CBCT: The latest diagnostic aid in dentistry used for different treatment

modalities … Mamatha J et al Journal of International Oral Health 2015; 7(Suppl 1):96-99

Received: 20th February 2015  Accepted: 13th May 2015  Conflicts of Interest: None Review Article
Source of Support: Nil

Cone Beam Computed Tomography-Dawn of A New Imaging Modality in Orthodontics

J Mamatha1, K R Chaitra2, Renji K Paul3, Merin George4, J Anitha5, Bharti Khanna6

Contributors: quality with a much lower radiation dose than the newest
1
Senior Lecturer, Department of Orthodontics Dentofacial multidetector row helical CT unit (1.19 mSvvs 458 mSv per
Orthopaedics, MR Ambedkar Dental College and Hospital, examination).3 The CBCT imaging technique is based on a
Bengaluru, Karnataka, India; 2Senior Lecturer, Department of cone-shaped X-ray beam that is centered on a 2D detector, and
Orthodontics and Dentaofacial Orthopaedics, MR Ambedkar
the beam performs one rotation around the object, producing a
Dental College and Hospital, Bengaluru, Karnataka, India; 3Reader,
series of 2D images. The images are reconstructed in a 3D data
Department of Orthodontics and Dentofacial Orthopaedics,
St. Gregorios Dental College, Kerala, India; 4Senior Lecturer, set using a modification of the original cone-beam algorithm
Deparment of Oral Medicine and Radiology, Mar Baselios Dental developed by Feldkamp et al. in 1984.4 CBCT images from the
College, Kerala, India; 5Post Graduate Student, Department of craniofacial region are often acquired at a higher resolution
Oral Medicine and Radiology, MR Ambedkar Dental College and than conventional CT. In addition, these systems are more
Hospital, Bangalore, Karnataka, India; 6Post Graduate Student, compact than conventional CT systems, which make them
Department of Orthodontics and Dentaofacial Orthopaedics, MR more practical for use in dental offices.5 Currently CBCT
Ambedkar Dental College and Hospital, Bengaluru, Karnataka, has a wide range of clinical applications and can be used for
India. maxillofacial surgical treatment planning, assessing impacted
Correspondence: teeth prior to surgical extractions, temporomandibular joint
Dr. Mamatha J. Department of Orthodontics and Dentaofacial
analysis, orthodontics, airway assessment, periodontics,
Orthopaedics, MR Ambedkar Dental College and Hospital,
Bengaluru, Karnataka, India. Email: mamathagiri@yahoo.com
bone level evaluation, implantology, endodontic assessment,
How to cite the article: diagnosis and treatment planning.6
Mamatha J, Chaitra KR, Paul RK, George M, Anitha J, Khanna B.
Cone beam computed tomography-dawn of a new imaging CBCT in Orthodontics
modality in orthodontics. J Int Oral Health 2015;7(Suppl 1):96-99. The present article is aimed to throw light on the usefulness of
Abstract: CBCT imaging in cases on impacted teeth. CBCT imaging can
Today, we are in a world of innovations, and there are various offer an insight into the impacted teeth ranging from etiology of
diagnostics aids that help to take a decision regarding treatment in impaction through the treatment phase and the final treatment.
a well-planned way. Cone beam computed tomography (CBCT) There are various bone diseases that increase the density of the
has been a vital tool for imaging diagnostic tool in orthodontics. bone surrounding the tooth which may cause impaction, such
This article reviews case reports during orthodontic treatment and as fibrous dysplasia, and syndromes associated with multiple
importance of CBCT during the treatment evaluation.
supernumerary teeth such as Gardner’s syndrome.6,7 The most
Key Words: Cone beam computed tomography, diagnosis, common site for single supernumerary teeth is in the maxillary
orthodontics incisor area, and multiple supernumerary teeth occur most
frequently in the premolar region, usually in the mandible.6
Introduction
Imaging is the most important and frequently used diagnostic Review of articles has shown that effective doses for digital
tool in dentistry. 1 Correct diagnosis is vital for proper panoramic radiographs range from 5.5 to 22.0 µSv, when
treatment. Although the history and clinical examination are the salivary glands are considered 2.4-6.2 µSv without while
of prime importance when evaluating patients, the use and digital cephalometric radiographs have effective doses of 2.2 to
evolution of non-invasive technology from two-dimensional 3.4 µSv with salivary glands, 1.6 to 1.7 µSv without.8-12
(2D) X-ray modalities to three-dimensional (3D) cone beam
computed tomography (CBCT), for imaging is increasingly Therefore, OPG will expose the patient to 7.5 to 25.4 µSv
becoming popular.2 CBCT was first developed for use in effective dose (with salivary glands). This is in relation with an
angiography. In 1998, Mozzo et al. reported the first CBCT average annual natural background radiation dose in the United
unit developed specifically for dental use, the NewTom 9000 States of 3.0 mSv (3000 µSv).13 Data have been published on
(Quantitative Radiology, Verona, Italy). Other similar devices four of the large field-of-view systems: the NewTom 9000 (QR,
introduced at around that time included the Ortho-CT, Verona, Italy), NewTom 3G, CB MercuRay (Hitachi Medical
which was renamed the 3DX (J. Morita Mfg Corp, Kyoto, Systems, Tokyo, Japan), and the i-CAT (Imaging Sciences
Japan) multi-image micro-CT in 2000. In 2003, Hashimoto International, Hatfield, PA).14,15 Few cases at our department
et al reported that the 3DX CBCT produced better image are a testimony to the usefulness of CBCT and how it changes

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CBCT: The latest diagnostic aid in dentistry used for different treatment
modalities … Mamatha J et al Journal of International Oral Health 2015; 7(Suppl 1):96-99

our treatment plan. CBCT imaging has became an vital role in quadrant. It proved to be the game changer indeed as the
the field of orthodontics for diagnosis and treatment planning treatment plan shifted from simple orthodontic mechanics to
for both adult and pediatric patients.15 This imaging modality the use of temporary anchorage devices.
has been used in the assessment of facial growth, airway,
disturbances of tooth eruption and cephalometric analysis, safe 3D images obtained from CBCT showed the third molar to be
insertion of mini screw implants (for anchorage) and proximity lying perpendicular to the second molar with the root of both
to vital structures can greatly aid complicated orthodontic case being intertwined. Use of the second molar as the anchor unit
management, for complicated tooth movement predictability could have jeopardized the prognosis of both first and second
and for evaluation of impacted canines, other impacted teeth, molars due to root resorption once the orthodontic forces were
root resorption, fractured roots, temperomandibular joint applied. It was thus, decided to use temporary anchorage device
degenerative changes, cleft lip and palate.16

Case 1
A 21-year-old non growing male patient named Praveen
reported with a complaint of a highly placed tooth and
space in the front region (Figure 1). He reported a history
of trauma at the age of 6 years when he suffered a blow to
the deciduous maxillary incisors, from the front in a superior
and posterior direction. On clinical examination, he was
found to have a Class I skeletal base relation (Figure 2),
Angle’s Class I malocclusion. Orthopantomogram (OPG)
showed the absence of root wrt 11 (Figure 3). It was decided
that the case required further evaluation with CBCT as the
blow was directed classically in the direction likely to cause
dilaceration. On CBCT examination, it was found that
the right maxillary central incisor had a root that is in Figure 1: Extra-oral.
contact with the root of the right maxillary lateral incisor
(Figure 4).

This finding led to a complete change in the treatment plan.

The initial plan to extract the central incisor was changed into
a conservative mode of fixed orthodontic mechanotherapy
wherein cantilever mechanics could be used to bring the central
incisor into alignment.

Case 2
1. A 24-year-old non-growing female patient named Snehal
Jain (Figure 5) with average growth pattern is diagnosed as
a case of skeletal Class I jaw relationship, bilateral end-on
canine relation, with proclined upper anteriors, an overjet
of 10 mm and overbite of 8 mm, missing 26 and 46, lower
arch crowding with orthognathic profile, competent lips Figure 2: Intra-oral.
with straight divergence (Figure 6).
2. With the history, clinical examination and radiographic
records (Figure 7) it was decided to proceed with fixed
mechanotherapy. In the second quadrant, it was decided to
use second molar as the anchor unit and maintain space for
replacement of first molar by prosthesis after completion
of orthodontic treatment. In the fourth quadrant, it was
decided to close the edentulous space with respect to
missing first molar by mesialization of second and third
molars.

A need was sought to obtain CBCT (Figure 8) to have a clear

picture of the relation of second and third molars in the second Figure 3: Orthopantomogram.

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CBCT: The latest diagnostic aid in dentistry used for different treatment
modalities … Mamatha J et al Journal of International Oral Health 2015; 7(Suppl 1):96-99

or mini-implant in the second quadrant to obtain absolute average growth pattern, class I molar relation bilaterally, with
anchorage from the bone. a decreased overjet and deep bite, with retroclined upper
anteriors by 1 mm and retroclined lower anteriors by 2 mm
Case 3 (Figure 10) straight profile, and anterior divergence.
1. A 14-year-old growing female patient named Divya (Figure 9)
From the current radiographic records such as the OPG
is diagnosed as a case of skeletal class II jaw relationship with
(Figure 11) and the intra oral periapical radiograph, we could infer
the presence of an impacted premolar but no information could
be obtained regarding the root region. No information could
be obtained regarding the root proximity of the canine that was
highly placed labial to the lateral incisor. A CBCT (Figure 12)
was recorded, and it was confirmed the presence of root for the

Figure 4: Cone beam computed tomography. Figure 7: Orthopantomogram.

Figure 5: Extra-oral image. Figure 8: Cone beam computed tomography.

Figure 6: Intra-oral image. Figure 9: Extra-oral image.

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CBCT: The latest diagnostic aid in dentistry used for different treatment
modalities … Mamatha J et al Journal of International Oral Health 2015; 7(Suppl 1):96-99

2. Makhija PG, Makhija P. Integrating cone beam computed

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3. Quereshy FA, Savell TA, Palomo JM. Applications of
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5. Alshehri MA, Alamri H, Alshalhoub M. Applications of
CBCT in dental practice a literature review. Dent News
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6. White SC, Pharoah MJ. Oral Radiology: Principles and
Interpretation, 6th ed. Philadelphia: Mosby; 2004.
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Figure 11: Orthopantomogram. Clinical recommendations regarding use of cone beam
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