The Influence of Three-Dimensional Cone Beam Computed Tomography (CBCT) Data on Decision-Making for Maxillary Impacted Canines

Although the increased use of three-dimensional (3D) cone beam computed tomography (CBCT) in orthodontic treatment, the necessity of the CBCT on treatment decision-making for maxillary impacted canines was not fully assessed compared to two-dimensional (2D) radiographs. This study aimed to assess differences in treatment decisions derived from CBCT data and 2D radiographs by analyzing survey responses from orthodontic specialists. Ten maxillary impacted canines with complete sets of two-dimensional (2D) radiographs and 3D CBCT data were selected and two sets of questionnaires were administered: using 2D radiographic data and 3D CBCT data. 31 orthodontists completed the survey. Diagnoses and treatment decisions were compared between the 2D and 3D imaging. Additionally, estimated angular and linear measurements of canine position were assessed with 2D and 3D and compared with actual CBCT measurements. The treatment decisions varied between 2D and 3D imaging. Notably, 51.5% of extraction decision with 2D were changed to orthodontic traction with 3D. The 3D imaging also improved the prediction of tooth collisions during traction and reduced the perceived treatment difficulty. CT proficiency influenced clinical decisions, with higher proficiency levels associated with fewer extractions and more accurate treatment predictions. 3D imaging offers greater diagnostic accuracy and improved treatment planning for impacted canines compared to 2D imaging, particularly for high and palatal impactions.