3D - The Curtain Has Risen
Dr. Pfister discusses the results of 3D imaging with a patient and his mother.
I’m often asked what has been the biggest change in Orthodontics in my 35 years in practice…
I’ve seen us go from full metal bands to one-surface brackets, from chemical bonding of braces to super-efficient light cure adhesives, and from metal brackets to clear polymer trays for moving teeth. But I’d have to say the biggest advancement to date would be in the diagnostic field of radiology.
The dawn of digital 3D imaging and the ability to go into the depths of the human skull with high-resolution accuracy (as well as rotate jaws and teeth for diagnosis from any angle) is as much a technological breakthrough as your grandfather’s phone leaving the wall and ending up in your back pocket.
Today, with the push of a button and a six-second rotation of the digital scanner (not to mention less than half the radiation we used just ten years ago), we are able to send signals from fifteen different sensors for a 360-degree diagnostic view of our subject. This information is then sent to imaging software, converted to a usable image, and displays on our chair-side monitor for my evaluation and presentation to the patient.
The magnitude of data presented, the clarity of the image, and the seamless transfer of the data (in less than eight minutes) to the patient is what I feel makes 3D imaging the hands-down greatest advancement in Orthodontics to date! But it wasn’t always this way…
When I graduated from Case School of Dentistry in the 80’s, the 2D panoramic radiograph was just getting out of research departments and into the dental community. During my second year of practice, I was able to purchase a Siemens Orthopantomograph, OP-100, that cost double the price of my first condo… but lasted over 28 years in the practice. With it, we learned about TMJ anatomy, dental abscesses, impacted teeth, broken jaws, wisdom teeth - you name it, we filmed it. And 2D flat panoramic views showed these various dental conditions far better than anything we had prior to date.
As technology advanced and we entered the new millennium (when all our computers didn’t crash and we all survived that epic New Year’s Eve in January 2001), the dawn and exponential growth of the Digital Age began.
Mankind may be a creature of habit - and we may not always welcome change - but we are an inquisitive lot, always striving for reinventing a better wheel. It only took roughly ten years for 3D digital imaging to reach the private dental practice. I traded in the OP-100 in 2012 and, with triple the cash of my first condo, bought my first 3D system. Four years later, I traded that one in for our current industry gold standard, the I-CAT 3D system.
You may be asking by now… what is the big difference between 2D and 3D? Let’s take a look…
I use the analogy that 2D is like watching the Wizard of Oz when they were in the room talking to the ethereal head of Oz. It’s great to look at, but you know there has to be more to it than meets the eye. In other words, “What’s behind the curtain?” The ability to show all, from all directions, is where 3D raises the curtain of total diagnosis. I can take a 6.5-second scan and, in 8 minutes, show not only the 2D panorex of old (great for viewing missing or extra teeth, or if anything is impacted), but also hit a button and bring up the 3D image and show why the tooth is impacted. Better yet, rotate the view, split the bone, and find that the tooth that was missing in a 2D flat view is laying on its side behind another tooth!
We can visually walk under the roots of an impacted wisdom tooth and evaluate the probability of nerve damage if and when they are extracted. The TMJ can only be seen on a single outside lateral view in 2D, but with 3D imaging, we can show limitless views and actually scroll right through the skeletal head of both right and left TMJs looking for arthritic damage. The density and levels of bone (as well as location of other anatomical structures) can all be determined by 3D imaging in order to ensure the successful placement and longevity of a dental implant. These are all great dental benefits of 3D imaging.
Let me close with the more dramatic systemic medical benefits for the patient from the same 6.5-second scan.
The ability to find bone tumors, cysts, and cellular abnormalities - though not common - can really be a blessing for a patient who was just wondering about getting braces! As an orthodontist treating growing young people, it would be nice to know when they were going to start growing and if they were nearing completion of the growth process. The 3D system allows us to analyze the vertebral column vertebrae and, when compared to a standardized graph, be accurate at the 70% level.
Finally, my favorite subject of the last 5 years is the human airway.
Short of the ability of MRI imaging (at more than 30 times the radiation and over ten times the cost), our I-CAT 3D can volumetrically measure airway in mm cubed, scan the entire nasal septum for deviations, and run the length of the airway to evaluate tonsil, adenoid, and nasal turbinate obstruction to air flow. I will discuss it further at a later date, but suffice it to say sleep apnea has been a much talked about health topic concerning adults, but its effects on adolescent attention deficit and hyperactivity have been the more recent findings. It was mainly for airway evaluations (after my staff and I completed a two-year fellowship traveling to Miami, Naples, Charlotte, Ann Arbor, and Scottsdale… this was no small education endeavor) that we moved to the I-CAT 3D system. It’s great for the orthodontist to correct the bite and smile, but when you can enhance a child’s life with restful sleep or discover a bone-consuming tumor… this, I feel, is the life-changing ability of 3D imaging!
Have a great weekend Medina County,
- Dr. Pfister