Cone Beam Computed Tomography: A Link with the Past, a Promise for the Future

During the last quarter of the 20th century, changes in clinical orthodontics were largely driven by improvements in bracket design, attachment mechanisms, and arch wire materials. This focus on the mechanical aspects of treatment led to decreased clinical interest in the underlying biology of facial growth and, for a time, craniofacial practitioners often ignored the bio in biomechanics. There was even more disappointment after the completion of the Human Genome Project. Although this project promised exciting possibilities for biologically based manipulation of the growing face, the resulting data were interesting but in most cases not clinically useful. In 2001, the introduction of low-cost, low-radiation dose, high-resolution cone beam computed tomography (CBCT) in clinical orthodontics created the potential for new discoveries in craniofacial biology and facial growth. This technology provides researchers and clinicians with the tools needed to study 3-dimensional changes in craniofacial anatomy associated with the growth process and clinical care. In the 20th century, radiographic cephalometry was a pioneering advance that led to many fundamental insights into the behavior of the face and neurocranium during growth. CBCT imaging promises similar advances in the 21st century. However, to take advantage of this opportunity, clinicians will need to interpret 3D anatomic changes in the context of the underlying growth process. This paper presents a short history of imaging in orthodontics, reports on the current state of the art, and suggests 3 ways CBCT imaging may influence the future of the specialty.