Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 68
Presentation Summary
Adding Real Value When Using CBCT
for Comprehensive Orthodontics
Dr. Dawn Pruzansky
PCSO Bulletin Contributing Editor
Dr. Brent E. Larson
Minneapolis, MN
Presented by Dr. Brent E. Larson at the PCSO Spring
Training, March 3, 2017.
Dr. Larson started off with a quote from Cecil
Steiner's 1953 AJO article:1 "Of this we can be
sure: The cephalometer is here to stay, and those
of you who are not using cephalometrics in your
everyday clinical practices now must soon bow to
its importance, accept the added burden it
imposes, and master its mysteries if you are to
discharge your full obligation to your patients."
Dr. Larson commented that this statement can
now be applied to CBCT in orthodontics, and that
it can take up to 15 years for a new dentistry technology to be adopted. He discussed the adoption
of new technology and its phases.
In dentistry, Dr. Larson posited, the decision
to adapt a new method is as much about
psychological and behavioral factors as it is
about technological advancement.
Dr. Larson described the following benefits
of CBCT:
1. No magnification or distortion in comparison
to a two-dimensional image, which always
has some distortion.
2. Improved localization, which is important in
cases with impacted canines.
3. Better view of root resorption. In a study by
Alqerban and colleagues in 2009, CBCT imaging was significantly more effective than
panoramic images at detecting resorption.2
4. Asymmetry detection. A study by Damstra
and colleagues showed that CBCT is better at
detecting chin deviation than are PA cephalograms.3
5. TMJ visualization. A study by de Boer and colleagues concluded that CBCT assessment of
TMJ disorders could lead to a change in primary diagnosis and management.4 Dr. Larson
went on to note that in adolescent patients,
active growth in the TMJ should not be mistaken for pathologic remodeling.
6. Airway assessment.
7. Incidental findings. Dr. Larson discussed a
chart showing that 50% of incidental findings
are in the airway, with 6% needing follow-up.
This was preceded by 35% in the TMJ, with 12%
follow-up, and 11% endodontic findings with
11% follow-up.
One novel use for CBCT imaging is the quantification of bone density at the maxillary suture to
predict skeletal vs. dental expansion.5
Adoption of new technology and its phases
68
PCSO Bulletin Summer 2017
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