CBCT Visualization Verifies Suspected Ankylosis and Affects Treatment Plan

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By Brett Coleman, DMD, MS

Case Overview:
A 32-year-old male patient presented with a desire to improve his smile through orthodontic treatment. The patient had previously undergone limited orthodontic treatment as a young boy. Upon clinical examination, the patient’s entire upper left quadrant was on a much higher plane than the right quadrant. The patient’s bite was in occlusion on the right side; however, the bite was completely open on the left side. His teeth in the lower left quadrant were supra-erupted in an effort to establish occlusion with the upper left teeth. The patient requested treatment to extrude the upper left side to correct the open bite. He reported no history of occlusal or facial trauma.

Treatment Plan:
The clinical concern was that the teeth on the upper left side may be ankylosed. If they were in fact ankylosed, braces would create more of a problem by canting his entire upper arch up and to the left. Standard 2D radiographs were reviewed in our practice and by a local oral surgeon. A definitive diagnosis regarding ankylosis could not be determined by these radiographs or clinical examination alone. A 10×10 field-of-view cone beam computed tomography (CBCT) scan was ordered using our CS 9300C CBCT, panoramic and cephalometric imaging system. Evaluation of the CBCT scan confirmed that teeth numbers 9, 10 and 11 were in fact ankylosed. The patient was informed that orthodontic treatment alone was not the proper solution to correct his problem; however, the patient elected to decline any orthodontic or surgical attempt to correct his malocclusion.

One of the unique features of the CS 9300C system is the ability to take excellent quality images in both 2D and 3D. This flexibly provides me with the all the clinical tools needed to provide the best care efficiently and in accordance with the ALARA and ALADA principals. Without the high-resolution CBCT image, it would have been a guess on the eventual diagnosis of ankylosis of the teeth in question. In this—and many other—cases, the CS9300C helped us to efficiently identify the best course of action for the patient.