The effect of cone beam computed tomography (CBCT) imaging on orthodontic diagnosis and treatment planning

Introduction: The effect of cone-beam computed tomography (CBCT) imaging on orthodontic diagnosis and treatment planning has not been fully elucidated despite the increasing use of 3-dimensional (3-D) radiography in dentistry. The application of CBCT imaging in orthodontics has been shown to provide information that aids in the localization of impacted canines, placement of miniscrews, identification of pathology, and assists in the assessment of alveolar bone levels, orthodontic tooth movements, the temporomandibular joint (TMJ), sinuses, and airway. In addition, CBCT is useful for the evaluation of root resorption and planning of orthodontic treatment. While the clinical value of CBCT is mostly empirical, there are no specific studies so far to evaluate the differences between the diagnosis and treatment plans of orthodontic patients when using conventional records and CBCT images.;Purpose: Our hypothesis is that CBCT imaging provides additional information that will influence orthodontic diagnosis and treatment planning.;Methods: Four orthodontic examiners diagnosed and created treatment plans for 38 consecutively selected orthodontic patients using conventional orthodontic records (photos, panoramic and lateral cephalometric radiographs) and CBCT images. Examiners completed written questionnaires to indicate their diagnosis and preferred plan of treatment for each case at three different points in time, each one month apart using conventional orthodontic records for the first two analyses (T1, T2) and CBCT data in addition to traditional records for the third (T3). The level of experience with CBCT imaging of the examiners was also scored. The diagnoses and treatment plans at the three points in time were compared.;Results: Statistically significant differences (p<.05) were found using conventional records and CBCT data when comparing T1 and T2 to T3 for all examiners. No significant differences (p<.05) were present among the 4 raters when comparing the diagnoses (p=.629) or treatment plans (p=.137) made using conventional radiographs at T1 and T2. Examiners with greater CBCT experience showed a higher correlation and statistically significant changes in diagnosis upon addition of the CBCT data when compared to the less experienced examiners.;Conclusion: CBCT imaging in orthodontics results in significant changes in diagnosis but not treatment planning. A sufficient level of training in CBCT is necessary to take advantage of the differences in diagnosis using 2-D and 3-D imaging. When compared to conventional 2-D imaging, CBCT provides additional diagnostic information to the orthodontist, however the impact that these diagnostic changes have on treatment planning needs to be further analyzed. Future studies with greater number of cases and examiners are needed to adequately evaluate the role of CBCT in routine orthodontic care.