Cone-beam computed tomography and the orthosurgical management of impacted teeth

Background. Three-dimensional (3-D) cone-beam computed tomography (CBCT) has been used to diagnose and treat impacted teeth. The authors describe the benefits of using CBCT to complement plain film two-dimensional (2-D) imaging. Methods. The authors compare the efficacy of 2-D and 3-D modalities in relation to the relative positions in space of adjacent and overlapping dental units, the existence of pathology in the buccolingual plane and the ability of each to define the orientation of individual teeth. Results. CBCT imaging can be used to interpret buccolingual information in detail, to distinguish and define the extent and depth of root resorption, and to delineate long-axis orientation of unerupted teeth, including root apex location. It is able to synthesize traditional panoramic and cephalometric radiographs. Conclusions. CBCT permits oral surgeons to visualize the position and surgical anatomy of the tooth as it will be seen in the operating theater and allows orthodontists to plan directional traction. Clinical Implications. Unexpected anatomical or pathological findings that are not noted in plain film radiographs and that may obstruct or delay orthodontic treatment until they are eliminated may be found when CBCT is used. Clinical diagnosis of existing pathology can be assessed accurately by using CBCT. In addition, 3-D imaging contributes to more accurate and less traumatic surgical exposure, as well as to more efficient and directionally appropriate orthodontic traction, than does traditional 2-D imaging and thus contributes to faster resolution and better overall tooth prognosis. The use of CBCT occasionally can be the difference between the success and the failure of the treatment plan.