatment plans in 40% of the patients! CBCT scans lead to more accurate diagnosis and better treatment.
Although sometimes portrayed by the media and some doctors as merely a gimmick, those of us who are using CBCT to diagnose and treatment plan for our patients realize that the game has changed and there is no turning back! Three-dimensional radiography is here to stay.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.