Effect of Cone-beam Computed Tomography on Orthodontists’ Diagnostic Confidence and Treatment Planning in Cases of Impacted Maxillary Canines

A BSTRACT Introduction: Impacted maxillary canines can cause significant complications if not accurately diagnosed and managed. Cone-beam computed tomography (CBCT) provides three-dimensional (3D) imaging that may improve diagnostic accuracy and treatment planning in compared with conventional radiographs; however, concerns regarding radiation exposure and cost limit its routine use. Objective: The objective of this study was to evaluate whether CBCT, compared with panoramic radiography, influences orthodontists’ diagnostic confidence and treatment planning decisions in cases of impacted maxillary canines. Subjects and Methods: Across-sectional, questionnaire-based study was conducted among 35 orthodontists in Jeddah, Saudi Arabia. One case of impacted maxillary canine was presented twice. In Questionnaire 1, participants reviewed clinical information and an Orthopantomogram (OPG). After a 30-day washout period, Questionnaire 2 presented the same case with additional CBCT images. Participants assessed canine position parameters, presence of root resorption, diagnostic confidence, perceived treatment difficulty, willingness for surgical exposure, and preferred treatment plan. Paired nonparametric tests were used for analysis, with significance set at P < 0.05. Results: CBCT significantly improved assessment of vertical canine position ( P = 0.001), labio-palatal location ( P = 0.001), and detection of root resorption in adjacent teeth ( P = 0.002). Diagnostic confidence and willingness to perform surgical exposure were significantly higher after CBCT evaluation ( P = 0.002 and P = 0.001, respectively). Treatment planning more frequently shifted toward surgical exposure and alignment ( P = 0.004). No significant differences were found for angulation, root apex position, or perceived treatment difficulty. Conclusion: CBCT substantially enhances diagnostic confidence and influences treatment planning for impacted maxillary canines, particularly in evaluating 3D position and root resorption. While OPG remains suitable for initial screening, CBCT provides essential information for safe and predictable management when used judiciously.