ANALYZING THE PROBLEM - CBCT
CBCT and software = digital treatment planning systems
The emergence of cone beam computer tomography (CBCT) around 2000, is going to be of major importance, and frankly, I don't understand why it is not a standard diagnostic tool right now, especially since the radiation now is comparable to a panoramic.
Actually, I suspect most orthodontists don't know what to do with CBCT. With technology, more training will be necessary. Orthodontists dealing with impacted teeth will have to be able to interpret the images, and generally know their way around. You need biomechanical knowledge, and a spatial imagination to solve a tangle of teeth in the tougher cases.
For the 3 D images, there are computer programs, like Anatomage (see anatomage.com) with software that allows you to create models that make molds obsolete. '3D imaging - the Light in the Attic' (2) describes a case where 'a potentially disastrous outcome was averted'. A patient with bilateral maxillary impacted canines, had the right canine on top of the incisor ('buccally'), but the left canine behind the incisor ('palataly') . Usually (95% of the time) the impacted teeth are both on the same side of the incisors. So in this case, following the 95% rule, and not knowing the real scenario,it would have been damaging to this patient's case.
With the Anatomage, and all the newer software programs that will developed, you can simulate different scenarios, to see what results you would get from different treatment plans, which sounds like a time saver.
suresmile.com. and OrthoCAD is something in the same vein I think. It can shorten treatment time (x), for an extra $ 1000 or so, but I don't know if it is useful for impacted teeth specifically; though it does rely on 3 D imaging, which can't hurt. There is very limited real information on the company website and not too many studies.
The 3D imaging quality and use is dependent of the software, and orthodontics are definitely going to be more and more high-tech. The problem seems more to be in how orthodontists are going to keep up with it and who
is going to be able to use technology to its fullest. For patients it will hopefully be the end of pulling here, then there, and trying things blindly. Here's an article I don't understand, but it gives a taste of what is to come:
More on CBCT see: 'Making the case for CBCT' under 'Saving canines'