Pre-operative picture of patient and CBCT scan showing his severe airway restriction
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This seven year old male patient was experiencing snoring, mouth breathing, and nighttime bruxism, as well as frequent sinus and ear infections. After numerous doctors were unable to reach a definitive diagnosis, we captured an i-CAT Quick Scan. This 4.8-second scan is approximately half the dose of the i-CAT 8.9-second scan – 74μSv, 2007 tissue weight – and is roughly equivalent to a traditional 2D X-ray series with rectangular collimation, or a pan/ceph/bitewings combination. 1,2 . The scan showed a very narrow trachea and airway with adenoid hyperplasia that caused a significant airway obstruction, which explained several of his symptoms. After viewing the anatomy in three dimensions, a treatment plan in conjunction with an ENT was developed that included adenoidectomy, coblation of turbinates, and orthodontic palatal expansion. Since treatment, the child progressed, with improvements in quality of life, breathing, sleeping, and tasting.

Pre- and post-operative scans of airway showing marked improvement and post-op picture of patient
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Two years later, a follow-up included another 4.8-second Quick Scan. The highly-developed software showed that the airway almost tripled in volume from 8 cc to 23 cc, and the smallest cross sectional area (the bottleneck) went from 23mm2 to 168 mm2 . The obstruction was removed, the palatal shelf, being the floor of the nose, was expanded though Phase I orthodontic therapy, the mandible was unlocked from its transverse discrepancy, and the vector of mandibular growth was improved though nose breathing. The TMJs probably received less stress and grew better as a result of treatment, teeth gained more room for eruption, and his profile and the color of his skin both look better. He is more alert and rested during the day from consistent sleep patterns.

Why 3D, Why i-CAT®
A 3D scan allows orthodontists to view the greater craniofacial complex, with airways, bone, sinus and TMJ health as a cohesive part of an integrated system. During treatment planning, I look at airways and sinuses first, then TMJs, then skeletal relationships, then alveolar housing, then lastly the teeth. Although this has always been considered vital anatomy, 3D diagnosis and treatment planning give me a more precise view, to catch the clues to unusual dental conditions. I must truly understand all of the underlying problems to plan proper treatment, rather than having a child suffer the consequences of an “educated guess” later. With my i-CAT®, I can collimate the scan to suit individual patient’s needs, and expand, rotate or dissect the volume to any angle or to view any axial slice. Parents and young patients are grateful for this thoroughness, and I am particularly thankful to the i-CAT® for the amazing results in this case. The patient was my own son, and the data I obtained with the i-CAT® imaging helped me to improve his life, and in the long run, the lives of my other young patients.

Dr. Juan-Carlos Quintero DDS, MS
Dr. Quintero received his dental degree from the University of Pittsburgh in Pennsylvania and degree in Orthodontics from the University of California at San Francisco (UCSF). He also holds a Masters of Science Degree in Oral Biology. He has served as National President of the American Association for Dental Research- SRG, is a faculty member at the L.D. Pankey Institute and an attending professor at Miami Children’s Hospital, Department of Pediatric Dentistry, as well as immediate past-president of the South Florida Academy of Orthodon- tists (SFAO). He currently practices in South Miami, FL.