3D Imaging Revolutionizes Orthodontics
By Paul L. Ouellette, DDS, MS, ABO // February 21, 2013
ABOVE VIDEO: The Ouellettes have developed the concept of the “Polymorphic Cube” skeletal base or the anatomical foundation. The above video demonstrates how this information can be used to make diagnostic decisions and often discover patients predisposed to obstructive sleep apnea (OSA).
Panoramic X-Rays Have Significant Limitations
Orthodontists are trained to diagnose, treatment plan and straighten crooked teeth. Two-dimensional x-rays such as panoramic, cephalometric, occlusal and periapical x-rays are the current standard of care used by 95 percent of orthodontists worldwide.
Using current dental imaging technology to diagnose orthodontic problems may not reveal the complete picture. The majority of orthodontic cases are diagnosed and treatment planned using 2D x-rays. Cone Beam Computed Tomography (3D CBCT) imaging recently introduced to orthodontics is changing the way we diagnose and safely move teeth.
In 1960-1970s Larry Andrews, DDS introduced the concept of the Six Keys to Optimal Occlusion (bite relationship) and the Andrews Straightwire Orthodontic Appliance (pre-adjusted braces).
Prior to Dr. Andrew’s significant contribution to orthodontics, doctors had to make multiple adjustments to archwires to effectively move teeth into corrected positions. In other words, the archwire was the key to moving teeth.
The Andrews Straightwire protocol transferred the force systems into the brackets (braces).
Precise angulations, in-out adjustments, tipping, torque and other force components were engineered into the braces. Therefore, the orthodontist could use a straight pre-formed wire to efficiently move teeth. Andrew’s concept was a paradigm shift in orthodontics that dramatically shortened treatment times and improved the overall quality of cases.
The majority of orthodontists today use a Straightwire protocol or variations of Andrews orthodontic appliance.
3D CBCT IMAGING GIVES COMPLETE PICTURE
The introduction of 3D CBCT imaging has now given us a more complete picture of how effective and safe orthodontic treatments can be using Andrew’s concepts.
3D CBCT images of teeth are near 100 percent accurate and have minimal distortions. The “Anatomical Truth” as stated by Dr. Scott Ganz, Maxillofacial Prosthodontist and Implant Surgeon, reveals what is really happening under the hood.
Determining the amount of bone around each tooth and identifying areas of thin bone or no bone is now possible before initiating orthodontic tooth movement.
SAFE TOOTH MOVEMENT
Impacted teeth can be safely retrieved if the doctor is able to determine the exact position of teeth prior to administering orthodontic forces. The picture below illustrates a significant complication of applying orthodontic forces to two maxillary impacted canines (upper eye-teeth). Sadly, the patient lost six front teeth because the treating doctor used 2D images to plan the movement of the impacted teeth. 3D CBCT is the evolving standard of care and is recommended for most impaction cases to avoid complications.
PANORAMIC X-RAY SHORTCOMINGS
Panoramic x-rays have significant limitations that must be considered when making diagnostic decisions.
Panoramic x-rays have significant limitations that must be considered when making diagnostic decisions. Panoramic images are generally magnified, exhibit distortions, double or triple images and have superimposed anatomical structures. Often these shortcomings can hide supernumerary (extra teeth) or missing teeth. On the panoramic image below you can see some of the problems described.
Panoramic images are generally magnified, exhibit distortions, double or triple images and have superimposed anatomical structures. Often these shortcomings can hide supernumerary (extra teeth) or missing teeth. On the panoramic image below you can see some of the problems described.
3D Imaging makes it possible to quantify or discover anatomical asymmetries present in the majority of orthodontic patients prior to initiating treatment. Anatomical variation in the human head and neck is the norm, not the exception!
The Ouellettes have developed the concept of the “Polymorphic Cube” skeletal base or the anatomical foundation. The above video demonstrates how this information can be used to make diagnostic decisions and often discover patients predisposed to obstructive sleep apnea (OSA).
The airway is a significant area to be evaluated for the most comprehensive orthodontic diagnosis according to Doctor Juan Carlos Quintero of Miami, Florida. The etiology (cause) of malocclusion, planning for orthodontic relapse and predicting future airway issues can now be quantified with 3D imaging.
For more information call 321-779-0000 or log on to DentalSpecialist.com
ABOUT THE AUTHOR
Paul L. Ouellette, DDS, MS, ABO, is a board certified orthodontist who has practiced for more than 35 years. He received his college education and Bachelor of Science degree at Texas A&M University. He studied dentistry at Loyola University in Chicago, Illinois, where he earned his Doctorate of Dental Surgery, Certificate of Orthodontic Specialty, and Masters Degree in Oral Biology. Dr. Ouellette has three Dental Specialist office locations in Brevard County, Florida, and can be reached at 321-779-0000, or Dental Specialists.com.