Reliability of a method for the localization of displaced maxillary canines using a single panoramic radiograph

Implant-to-nasal floor dimensions projected by panoramic radiographs in the maxillary incisor-canine region: implications for dental implant treatment

To make a comparison of panoramic radiography (PAN) and cone-beam computed tomography (CBCT) determinations of implant-to-nasal floor dimensions (INFD) in the anterior maxillary region, and to assist in determining in which tooth regions additional radiation exposure involved in CBCT scans is justifiable. Data related to INFD by PAN (PAN-D) at implant-to-nasal floor sites (central incisor, lateral incisor, canine) were gathered using 141 implant sites from 119 adult patients. INFD was estimated employing the CBCT technique as a reference method. PAN analysis equations were created for estimation of INFD by CBCT (CBCT-D) specific to implant sites. For assessment of the agreement between the PAN and CBCT methodologies, the Bland-Altman approach was employed. There were robust and significant odds ratios that implants in the canine region would fall into the underestimation groups of > 0 mm (4.5:1) (p = 0.003), > 0.5 mm (6.2:1) (p < 0.001), and > 1 mm (5.4:1) (p = 0.002). The root mean squared error (RMSE) and pure error (PE) were highest for the canine region (RMSE = 1.973 mm, PE = 2.20 mm). This research offers evidence of site-specific underestimations of available horizontal bone dimensions for implants when PAN is employed to assess the availability of vertical bone dimensions. The data suggest that it may be necessary to exclude canine regions when making assessment of INFD through PAN. Use of CBCT may, therefore, be recommended for all implant size and angulation estimations in this region.

Implant-to-root dimensions projected by panoramic radiographs inthe maxillary canine-premolar region: implications for dental implant treatment

BACKGOUND

This study aimed to compare panoramic radiography (PAN) and cone beam computed tomography (CBCT) determinations of implant-to-root dimensions (IRD) in anterior and posterior maxillary regions, and to help determine in which instances increased radiation exposure from CBCT scans may be justified.

METHODS

IRD measured by PAN (PAN-D) from implant-to-root sites (central incisor, lateral incisor, canine, first premolar, and second premolar) was collected from 418 implant sites in 110 adults. The CBCT technique was used as the reference method for the estimation of IRD. The PAN analysis equations were developed using stepwise multiple regression analysis and the Bland-Altman approach was applied to assess the agreement between PAN and CBCT methods.

RESULTS

The odds ratio that an implant at the canine-to-first premolar (9.7:1) (P = 0.000) or at the first premolar-to-second premolar region (4.5:1) (P = 0.000) belongs to the underestimation group was strong and highly significant. The root mean square error (RMSE) and pure error (PE) were highest for the canine-to-first premolar (RMSE = 0.886 mm, PE = 0.45 mm) and the first premolar-to-second premolar region (4.5:1) (RMSE = 0.944 mm, PE = 0.38 mm).

CONCLUSIONS

This study provides evidence of site-specific underestimations of available horizontal bone dimensions for implants when assessed by PAN. These data suggest that the canines and first and second premolars may have to be excluded when assessing root angulations via PAN.

"Canine tracker"; an app based on android platform for localisation of impacted maxillary canines using digital panoramic radigraphs

The panoramic radiographs for localisation of impacted canines are now mostly available in the digital form. It is difficult to apply the localisation techniques in the digital format especially when it is viewed and diagnosed using smart phones. So in this paper we are describing about an app we created based on the android platform. Using this app three localisation methods can be applied by using multiple tools.

Surgical Exposure of Impacted Teeth

Impacted incisors, canines, premolars, and second molar are problems encountered frequently by general dentists, orthodontists, and oral and maxillofacial surgeons. The etiology of impacted teeth is multifactorial. Traditional radiographs can be used for location of the impacted tooth but 3-D CBCT is superior in evaluating the tooth's position. Successful management requires an interdisciplinary approach with an orthodontist responsible for the overall success of the treatment plan. Surgical exposure of these impacted teeth is accomplished using an open or closed surgical procedure. Choosing the appropriate surgical procedure and orthodontic treatment plan will result in a stable, predictable, and aesthetic result.

Strategies for Managing the Risk of Mucogingival Changes During Impacted Maxillary Canine Treatment

Gingival recession is a frequent mucogingival defect in the adult population. It affects the esthetics and is related to hypersensitivity and a high risk of periodontal attachment loss. The connection between orthodontic treatment and periodontal health has been debated for a long time. A healthy periodontium can be preserved during safe orthodontic tooth movement even in patients with poor mucogingival anatomy. This article aimed to review the strategies around managing the risks of mucogingival and apical root changes owing to maxillary canine impaction, with a special focus on gingival recession and impacted maxillary canine treatment. Maxillary canines are the second most frequently impacted teeth after the third molars. They can be located in the labial or buccal aspect of the alveolar bone. If interceptive procedures fail, the next step is the challenging and time-consuming comprehensive orthodontic-surgical treatment. Determining the exact impacted canine location, its relation to the adjacent teeth and structures, the least invasive surgical approach, and the best path for traction are all a part of the standard diagnostic process. It has also been suggested that orthodontists should evaluate periodontal risks to achieve the best possible results. Clinical examination and cone beam computed tomography provide valuable information for the treatment plan that yields good results with a healthy periodontium.

Correlation Between Maxillary Canine Impaction and Facial Biotype

AIM

The etiology of teeth impaction is still not fully understood, despite that cofactors have been considered important to develop such a clinical picture. The aim of the authors' paper was to investigate about facial biotype, about the values of inclination of the upper cuspid axis to the perpendicular to Frankfort-horizontal plane and about the distance "d" of the canine cuspid to occlusal plane: each factor was statistically compared. The authors also performed a comparative analysis on the radicular length of the left and right lateral incisors of subjects with impacted maxillary canine.

METHODS

The authors recruited with "cluster sampling" randomization more than 30 patients, then refined to 25 after the application of exclusion criteria. Specific values were carried out by x-rays: the authors calculated both the α and β angles, the intermaxillary angle, the distance "d" and the inclination of upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane. Spearman rank correlation coefficient or Spearman rho (ρ) was used as statistical methods.

RESULTS

The authors' results assessed that the inclination of the upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane showed a statistically significant inverse correlation with the intermaxillary angle.

CONCLUSION

The authors' data clearly indicate that hyperdivergence is a key-factor that will certainly support the eruption path of canine cuspid: in this light, the treatment of tooth impaction in hyperdivergent subjects can be considered as predictive for a good prognosis.

Reliability of different radiographic methods for the localization of displaced maxillary canines

INTRODUCTION

The purpose of this study was to evaluate the reliability of the radiographic images of the main conventional x-ray techniques compared with the information from cone-beam computed tomography (CBCT).

METHODS

Twenty patients with unilateral or bilateral impaction of the maxillary canines had radiographic examinations by means of periapical x-rays, occlusal x-rays, panoramic x-rays, and CBCT scans. Three experienced orthodontists examined all x-rays from each patient and evaluated the radiographic images of the impacted canines. The examiners were asked to detect resorption in adjacent teeth and the buccal-palatal position of the impacted canines. Agreement between examiners was statistically tested.

RESULTS

Different diagnoses were produced by the 3 examiners regarding localization of the impacted canines and the presence or absence of root resorption of the adjacent teeth in conventional radiographic images. It appears that whereas panoramic x-ray is more sensitive in detecting resorption and tooth position, occlusal and periapical imaging have higher specificity and positive predictive value. The examiners were in good or excellent agreement when occlusal and periapicals were used for the definite diagnosis of resorption and tooth position. There was no disagreement of the examiners in CBCT images, which were used as the gold standard.

CONCLUSIONS

Conventional radiographic methods demonstrated a more subjective diagnostic procedure compared with CBCT images. CBCT is a more accurate and precise examination method compared with conventional radiography for the localization of impacted teeth and root resorption of the adjacent teeth.

Retrospective Analysis of the Correlation Between the Facial Biotype and the Inclination of the Upper Canine Cusp Axis to the Occlusal Plane

Permanent maxillary canines are the second most frequently impacted teeth and the prevalence of this clinical condition is estimated to be 1-2% in the general population. The diagnosis of maxillary canine impaction should be based on both clinical and radiographic examinations. The aim of this study was to evaluate the presence of a correlation between the facial biotype and the inclination of the upper cusp axis. A correlation between the total radicular length of the lateral incisors was also evaluated, by comparing the side of impaction with the healthy side. Twenty three patients with a diagnosis of unilateral upper cusp impaction were recruited. For each patient, dental casts and radiographic material (panoramic radiographs and lateral cephalograms) were examined. Statistical analyses were done with Spearman's rank correlation coefficient or Spearman's rho (ρ). X-ray examinations demonstrated that canine impaction was associated to other dental anomalies (32% of the sample). The mean α angle measurements were 22.9° ± 4.1°, and mean values of the β angle were 34.7°± 4.0°. The mean distance "d" value was 14.6 mm ± 1.2 mm. The mean values of the angle between the upper cusp axis and the perpendicular-to-Fh plane were 20.8° ± 2.6°. Among the 23 subjects recruited, 5 showed values included in the range 25°-45° and 1 an inclination > 45°. The results obtained in the present study demonstrate a significant inverse correlation between the MM angle and the inclination of the upper cusp axis to the perpendicular-to-Fh plane.

Comparison of methods for localization of impacted maxillary canines by panoramic radiographs

OBJECTIVES

The objective of this study was to compare three methods for localization of impacted maxillary canines using only conventional panoramic radiographs.

METHODS

The panoramic radiographs of 94 patients (102 impacted maxillary canines) were reviewed and evaluated using the methods magnification, angulation and superimposition. The actual positions of them were decided with cone beam CT images. The predicted positions of impacted canines from the magnification and angulation methods were compared using the McNemar χ(2) test. Sensitivity, specificity, accuracy, positive-likelihood ratio and negative-likelihood ratio were calculated. The canine-incisor index values and α angles of palatally and bucally non-rotated impacted canines were compared using the Mann-Whitney U test.

RESULTS

The statistical analysis revealed that there was a significant difference between the magnification and angulation methods (p < 0.01). Using the magnification method, 68.00% of buccal canines and 69.57% of palatal canines could be localized correctly. The results of the angulation method were 28.57% and 84.91%, respectively. The sensitivity of the angulation method for buccal canines was very low. In the superimposition method, 82.98% of the superimposing samples were palatal.

CONCLUSIONS

The magnification and angulation methods were not reliable methods for locating the impacted canine with a single panoramic radiograph. Magnification was more successful than the angulation method. Further research is needed on the magnification method. The image superimposition method could be used as an adjunct to others.

Use of panoramic x-ray to determine position of impacted maxillary canines

PURPOSE

To evaluate the position of impacted maxillary canines in the alveolus using panoramic radiographs.

MATERIALS AND METHODS

The present study was a retrospective chart review of 102 patients with 130 impacted maxillary canines from the University of Illinois at Chicago College of Dentistry and private practice. Of the 130 impacted maxillary canines, 59 were impacted buccally and 71 were impacted palatally. The inclination of the impacted maxillary canines to a horizontal line from the mesiobuccal cusps of the maxillary molars was measured. We used these measurements to predict the position of the tooth and correlate this prediction with the actual approach used during surgery.

RESULTS

The mean angulation of the buccally impacted maxillary canines was 75.1 degrees +/- 18.2 degrees (range, 8 degrees to 111 degrees ). The mean angulation of the palatally impacted maxillary canines was 51.3 degrees +/- 15.3 degrees (range, 12 degrees to 91 degrees ). The mean difference between the angulation of the impacted maxillary canines as measured on the panoramic radiographs was statistically significant (P < .001). From a receiver-operator characteristic curve and using a logistic regression model, impactions greater than 65 degrees were 26.6 times more likely to be buccally impacted maxillary canines (P < .001).

CONCLUSIONS

Panoramic radiographs are useful for predicting the location of impacted maxillary canines and the subsequent surgical approach required for exposure and orthodontic appliance attachment when computed tomography is unavailable or unnecessary otherwise. The use of panoramic radiographs for determing impacted maxillary canine position has a high sensitivity and specificity, with angulations greater than 65 degrees associated with buccal impactions.