Seminars in Orthodontics

VOL 17, NO 1

MARCH 2011

Introduction
one beam computed tomography (CBCT)
has revolutionized the way radiographs are
evaluated. For more than a century the orthodontic literature has included articles in which
orthodontists are advised about the importance
of diagnosis in all dimensions. Several techniques, including the combination of lateral and
frontal cephalograms and cone shift methods,
have been suggested but were never practical or
sufficiently practicable for widespread adoption.
CBCT was introduced at a much lower cost than
helical computed tomography (CT), with smaller-sized machines that would fit in a private office, and radiation levels equivalent to current
radiographic modalities available to the profession of orthodontics. This allowed a 3-dimensional (3D) representation of patients and has
become practical, fast, and distortion free.
Orthodontists are constantly seeking new and
simpler methods; perhaps that is why it took an
orthodontist to bring the first CBCT scanner to
the United States. Within a decade, thousands of
scanners have been installed, with many major
manufactures offering their own version of
CBCT. There is no doubt that the acceptance
and technology penetration was rapid, but this
was not necessarily attributable to allowing for
additional diagnostic data, or the possibility of
providing better service to the patients. We still
need to assess whether the use of CBCT does
indeed allow a more comprehensive diagnosis
and whether such a diagnosis would change the
treatment plan or improve the treatment outcome. In orthodontics some procedures or appliances may prove more effective on some patients than on others. There appears to be some
differences among those patients that were not
able to be seen with the currently used technology. This may be attributable to bone quality,
thickness, or buccolingual inclination of teeth.

2011 Elsevier Inc. All rights reserved.

doi:10.1053/j.sodo.2010.08.002

Perhaps with the aid of CBCT and the ability to

assess the third dimension, such differences may
become identifiable.
A very important disadvantage of CBCTs rapid
incorporation is the lack of standardization for
both CBCT hardware and software. Different scanners offer different x-ray setting options, which
results in patients receiving different radiation dosages depending on the system used and not the
purpose of the image. There is a need for radiological protocols for each situation, the same way
that there are for periapical and bitewing radiographs. However, even if such protocols existed at
present, not all the currently installed scanners,
which offer different options, would allow for immediate compliance. The same problems exists for
software, where currently, different programs perform calculations by the use of different methods,
resulting in, for example, different airway volume
values for the same patient, depending on the
software used. This creates a need to arrive at and
define standards, and thus permit a 3D version of
orthodontic cephalometry.
This issue of Seminars in Orthodontics provides
the orthodontists point of view on this emerging technology. The issue describes the history
of 3D imaging in orthodontics, followed by a
philosophic paper on what should be kept in
mind when using new methods for current applications. The articles that follow show different
uses of CBCT in orthodontics from diagnosis to
outcome assessments. The final article assesses
the present and possible future directions for
CBCT in orthodontics.
CBCT 3-dimensional orthodontic imaging is
rapidly developing and is of interest to all orthodontic clinicians. This current issue is a succinct representation of where the process is now.
It is a rapidly developing technology but requires continual assessment and reassessment to
better serve the patients and the specialty.
Juan Martin Palomo, DDS, MSD
Guest Editor

Seminars in Orthodontics, Vol 17, No 1 (March), 2011: p 1