3D vs. 2D Imaging – Is the 2D Ceph Still Necessary? (Part 1)

By Matt Hendrickson, U.S. Orthodontic Director

3D images are an important tool in today’s orthodontic practice. However, capturing cephalometric images is critical for evaluating treatment in orthodontics. To ensure that you are getting the most reliable radiographs possible—and to streamline your practice workflow—it’s important to choose the right imaging system for your office. While there are a number of units on the market that can reconstruct a cephalometric image from a cone beam computed tomography (CBCT) scan, these can take a toll on your workflow as well as introduce legal complications into your practice. Wise practitioners are implementing CBCT systems that give them the flexibility of both 2D and 3D imaging.

Cephalometic Image
Cephalometic Image

Why Do You Still Need a 2D Cephalometric Unit?

There is no doubt that CBCT technology is growing in popularity in the orthodontic market. While these 3D machines can be used in a number of clinical applications, that shouldn’t discount the place that 2D cephalometric images have in the practice.

“I routinely utilize 3D imaging technology in my practice in the appropriate applications,” said Dr. David M. Sarver, of Sarver Orthodontics in Birmingham, Ala. “However, I feel traditional 2D cephalometric imaging is still the best way to measure growth and treatment response through serial cephalometric superimpositions—the main purpose of cephalometry. I believe it is important for the modern practice to combine both high-quality 2D and 3D imaging in order to maximize treatment quality and practice efficiency.”

The key benefits of using true 2D cephalometric imaging as opposed to cephalometric images reconstructed by a 3D unit include:

  • Elimination of motion artifacts through one-shot acquisition
  • Improved workflow
  • Ability to evaluate treatment response of patients who started treatment with a 2D ceph
  • Decreased legal liability

Not All 2D Cephalometric Imaging Systems Are Created Equal

Before going into the benefits of 2D cephalometric imaging, it’s important to differentiate between the different systems. Most digital 2D cephalometric units work like a copy machine, meaning they scan from one side of the head to the other over a period of up to 16 seconds. This is actually a step backward from film-based cephalometry, which captured the entire image with one pulse of radiation. This prolonged scan time drastically increases the likelihood of motion artifacts in the 2D cephalometric image. It is critical that clinicians understand this setback and look carefully for systems that offer a “one-shot” ceph. With one-shot cephalometric, one pulse of radiation is generated and the entire image is captured simultaneously. This technology provides a number of benefits, including minimized distortion, improved patient comfort, optimized image quality and reduced exposure time.

Please check back next week, when I will go into more details regarding the advantages of utilizing a 2D cephalometric imaging system within your orthodontic practice.

Author: Carestream Dental Blog Administrator

Carestream Dental provides industry-leading imaging, CAD/CAM, software and practice management solutions for dental and oral health professionals. With more than 100 years of industry experience, Carestream Dental products are used by seven out of 10 practitioners globally and deliver more precise diagnoses, improved workflows and superior patient care. For more information visit www.carestreamdental.com.

5 thoughts

  1. Thank you so much for your comment. There is no doubt that 3D is a growing part of the future for all specialties, including orthodontics. I agree application, understanding, measurement standards, etc. will continue to grow. This is, in large part, why we dedicated significant time and resources offer our primary Orthodontic CBCT system (CS 9300) with ultra-low dose options. We offer what we believe is the lowest dose CBCT scan in the industry at under 2.2 microsieverts. We also went to great lengths to ensure that our existing CS 9300 users can upgrade their CBCT system with the low dose option at a very low cost vs. forcing them to replace the system in order to get the low dose options. This has been done to support dose responsible, high-resolution CBCT images whenever the clinician feels they are appropriate.

    However, the fact is that today most of the profession has been trained to use 2D imaging as a significant part of their treatment. If you are going to invest $100k+ into a system, why not have a system that can do it all? Owning a system with all of the options lets each clinician decide what is appropriate for their practice and patient at any point in time.

    1. CBCT generated Ceph gives more precise dimensions when compared to 2D Ceph. The image is more sharper and landmarks are more precisely identified. Then why not use 3D Ceph.

      I am using CS9300c. The 2D ceph has Auto tracing tool which we need to adjust precisely so I feel doing tracing on system gives false markings.

  2. Sadly, if the orthodontic profession maintains the position that the 2D lateral cephalogram is an adequate representation of our patient’s anatomy when low-dose full-volume CBCT 3D imaging is readily available, we will be taking a monumental step in the wrong direction. The research on the inherent flaws of the 2D lateral cephalogram from enlargement to landmark identification errors to lacking transverse data have been widely published in peer reviewed literature for over 40 years. It is time for the profession to work together to help make CBCT 3D imaging and analysis the new standard of care. It is here to stay, whether we are ready or not.

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