Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 69

Presentation Summary

Dr. Larson recommends the following systematic
method to review CBCT images, noting that he
uses Anatomage software.

References

1. Orientation of the image.
i. Orient mid-sagittal plane using Frankfort
or superimposition of profile photograph.
ii. Orient coronal plane using mid-cranial
fossa and orbits.
iii. Orient axial plane using ANS (unless there
is a history of cleft or trauma) and middle
of foramen magnum.
iv. Minor corrections in all three planes to orient final view.
v. Quick, moving scan of reconstructed
volume for an overview of symmetry and
dentition.
2. Scroll through the axial slices, starting from
the top and working down, to view symmetry,
airway and position of teeth.
3. Scroll through the coronal slices, starting back
and moving forward, to view symmetry.
4. Assess asymmetry using the axial slices in
four areas:
i. Maxillary skeletal at ANS slice.
ii. Maxillary dental at dentition level: position
the x-axis line at the mesial of the first
molars. Do not adjust the y-axis line, since
this was established during orientation.
iii. Mandibular dental using the same parameters as the maxillary dental slice.
iv. Mandibular skeletal at the mandible.
5. TMJ images to assess shape, cortication, and
position within the mandibular fossa.
6. Lastly, view specific teeth and areas of interest. Resist the urge to jump right to an
impacted canine without completing steps
one to five above.

2. Alqerban A, Jacobs R, Souza PC, Willems G. In-vitro
comparison of 2 cone-beam computed tomography
systems and panoramic imaging for detecting
simulated canine impaction-induced external root
resorption in maxillary lateral incisors. Am J Orthod
Dentofacial Orthop 2009;136:764.e1-764.e11.

1. Steiner CC. Cephalometrics for you and me. Am J
Orthod 1953;39:729-755.

3. Damstra J, Fourie Z, Ren Y. Evaluation and comparison
of postero-anterior cephalograms and cone-beam
computed tomography images for the detection of
mandibular asymmetry. Eur J Orthod 2013;35:45-50.
4. de Boer EW, Dijkstra PU, Stegenga B, de Bont LG, Spijkervet FK. Value of cone-beam computed tomography in
the process of diagnosis and management of disorders
of the temporomandibular joint. Br J Oral Maxillofac
Surg 2014;52:241-246.
5. Grunheid T, Larson CE, Larson BE. Midpalatal suture
density ratio: A novel predictor of skeletal response to
rapid maxillary expansion. Am J Orthod Dentofacial
Orthop 2017;151:267-276.

Suggested reading
Larson, BE. Cone-beam computed tomography is the
imaging technique of choice for comprehensive orthodontic assessment. Am J Orthod Dentofacial Orthop
2012;141:402-410

The first five steps of the process should take no
longer than five minutes and will enhance your
diagnosis and treatment planning capabilities. 

Summer 2017  PCSO Bulletin

69



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