Background: 3D cone beam imaging allows localization of impacted canines, using spatial relationships, with excellent tissue contrast. The aim of this project was to assess the degree of difficulty for the treatment of impacted canines, based on the 3D information provided by cone beam imaging. Methods: 3D cone beam images taken from subjects with impacted canines were obtained from a private practice and school setting. Results: A novel measuring scale was devised, based on three different viewpoints, in order to grade the difficulty of impaction and the potential efficacy of treatment. Depending on its anatomical location, the cusp tip and the root tip are each given a number 0-5 in three dimensions taken from a pretreatment image. The sum of the cusp tip and root tip scores in the three views dictated our anticipated difficulty of treatment. Conclusions: A novel method of analysing impactions using cone beam imaging was proposed. This method utilizes the entire three views of a CBCT image. Copyright © 2009 John Wiley & Sons, Ltd.