UCLA

The increasing use of Cone Beam Computed Tomography (CBCT) in orthodontics is driven by its ability to provide three-dimensional (3D) images, offering detailed insights into dental and skeletal structures crucial for accurate diagnosis and treatment planning. CBCT's enhanced visualization capabilities contribute to improved treatment outcomes and a more comprehensive understanding of craniofacial complexities. Often, the CBCTs taken for orthodontic purposes are large field of view (FOV) scans capturing the entire craniofacial complex, instead of focusing on a small region of interest. As a result, there may be incidental findings (IFs) throughout the scan, which are defined as unexpected observations unrelated to the primary purpose of the imaging study. It is important to understand the prevalence of IFs, their location, and clinical severity to better serve the patient’s overall well-being.

The purpose of this study was to identify the most common IFs and their prevalence in large FOV maxillofacial CBCTs and understand their clinical significance, particularly in orthodontic treatment. We aimed to do this by investigating the prevalence and characteristics of the IFs listed in radiology reports, categorizing each IF as having either mild, moderate, or severe clinical significance, and reviewing their clinical treatment notes to examine whether the IFs influenced the patient’s orthodontic treatment. Furthermore, we examined whether there were differences in IFs across different age groups and genders. We hypothesized that there would be a difference in the prevalence of IFs across different ages and gender.

Our study was designed as a retrospective analysis of 256 radiology reports from CBCT scans taken for initial orthodontic evaluation. All reports were derived from large FOV CBCTs of patients at the UCLA Orthodontic Clinic and were obtained from the UCLA Oral and Maxillofacial Radiology Clinic. Radiology reports were reviewed for IFs and organized using Microsoft Excel. Descriptive statistics were used to analyze the IFs and chi-squared test was performed to assess whether there was a difference in IFs across different ages and gender. Our results demonstrated that of all the IFs in this study, airway IFs were most prevalent (22.92%), followed by paranasal (20.12%), dentoalveolar (19.52%), temporomandibular joint (TMJ) (15.02%), calcification (11.61%), nasal (6.51%), osseous (3.30%), and other (1.10%) IFs. The chi-squared analysis revealed a statistically significant difference in the distributions of IFs in the calcifications category across different genders (P value= 0.040). Additionally, statistical significance was found between age and TMJ IFs (P value < 0.001), osseous IFs (P value < 0.001), and calcification IFs (P value < 0.001). Most IFs (64.76%) were of mild clinical significance, followed by moderate clinical significance (44.54%), and only a small percentage (4.30%) of severe clinical significance. This study found a total of 15 different IFs that influenced orthodontic treatment, most of which were of dentoalveolar origin.

This study provides orthodontists with a comprehensive list of common IFs found in routine orthodontic CBCTs. With this information, orthodontists will be better equipped to thoroughly analyze CBCTs and improve the well-being of their patients by identifying pathologies that may have otherwise gone unnoticed.