Appropriate use of ionizing radiation in orthodontic practice and research

Accuracy of a Method to Monitor Root Position Using a 3D Digital Crown/Root Model during Orthodontic Treatments

This study aimed to assess the accuracy of a method of predicting post-movement root position during orthodontic treatment using a 3D digital crown/root model (3DCRM) created with pre-movement records of both cone-beam computed tomography (CBCT) and dental arch digital scans. Pre- and post-movement CBCT scans and dental arch digital scans of five patients who had completed orthodontic treatments were used in this study. The 3DCRM was superimposed onto the post-movement scanned dental arch to identify the post-movement root position (test method). Post-movement CBCT (referenced as the current method) served as the control to identify the actual post-movement root position. 3D-coordinate analysis revealed no significant differences between the test and current methods along the X and Y axes. However, the discrepancy on the Z axis (especially in cases of intrusion) was greater than that in all other directions for all three tooth types examined (p < 0.05). A strong positive correlation between the degree of discrepancy and the distance of tooth movement was observed on the Z axis (r = 0.71). The 3DCRM method showed promising potential to accurately predict root position during orthodontic treatments without the need for a second CBCT. However, root resorption, which affected the Z axis prediction, needs to be closely monitored using periapical radiographs to complement this method.

Choice of radiography in orthodontic treatment on children and adolescents: A questionnaire-based study performed in Sweden

The aim was to investigate the objective and choice of different radiographic examinations used in orthodontic treatment of children and adolescents, using a web-based questionnaire directed toward specialists in orthodontics. The questionnaire was distributed to 255 orthodontists in Sweden. In total, 142 responses were received, and 11 specialists were interviewed. Questions were related to the use of radiography during different treatment stages; modifications to the treatment regimen owing to radiographic findings; and the use of and/or need for guidelines in radiography. Radiographic examinations were performed in all treatment stages and mainly during treatment planning. Panoramic radiographs were always or often used by the respondents (99%), less frequently used were lateral radiographs (66%) and intra-oral radiographs of the incisor regions (69%). Cone beam computed tomography (CBCT) was sparsely employed. A majority of the respondents considered that radiographic findings often or occasionally affected the treatment. Local- or clinic-specific guidelines were used by 85% of respondents. The need for national guidelines was considered low. The frequent use of panoramic radiography together with application of local guidelines, may indicate that radiographic selection criteria are not individualised. National guidelines might facilitate updates on radiographic techniques, and on radiation doses and risks in young patients.

Morphometric Analysis of the Mandibular Canal, Anterior Loop, and Mental Foramen: A Cone-Beam Computed Tomography Evaluation

This study investigated the cone-beam computed tomography (CBCT)-based features of the mandibular canal, mental foramen, anterior loop, and accessory mental foramina with respect to age and sex. A total of 306 CBCT mandibular images were included in this retrospective study to measure the mandibular canal location and extension, the mental foramen position, the presence of the anterior loop, and the accessory mental foramina. The measurements were obtained in sagittal, coronal, and axial views. Descriptive statistics are presented. Sex-related differences, correlations, and comparisons were calculated using SPSS at 5% significance level. The mandibular canal was located more coronal and medial in male patients. The majority of cases had the mental foramen located just apical to the mandibular second premolar with a mean height of 2.94 mm and a mean length of 3.28 mm. Age affected the size of the mental foramen. The mental canal in all cases tended to show a coronal direction. Mesial extension of the anterior loop was found in 66.01% of the images while accessory mental foramina were detected in 2.6%. The complexity of the mandibular canal, mental foramen, anterior loop, and accessory mental foramina among Sudanese patients with respect to age and sex was confirmed.

Effects of root-cortex relationship, root shape, and impaction side on treatment duration and root resorption of impacted canines

OBJECTIVES

This retrospective longitudinal study aimed to evaluate the factors that affect the orthodontic treatment duration (OTD) and external apical root resorption (EARR) of maxillary impacted canines (MIC) as root-cortex relationship, root shape, impaction side, and gender.

MATERIAL AND METHOD

Thirty-eight patients (mean age 15.28 ± 1.48 years) who had unilateral MIC and undergone orthodontic treatment were included in this study. Root-cortex relationship, root-cortex intersection amount, root shape, impaction side, height, alpha angle, impaction zone, and length of the MIC were evaluated on cone-beam computed tomography images at the beginning of the treatment. Final assessments were performed on ortopantograms at the end of the treatment as canine angulation and tooth length. The sample was characterized by descriptive statistics; t-tests, Mann-Whitney U-test, ANOVA, and Kruskal-Wallis tests were used for the comparison of EARR and OTD values between the categorical groups.

RESULTS

Root shape affected OTD, and the longest value was detected in MIC with bent root (P < 0.000). The presence of root-cortex relationship also prolonged OTD for approximately 3 months (P = 0.006). MIC with risk factors like positive root-cortex relationship and bent roots had higher EARR values than those with negative root-cortex relationship and normal roots (P = 0.042, P = 0.021, respectively). EARR of the palatal MIC was also higher than the buccal MIC (P = 0.009). OTD was significantly influenced by root-cortex intersection amount (P = 0.004).

CONCLUSION

The presence of root-cortex relationship and abnormal root shape were risk factors for greater EARR of MIC along OTD, which was also significantly influenced by root shape and root-cortex relationship.

Cone-Beam Computed Tomography in Orthodontics

Unlike patients receiving implants or endodontic treatment, most orthodontic patients are children who are particularly sensitive to ionizing radiation. Cone-beam computed tomography (CBCT) carries risks and benefits in orthodontics. The principal risks and limitations include ionizing radiation, the presence of artifacts, higher cost, limited accessibility, and the need for additional training. However, this imaging modality has several recognized indications in orthodontics, such as the assessment of impacted and ectopic teeth, assessment of pharyngeal airway, assessment of mini-implant sites, evaluation of craniofacial abnormalities, evaluation of sinus anatomy or pathology, evaluation of root resorption, evaluation of the cortical bone plate, and orthognathic surgery planning and evaluation. CBCT is particularly justified when it brings a benefit to the patient or changes the outcome of the treatment when compared with conventional imaging techniques. Therefore, CBCT should be considered for clinical orthodontics for selected patients. Prescription of CBCT requires judicious and sound clinical judgment. The central question of this narrative review article is: when does CBCT add value to the practice of orthodontics? To answer this question, this article presents discussion on radiation dosage of CBCT and other imaging techniques used in orthodontics, limitations of CBCT in orthodontics, justifying the use of CBCT in orthodontics, and the benefits and evidence-based indications of CBCT in orthodontics. This review summarizes the central themes and topics in the literature regarding CBCT in orthodontics and presents ten orthodontic cases in which CBCT proved to be valuable.

Accuracy of three-dimensional cephalograms generated using a biplanar imaging system

Objective

Biplanar imaging systems allow for simultaneous acquisition of lateral and frontal cephalograms. The purpose of this study was to compare measurements recorded on three-dimensional (3D) cephalograms constructed from two-dimensional conventional radiographs and biplanar radiographs generated using a new biplanar imaging system with those recorded on cone-beam computed tomography (CBCT)-generated cephalograms in order to evaluate the accuracy of the 3D cephalograms generated using the biplanar imaging system.

Methods

Three sets of lateral and frontal radiographs of 15 human dry skulls with prominent facial asymmetry were obtained using conventional radiography, the biplanar imaging system, and CBCT. To minimize errors in the construction of 3D cephalograms, fiducial markers were attached to anatomical landmarks prior to the acquisition of radiographs. Using the 3D Ceph™ program, 3D cephalograms were constructed from the images obtained using the biplanar imaging system (3D ceph_biplanar), conventional radiography (3D ceph_conv), and CBCT (3D ceph_cbct). A total of 34 measurements were obtained compared among the three image sets using paired t-tests and Bland-Altman plotting.

Results

There were no statistically significant differences between the 3D ceph_biplanar and 3D ceph_cbct measurements. In addition, with the exception of one measurement, there were no significant differences between the 3D ceph_cbct and 3D ceph_conv measurements. However, the values obtained from 3D ceph_conv showed larger deviations than those obtained from 3D ceph_biplanar.

Conclusions

The results of this study suggest that the new biplanar imaging system enables the construction of accurate 3D cephalograms and could be a useful alternative to conventional radiography.

Maxillary second molar impaction in the adjacent ectopic third molar: Report of five rare cases

Maxillary second molar impaction in the adjacent ectopic third molar is a rare condition that practitioners might face in the field of pediatric dentistry and orthodontics. The early diagnosis and extraction of the adjacent ectopic third molar have been advocated, and prior research has reported a high rate of spontaneous eruption following third molar removal. However, some challenges in the daily practice are that the early diagnosis of this type of tooth impaction is difficult with conventional radiographic examination, and sometimes the early surgical removal of the maxillary third molar must be postponed because of the risks of damaging the second molar. The objective of this study is to report a case series of five young patients with maxillary second molar impaction and to discuss the difficulty of early diagnosis with the conventional radiographic examination, and unpredictability of self-correction.