Cone-beam computed tomographic reconstructions in the evaluation of maxillary impacted canines

Prior to cone-beam computed tomography (CBCT), orthodontic competence included radiological interpretation. Nevertheless, maxillary impacted canines (MICs), because of their position and adjacent complex anatomy, have been challenging to interpret, particularly with regard to root resorption. Although CBCT cross-sectional reconstructions of MICs yielded clearer insights into its diagnosis and treatment planning, the value of simultaneously using 2 different cross-sectional or multiplanar reconstructions of the CBCT datasets - orthogonal and curved/panoramic multiplanar reconstructions - has hitherto not been considered.

Both orthogonal and curved/panoramic multiplanar reconstruction series of 5 screenshots were each reconstructed from the 5 cm × 5 cm CBCT datasets of 15 separate MICs. Fifteen credentialled and experienced orthodontist volunteers reviewed 2 separate PowerPoints of 15 randomized series each, 1 week apart. Their review considered 6 factors that could affect treatment: the position and level of the MIC, the presence or absence of root resorption, ankylosis, cysts, and dilaceration.

All 15 orthodontists were statistically similar regarding overall years of experience and of CBCT use. Although either reconstruction alone allowed the orthodontists to determine whether ankylosis and, to a lesser extent, most of the other features were present or absent in the MIC, reviewing both reconstructions together was necessary to determine whether root resorption was present or absent in the adjacent tooth.

Reviewing both orthogonal and curved/panoramic multiplanar reconstructions was necessary to evaluate the presence or absence of root resorption in the teeth adjacent to MICs and that of many other features.