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Yadav U, Shenoy N, Ahmed J, Sujir N, M A, Gupta A. Assessment of variations in the nasopalatine canal on CBCT: considerations from an anatomical point of view. J Periodontal Implant Sci 2024; 54:54.e20. [PMID: 39058352 DOI: 10.5051/jpis.2401300065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/12/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE The nasopalatine canal (NPC) is one of the most significant anatomical markers in the anterior maxillary region. Its location is quite important, especially for implant placement. Therefore, the purpose of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphology, size, and anatomic variations of the NPC. METHODS A total of 150 individual CBCT images were assessed in various sections to evaluate the dimensions, morphology, and extent of the NPC. Reformatted sagittal images were chosen to classify the shape and course of the canal. The Student's t-test, the χ² test, and Pearson correlation coefficients were used. RESULTS The NPC was longer in males than in females, and the mediolateral diameter of the canal was greater in older adults. In sagittal sections, the canal predominantly exhibits a cylindrical shape, while a spindle shape is the least common. In coronal sections, a single shape is most frequently observed, with a Y-shape being the least common. Regarding the orientation of the canal, slanted canals are more prevalent, whereas vertically curved canals are rare. Typically, 2 canal openings are observed, with 4 openings being the least common. CONCLUSION The current study highlights the challenges associated with identifying the anatomical appearance and variations of the NPC. Consequently, possessing a thorough understanding of this anatomy is essential before undertaking any surgical procedures, such as implant placement. This knowledge helps prevent complications such as nerve injury-related loss of sensation, bleeding due to blood vessel injury, and the development of a nasopalatine duct cyst following trauma to the canal during surgery.
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Affiliation(s)
- Utkarsh Yadav
- Oral Medicine and Radiology, Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Nandita Shenoy
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Affiliated to Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Junaid Ahmed
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Affiliated to Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nanditha Sujir
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Affiliated to Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Archana M
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Affiliated to Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Aarti Gupta
- Oxford Dental College, Rajiv Gandhi University, Bangalore, Karnataka, India
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Selvaraj A, Kumar Subramanian A. Cone-Beam Computed Tomography Study of Incisive Canal and Maxillary Central Incisors in Dravidian Population. Cureus 2024; 16:e63707. [PMID: 39099987 PMCID: PMC11294486 DOI: 10.7759/cureus.63707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 06/30/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION En-masse maxillary anterior retraction is necessary to attain an esthetic profile in Angle's class I bimaxillary dentoalveolar protrusion and Angle's class II division 1 malocclusion. The objective of this study was to evaluate configurational relationships between maxillary incisors and incisive canal in Angle's class I bialveolar protrusion and Angle's class II division 1 malocclusion by cone-beam computed tomography (CBCT). METHODS A total of 108 adult CBCT scans of 54-skeletal class I bialveolar protrusion and 54-skeletal class II division 1 malocclusions were retrospectively analyzed. Angles between palatal plane and axis of maxillary alveolar border (θ1), incisive canal (θ2), and maxillary right central incisor (θ3) were measured in relation to the midsagittal plane. Linear measurements such as incisive canal width (IC-IC), medial inter-root distance (Rm-Rm), posterior inter-root distance (Rp-Rp), anteroposterior distance from Rm to tangent of right central incisor (11 Rm-Cat), and left central incisor (21 Rm-Cat) corresponding to three vertical levels (L1, L2, and L3) were assessed in axial cross-sectional plane. Association among angular measurements was examined by Spearman correlation coefficient analysis. Mann-Whitney U test compared variables of linear measurements at three vertical levels. RESULTS Estimated distance from incisor root to incisive canal was 5-6 mm in both groups slightly influenced by skeletal class and vertical levels but not gender. Mann-Whitney test demonstrated significant differences between groups at three vertical levels (p<0.05). Only θ2 revealed a significant difference (p<0.05) between malocclusions compared to θ1 and θ3. The angular measurements for both malocclusions were positively correlated (p<0.05). CONCLUSION Sagittal root-canal cortical plate distance varied significantly in both malocclusions (5-6 mm). Inter-root distance (Rp-Rp) was greater than incisive canal width (IC-IC) at all three vertical levels indicating a reduced possibility of canal invasion after maximum retraction at posterior levels.
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Affiliation(s)
- Abirami Selvaraj
- Orthodontics and Dentofacial Orthopedics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Aravind Kumar Subramanian
- Orthodontics and Dentofacial Orthopedics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Çınarsoy Ciğerim S, Sezen Erhamza T. Cone-Beam Computerized Tomography Evaluation of the Relationship between Orthodontic Vertical Direction Parameters and the Distance from the Apex of the Upper Central Tooth to the Nasal Floor and Anterior Nasal Spine. Tomography 2024; 10:37-46. [PMID: 38250950 PMCID: PMC10818777 DOI: 10.3390/tomography10010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements (p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements (p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans.
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Affiliation(s)
- Saadet Çınarsoy Ciğerim
- Department of Orthodontics, Faculty of Dentistry, Van Yuzuncu Yil University, 65090 Van, Turkey
| | - Türkan Sezen Erhamza
- Department of Orthodontics, Faculty of Dentistry, Kirikkale University, 71450 Kırıkkale, Turkey;
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Chatzipetros E, Tsiklakis K, Donta C, Damaskos S, Angelopoulos C. Morphological Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography: A Retrospective Study of 124 Consecutive Patients. Diagnostics (Basel) 2023; 13:diagnostics13101787. [PMID: 37238271 DOI: 10.3390/diagnostics13101787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to assess and analyze the morphology and dimensions of the nasopalatine canal (NPC), as well as the adjacent buccal osseous plate (BOP), and to investigate the effect of gender, edentulism, NPC types, absence of maxillary central incisors (ACI) and age on the NPC and BOP, using cone beam computed tomography (CBCT). A total of 124 CBCT examinations (67 female and 57 male patients) were retrospectively included and evaluated. The assessment of the dimensions of the NPC, as well as the dimensions of the adjacent BOP, was performed by three Oral and Maxillofacial Radiologists on reconstructed sagittal and coronal CBCT sections under standardized conditions. Regarding the dimensions of the NPC and the adjacent BOP, the mean values were significantly higher among males than females. Furthermore, edentulous patients showed a significant reduction in BOP dimensions. Additionally, NPC types showed a significant effect on the length of the NPC, and the ACI had a significant effect on reducing BOP dimensions. Age had a significant effect on the diameter of the incisive foramen, with the mean values generally increasing with an increasing age. CBCT imaging of this anatomical structure contributes significantly to its full assessment.
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Affiliation(s)
- Emmanouil Chatzipetros
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., Goudi, 115 27 Athens, Greece
| | - Kostas Tsiklakis
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., Goudi, 115 27 Athens, Greece
| | - Catherine Donta
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., Goudi, 115 27 Athens, Greece
| | - Spyros Damaskos
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., Goudi, 115 27 Athens, Greece
| | - Christos Angelopoulos
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., Goudi, 115 27 Athens, Greece
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Kuc AE, Kotuła J, Nawrocki J, Babczyńska A, Lis J, Kawala B, Sarul M. The Assessment of the Rank of Torque Control during Incisor Retraction and Its Impact on the Resorption of Maxillary Central Incisor Roots According to Incisive Canal Anatomy-Systematic Review. J Clin Med 2023; 12:jcm12082774. [PMID: 37109117 PMCID: PMC10144814 DOI: 10.3390/jcm12082774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Root resorption is one of the complications of orthodontic treatment, and has a varied and unclear aetiology. OBJECTIVE To evaluate the relationship between upper incisor resorption and contact with the incisive canal and the risk of resorption during orthodontic treatment associated with upper incisor retraction and torque control. SEARCH METHODS According to PRISMA guidelines, the main research question was defined in PICO. Scientific databases MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for linking keywords: Resorption of roots incisive canal, Resorption of roots nasopalatine canal, Incisive canal retraction and Nasopalatine canal retraction. SELECTION CRITERIA No time filters were applied due to the significantly limited number of studies. Publications in the English language were selected. Based on the information provided in the abstracts, articles were selected according to the following criteria: controlled clinical prospective trials and case reports. No randomised clinical trials (RCTs) or controlled clinical prospective trials (CCTs) were found. Articles unrelated to the topic of the planned study were excluded. The literature was reviewed, and the following journals were searched: American Journal of Orthodontics and Dentofacial Orthopedics, International Orthodontics, Journal of Clinical Orthodontics, Angle Orthodontist, Progress in Orthodontics, Orthodontics and Craniofacial Research, Journal of Orofacial Orthopedics, European Journal of Orthodontics and Korean Journal of Orthodontics. DATA COLLECTION AND ANALYSIS The articles were subjected to risk of bias and quality assessment using the ROBINS-I tool. RESULTS Four articles with a total of 164 participants were selected. In all studies, differences in root length were observed after contact with the incisive canal, which was statistically significant. CONCLUSIONS AND IMPLICATIONS The contact of incisor roots with the incisive canal increases the risk of resorption of these roots. IC anatomy should be considered in orthodontic diagnosis using 3D imaging. The risk of resorption complications can be reduced by appropriate planning of the movement and extent of the incisor roots (torque control) and the possible use of incisor brackets with built-in greater angulation. Registration CRD42022354125.
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Affiliation(s)
- Anna Ewa Kuc
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Jacek Kotuła
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Jakub Nawrocki
- Dental Star Specialist Aesthetic Dentistry Center, 15-215 Białystok, Poland
| | - Alicja Babczyńska
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Joanna Lis
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Beata Kawala
- Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Michał Sarul
- Department of Integrated Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland
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Magat G, Akyuz M. Are morphological and morphometric characteristics of maxillary anterior region and nasopalatine canal related to each other? Oral Radiol 2023; 39:372-385. [PMID: 35941313 DOI: 10.1007/s11282-022-00647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The main purpose of this article was to clarify the relationship of anterior bone and tooth morphology with NPC. The anatomical features of the NPC region in three dimensions from coronal, axial, and sagittal directions were analyzed using CBCT and the effects of age, gender, sagittal root positions (SRPs) of central teeth, anterior overbite depth (AOD), central incisor (CI)/palatal plane (PP) angle, NPC/PP angle, and collum angles (CA) on NPC were evaluated in a group of the Turkish population. MATERIALS AND METHODS In this retrospective study, CBCTs of a total of 330 individuals between the ages of 17 and 82 were evaluated. The effects of SRP, AOD, CI/PP angle, NPC/PP angle and CA on the anatomical features of NPC were examined on the basis of age and gender. Descriptive statistics, Kolmogorov-Smirnov, Chi-square, Wilcoxon, Mann-Whitney-U, Kruskal-Wallis, and Spearman correlation tests were used. p values of < 0.05 were accepted as statistically significant. RESULTS While the SRPs, CI/PP angle, NPC/PP angle, CA, and age did not differ statistically according to NPC shape (p > 0.05), NPC shape varied according to gender and AOD (p < 0.05). It was found that cylindrical NPC (32.8%) was more common in females, while conical-shaped NPC (30.7%) was more common in males (p < 0.01). While most conical NPC was detected in individuals with Class I overbite depth, cylindrical NPCs were found in Class II and III individuals (p < 0.01). CONCLUSIONS The results showed that gender and AOD are influential factors on NPC shape. While conical-shaped NPC is more common in individuals with bite depth incisal, cylindrical-shaped NPC is more likely to be seen in individuals with middle and cervical thirds.
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Affiliation(s)
- Guldane Magat
- Department of Oral and Maxillofacial Radiology, Dentistry Faculty, Necmettin Erbakan University, Konya, Turkey.
| | - Mehmet Akyuz
- Department of Oral and Maxillofacial Radiology, Dentistry Faculty, Necmettin Erbakan University, Konya, Turkey
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Ongprakobkul N, Ishida Y, Petdachai S, Ishizaki A, Shimizu C, Techalertpaisarn P, Ono T. Morphometric and volumetric analysis of the proximity between the incisive canal and maxillary central incisors during anterior retraction: a retrospective cone-beam computed tomography study. Angle Orthod 2022; 93:488615. [PMID: 36440986 PMCID: PMC9933555 DOI: 10.2319/060222-406.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To elucidate the relationships and factors affecting the proximity between the incisive canal (IC) and maxillary central incisors and to predict the probable outcomes after anterior tooth retraction using cone beam computed tomography (CBCT). MATERIALS AND METHODS Retrospective CBCT data taken before and after maxillary anterior retraction in 36 patients were used in this study. The incisive canal length (ICL), maxillary central incisor length (TL), angles between the palatal plane and axes of the maxillary alveolar border (θ1), IC (θ2), and maxillary central incisor (θ3), retraction distance (TDE), distance from the maxillary central incisors to the IC (D), cross-sectional area of the IC (CSA), and volume of the IC were evaluated. Comparison of the parameters between contact and noncontact groups were examined. Logistic regression was performed to analyze the probable outcome prediction. RESULTS All parameters significantly decreased after anterior retraction, except for the ICL. Eighteen roots in 12 patients contacted the IC. The θ1, θ2, θ3, and D values at all levels were significantly lower, whereas the TDE, midlevel and oral opening CSA, and volume were significantly higher in the contact group compared with the noncontact group. The larger the pretreatment θ1 and θ3 were, the higher was the chance of incisors not contacting the IC. CONCLUSIONS Maxillary central incisors not contacting the IC after anterior retraction was positively associated with larger degrees of pretreatment maxillary alveolar bone angle and maxillary central incisor angle.
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Al-Rokhami RK, Sakran KA, Alhammadi MS, Al-Tayar B, Al-Gumaei WS, Al-Yafrusee ES, Al-Shoaibi LH, Cao B. Tridimensional Analysis of Incisive Canal and Upper Central Incisor Approximation. Int Dent J 2022; 73:410-416. [PMID: 36153169 DOI: 10.1016/j.identj.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/27/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The present study aimed to estimate the location of the incisive canal (IC) concerning the upper central incisor roots (U1) in order to explore the amount of incisor retraction as per the envelope of discrepancy amongst Chinese patients with different vertical facial growth patterns. METHODS This is a cross-sectional study that used a total of 207 pretreatment cone-beam computed tomography (CBCT) scans of adults with a skeletal class I relationship. Sixty-nine cases were included in each of the normodivergent, hypodivergent, and hyperdivergent facial groups. The IC volume was measured using Mimics 21 software. The IC width and IC-U1 proximity were measured using in vivo 6 software. Linear measurements were conducted at 3 vertical levels. RESULTS The IC has shown a larger volume in the hyperdivergent group and male patients. Overall, the IC has recorded linear width greater than the inter-root distance of U1 in 59.1%, 66%, and 68.8% amongst the normodivergent, hypodivergent, and hyperdivergent facial groups, respectively, and in 58.3% of males and 70.8% of females. The overall sagittal distances between the U1 and IC were 4.00 ± 0.82 mm, 4.60 ± 0.83 mm, and 3.60 ± 0.80 mm amongst the normodivergent, hypodivergent, and hyperdivergent facial groups, respectively. CONCLUSIONS The maximum sagittal distances between U1 and IC were 4.8 mm, 5.4 mm, and 4.4 mm amongst the normodivergent, hypodivergent, and hyperdivergent facial groups, respectively. Thereby, our findings have revised the retraction aspect of the envelope of discrepancy as per the different vertical facial growth patterns, which could serve a reference for the clinical practice involved considerable incisors movement, especially among Chinese patients.
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Affiliation(s)
- Remsh K Al-Rokhami
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, Gansu, China
| | - Karim A Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Maged S Alhammadi
- Division of Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Barakat Al-Tayar
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, Gansu, China
| | - Waseem S Al-Gumaei
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, Gansu, China
| | - Enas S Al-Yafrusee
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, Gansu, China
| | - Lina H Al-Shoaibi
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, Gansu, China
| | - Baocheng Cao
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, Gansu, China.
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Al-Rokhami RK, Sakran KA, Alhammadi MS, Mashrah MA, Cao B, Alsomairi MAA, Al-Worafi NA. Proximity of upper central incisors to incisive canal among subjects with maxillary dentoalveolar protrusion in various facial growth patterns. Angle Orthod 2022; 92:529-536. [PMID: 35130336 DOI: 10.2319/080721-620.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the position of the upper central incisor roots (U1) relative to the incisive canal (IC) among subjects with maxillary dentoalveolar protrusion in various facial growth patterns. MATERIALS AND METHODS 240 cone beam computed tomography images of skeletal Class I and II maxillary or bimaxillary protrusive subjects with a mean age of 23.74 ± 3.73 years were enrolled according to their facial growth pattern. The IC volume was measured using Mimics 21 software (Materialise, Leuven, Belgium). The U1 inter-root distance, width of IC, and their proximity were estimated using Invivo6 software (Anatomage, San Jose, CA). RESULTS The IC volume was slightly greater among the high angle facial group and female patients than the other groups. Overall, the IC width was greater than the U1 inter-root distance in 55.65%, 57.6%, and 65% among the average, low, and high angle facial groups, respectively, and in 56.5% and 62.9% of males and females, respectively. The overall anteroposterior (sagittal) distances between the U1 roots and IC were 4.36 ± 1.18, 4.78 ± 1.17, and 3.83 ± 0.90 mm among the average, low, and high angle facial groups, respectively. CONCLUSIONS The high angle facial group and female patients showed slightly greater IC dimensions than the other groups. The overall maximum sagittal distances between the U1 and IC were around 5.5, 6, and 4.7 mm among the average, low, and high angle facial groups, respectively. The low angle facial group and male patients tended to have greater sagittal distances. Therefore, the present findings could serve as a guideline when a considerable amount of upper incisor retraction is planned for Class I or II maxillary or bimaxillary dentoalveolar protrusion patients.
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The Role of Morphometric Characteristics of Anterior Maxilla in Planning the Interventions Accompanied by Orthodontic Teeth Movement – An Overview. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The anterior maxilla or premaxilla is part of the upper jaw and the most significant content of this region, from the aspect of orthodontic therapy, are the incisor teeth. The frequency of complications during orthodontic movement of the upper incisors refers to a more detailed evaluation of the anatomical structures of the premaxilla. The aim of this study was to investigate morphological and morphometric characteristics of the anterior maxilla by cone beam computed tomography, which could be of interest for planning orthodontic teeth movement. By reviewing the available literature, we compared the values of the alveolar bone height, the distance between the alveolar crest and enamel – cement boundary, total alveolar bone width, the thickness of the buccal, and palatal plate, nasopalatine canal, and accessory canals of the anterior maxilla. The results of our study show changes in the labial and palatal aspects of the alveolar bone height during orthodontic interventions. Different results of the alveolar bone width are in correlation with gender, age, and type of orthodontic tooth movement. Distance between the nasopalatine canal and maxillary central incisors was estimated at the value from 4 to 6 mm, which is below the recommended value for maximum incisal retraction by Proffit. Research results show variations in shape, length, and diameter of the nasopalatine canal, which indicates individual varieties detected on cone beam computed tomography. Other anatomical structures and measures show an insignificant correlation with orthodontic teeth movement. According to the contradictory results of the available articles, it is required to achieve an individual approach to orthodontic interventions in the area of the anterior maxilla.
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Arnaut A, Milanovic P, Vasiljevic M, Jovicic N, Vojinovic R, Selakovic D, Rosic G. The Shape of Nasopalatine Canal as a Determining Factor in Therapeutic Approach for Orthodontic Teeth Movement-A CBCT Study. Diagnostics (Basel) 2021; 11:diagnostics11122345. [PMID: 34943581 PMCID: PMC8700672 DOI: 10.3390/diagnostics11122345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 01/18/2023] Open
Abstract
The aim of this study was to evaluate the impact of the nasopalatine canal (NPC) shape and its morphometric characteristics on expected teeth movement by assessing the distance to maxillary central incisors (MCIs) according to NPC type. The retrospective study was performed on 133 CBCT images. The following parameters were obtained: the antero-posterior diameter (A-P) of the nasal foramen (NF), canal length, A-P and mediolateral diameter (M-L) of the incisive foramen (IF), and the distance between NPC and MCIs. With the exception of being hourglass-shaped, each NPC shape showed specific impacts of NPC shape on the relationship between NPC diameters at different sections and distances to MCIs. In banana-shaped NPC, a significant correlation was observed for A-P NF diameter, while in cylindrical-shaped NPC, a significant correlation was observed for NPC length. The increase in M-L IF, A-P IF, A-P NF, and NPC length in funnel-shaped NPC may be a risk factor for interventions that could result in teeth movement. According to the results, it seems that the proposed methodological approach for analysis of CBCT slices in the anterior maxilla may offer detailed information that could be an additional tool in planning the procedures that result in expected teeth movement.
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Affiliation(s)
- Aleksandra Arnaut
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (A.A.); (P.M.); (M.V.)
| | - Pavle Milanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (A.A.); (P.M.); (M.V.)
| | - Milica Vasiljevic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (A.A.); (P.M.); (M.V.)
| | - Nemanja Jovicic
- Department of Histology and Embryology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Radisa Vojinovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Dragica Selakovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Correspondence: (D.S.); (G.R.)
| | - Gvozden Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Correspondence: (D.S.); (G.R.)
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Arnaut A, Milanovic P, Vasiljevic M, Jovicic N, Vojinovic R, Selakovic D, Rosic G. The Shape of Nasopalatine Canal as a Determining Factor in Therapeutic Approach for Orthodontic Teeth Movement—A CBCT Study. Diagnostics (Basel) 2021. [DOI: https://doi.org/10.3390/diagnostics11122345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the impact of the nasopalatine canal (NPC) shape and its morphometric characteristics on expected teeth movement by assessing the distance to maxillary central incisors (MCIs) according to NPC type. The retrospective study was performed on 133 CBCT images. The following parameters were obtained: the antero-posterior diameter (A-P) of the nasal foramen (NF), canal length, A-P and mediolateral diameter (M-L) of the incisive foramen (IF), and the distance between NPC and MCIs. With the exception of being hourglass-shaped, each NPC shape showed specific impacts of NPC shape on the relationship between NPC diameters at different sections and distances to MCIs. In banana-shaped NPC, a significant correlation was observed for A-P NF diameter, while in cylindrical-shaped NPC, a significant correlation was observed for NPC length. The increase in M-L IF, A-P IF, A-P NF, and NPC length in funnel-shaped NPC may be a risk factor for interventions that could result in teeth movement. According to the results, it seems that the proposed methodological approach for analysis of CBCT slices in the anterior maxilla may offer detailed information that could be an additional tool in planning the procedures that result in expected teeth movement.
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Morphologic changes of the incisive canal and its proximity to maxillary incisor roots after anterior tooth movement. Am J Orthod Dentofacial Orthop 2021; 161:396-403.e1. [PMID: 34654602 DOI: 10.1016/j.ajodo.2020.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 08/01/2020] [Accepted: 08/01/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The objectives were to evaluate the morphologic changes of the incisive canal (IC) and the influence of IC proximity to apical root resorption of maxillary central incisors after anterior tooth movement. METHODS Pretreatment and posttreatment cone-beam computed tomography images of adults (aged 18-47 years) were retrospectively evaluated. Subjects were divided into control group with minimal incisor movement (n = 32; maxillary incisor tip movement <2 mm) and maximum retraction group (n = 35; maxillary incisor tip movement >4 mm). The shape, direction, morphologic changes of the IC, the proximity of the central incisor root to IC, and the amount of apical root resorption associated with the proximity after orthodontic treatment were compared. RESULTS Changes in the shape of the IC were not observed in both control and retraction groups. However, 11.4% (4 of 35 subjects) in the retraction group indicated changes in the direction of the IC from slanted-straight to slanted-curved type after the direction of anterior retraction. The thickness of the cortical bone surrounding the IC and the distance between the incisor root and IC significantly decreased after orthodontic treatment in both groups (P <0.05). However, these changes were significantly greater in the retraction group than in control (P <0.0001). Contact or invasion of the incisor root to the IC was more prominent in the retraction group (42.8%-54.3%) than the control (10.9%-12.5%) (P <0.0001). The amount of root resorption indicated a tendency to increase in the order of separation, approximation, contact, and invasion in relation to IC. CONCLUSIONS Although remodeling of IC was evident in some patients, contact or invasion of the maxillary central incisor roots to IC was fairly high after maximum anterior retraction.
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Costa ED, de Oliveira Reis L, Gaêta-Araujo H, Martins LAC, Oliveira-Santos C, Freitas DQ. Comparison of distance of upper central incisor root and incisive canal in different sagittal and vertical skeletal patterns and sex: A retrospective CBCT study. Int Orthod 2021; 19:462-470. [PMID: 34312102 DOI: 10.1016/j.ortho.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION To evaluate the influence of sagittal and vertical skeletal patterns (skeletal classes and facial profiles), and sex on the distance between upper central incisors roots and incisive canal. MATERIAL AND METHODS Cone-beam computed tomography exams of 172 patients were classified into skeletal classes I, II, and III and according to the facial profile into mesofacial, brachyfacial, and dolichofacial. In sagittal reconstructions, linear measurements were done between central incisors roots and incisive canal at three levels: incisive foramen opening, intermediate region, and the region close to the apex of upper central incisors. In axial reconstructions, measurements of incisive canal width and distance between the roots were obtained. Analysis of Variance (three-way ANOVA) was used to evaluate measurement differences in relation to skeletal classes, facial profiles, and sex. RESULTS The distance between upper central incisors roots and incisive canal anterior region was little influenced by sagittal and vertical skeletal patterns and sex. Men had significantly greater incisive canal (mean=2.85mm; SD=1.18) width compared to women (mean=2.40mm; SD=1.04), regardless of skeletal class and facial profile (P<0.05). In general, inter-root distance between medial points of central incisors roots and incisive canal opening was greater in the region close to upper central incisors apex (mean=3.84mm; SD=1.44) than in incisive foramen opening (2.44mm; SD=1.04), (P<0.05). CONCLUSIONS The distance between upper central incisors roots and incisive canal is little influenced by sagittal and vertical skeletal patterns and sex.
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Affiliation(s)
- Eliana Dantas Costa
- University of Campinas, Piracicaba Dental School, Division of Oral Radiology, Department of Oral Diagnosis, Avenue Limeira 901, Areião, 13414-018 Piracicaba, Brazil.
| | - Larissa de Oliveira Reis
- University of Campinas, Piracicaba Dental School, Division of Oral Radiology, Department of Oral Diagnosis, Avenue Limeira 901, Areião, 13414-018 Piracicaba, Brazil
| | - Hugo Gaêta-Araujo
- University of Campinas, Piracicaba Dental School, Division of Oral Radiology, Department of Oral Diagnosis, Avenue Limeira 901, Areião, 13414-018 Piracicaba, Brazil
| | - Luciano Augusto Cano Martins
- University of Campinas, Piracicaba Dental School, Division of Oral Radiology, Department of Oral Diagnosis, Avenue Limeira 901, Areião, 13414-018 Piracicaba, Brazil
| | - Christiano Oliveira-Santos
- University of São Paulo, Ribeirão Preto, Public Health and Forensic Dentistry, Department of Stomatology, Division of Oral Radiology, School of Dentistry of Ribeirão Preto, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- University of Campinas, Piracicaba Dental School, Division of Oral Radiology, Department of Oral Diagnosis, Avenue Limeira 901, Areião, 13414-018 Piracicaba, Brazil
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Chung CJ, Nguyen T, Lee JH, Kim KH. Incisive canal remodelling following maximum anterior retraction reduces apical root resorption. Orthod Craniofac Res 2020; 24 Suppl 1:59-65. [PMID: 33369873 DOI: 10.1111/ocr.12464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The objectives were to visualize the incisive canal (IC) remodelling following maximum incisor retraction and to evaluate its impact on canal-invasion-associated apical root resorption. METHODS Pre- and post-treatment CBCT images of 34 adult orthodontic patients (age 18-47 years) with a large amount of maxillary incisor retraction (>4 mm) using temporary anchorage devices (TADs) were retrospectively evaluated. Maxillary regional superimpositions and 3D models of the IC along with central incisors were used to measure the changes in IC dimension, IC invasion by the roots and IC remodelling. In addition, the association of the amount of apical root resorption with the root-IC relationship and IC remodelling were evaluated. RESULTS IC invasion by the incisor roots following maximum retraction was seen in 53% (18 out of 34) of the cases. IC with larger volume and area showed more invasions compared with those with smaller volume and area (P < .01). The amount of root resorption was significantly higher with IC invasion than without invasion (2.39 mm vs 0.82 mm, P < .0001). IC remodelling following maximum retraction was seen in 24% of the subjects. IC remodelling group demonstrated less apical root resorption than the non-remodelling group (0.98 mm vs 3.27 mm, P < .0001). CONCLUSION IC with larger volume and surface area before treatment were more likely to show canal invasion by the incisor roots after maximum retraction. IC invasion resulted in apical root resorption. However, approximately one-fourth of cases showed remodelling of the IC, which reduced the amount of root resorption.
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Affiliation(s)
- Chooryung J Chung
- Department of Orthodontics, Gangnam Severance Hospital, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Tung Nguyen
- Department of Orthodontics, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA
| | - Jee-Hyun Lee
- Department of Orthodontics, Gangnam Severance Hospital, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Gangnam Severance Hospital, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
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Imamura T, Uesugi S, Ono T. Unilateral maxillary central incisor root resorption after orthodontic treatment for Angle Class II, division 1 malocclusion with significant maxillary midline deviation: A possible correlation with root proximity to the incisive canal. Korean J Orthod 2020; 50:216-226. [PMID: 32475849 PMCID: PMC7270934 DOI: 10.4041/kjod.2020.50.3.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
Root resorption can be caused by several factors, including contact with the cortical bone. Here we report a case involving a 21-year-old female with Angle Class II, division 1 malocclusion who exhibited significant root resorption in the maxillary right central incisor after orthodontic treatment. The patient presented with significant left-sided deviation of the maxillary incisors due to lingual dislocation of the left lateral incisor and a Class II molar relationship. Cephalometric analysis demonstrated a Class I skeletal relationship (A point-nasion-B point, 2.5°) and proclined maxillary anterior teeth (upper incisor to sella-nasion plane angle, 113.4°). The primary treatment objectives were the achievement of stable occlusion with midline agreement between the maxillary and mandibular dentitions and appropriate maxillary anterior tooth axes and molar relationship. A panoramic radiograph obtained after active treatment showed significant root resorption in the maxillary right central incisor; therefore, we performed cone-beam computed tomography, which confirmed root resorption along the cortical bone around the incisive canal. The findings from this case, where different degrees of root resorption were observed despite comparable degrees of orthodontic movement in the bilateral maxillary central incisors, suggest that the incisive canal could be an inducing factor for root resorption. However, further investigation is necessary to confirm this assumption.
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Affiliation(s)
- Toshihiro Imamura
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Uesugi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Morphological Evaluation of the Nasopalatine Canal in Patients With Different Facial Profiles and Ages. J Oral Maxillofac Surg 2019; 77:721-729. [DOI: 10.1016/j.joms.2018.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
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Pan Y, Chen S. Contact of the incisive canal and upper central incisors causing root resorption after retraction with orthodontic mini-implants: A CBCT study. Angle Orthod 2018; 89:200-205. [PMID: 30484326 DOI: 10.2319/042318-311.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To explore risk factors for contact between the incisive canal (IC) and upper central incisors (U1) and to evaluate the relationship between contact and root resorption using cone-beam computer tomography (CBCT). MATERIALS AND METHODS This retrospective study used CBCT data of 33 patients treated by a senior orthodontist. Anterior teeth were retracted with mini-implants, and CBCT scans were taken before and after retraction. IC height and width, U1 lingual movement, and U1-IC distance and root length decrease were compared between contact and noncontact groups. RESULTS Sixteen U1 roots in 11 patients touched the IC. The contact group had lower positioned ICs (2.86 ± 1.10 mm) than the noncontact group (4.07 ± 1.72 mm). The middle of the U1 roots showed more lingual movement to ICs in the contact group (2.30 ± 1.20 mm) than in the noncontact group (1.07 ± 1.16 mm). Right central incisors were closer to the IC than were the left. Root length decreased significantly more in the contact group (2.63 ± 0.93 mm) than in the noncontact group (1.14 ± 0.83 mm). CONCLUSIONS There is a risk for the U1 root to contact the IC during anterior retraction when the IC is lower positioned. This contact might cause external apical root resorption.
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Lake S, Iwanaga J, Kikuta S, Oskouian RJ, Loukas M, Tubbs RS. The Incisive Canal: A Comprehensive Review. Cureus 2018; 10:e3069. [PMID: 30280065 PMCID: PMC6166911 DOI: 10.7759/cureus.3069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The incisive canal, also known as the nasopalatine canal, is an interosseous conduit through the anterior maxilla connecting the oral and nasal cavities. Within this canal lies the nasopalatine nerve and the vascular anastomosis between the greater palatine and sphenopalatine arteries. The embryology of the canal has led to interesting theories explaining its function. Efforts have been made to describe the morphometrics of the incisive canal by radiologic evaluation across sex and ethnicities. This paper aims to review the current literature on the embryology, anatomy, and clinical relevance of the incisive canal.
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Affiliation(s)
- Sasha Lake
- Anatomical Studies, St. George's, St. George, GRD
| | - Joe Iwanaga
- Medical Education and Simulation, Seattle Science Foundation, Seattle, WA, USA
| | | | - Rod J Oskouian
- Neurosurgery, Swedish Neuroscience Institute, Seattle, USA
| | - Marios Loukas
- Anatomical Sciences, St. George's University, St. George's, GRD
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, WA, USA
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Matsumura T, Ishida Y, Kawabe A, Ono T. Quantitative analysis of the relationship between maxillary incisors and the incisive canal by cone-beam computed tomography in an adult Japanese population. Prog Orthod 2017; 18:24. [PMID: 28762152 PMCID: PMC5554776 DOI: 10.1186/s40510-017-0181-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023] Open
Abstract
Background In setting goals for orthodontic treatment, determining the morphologies of the alveolar bone and maxillary incisor root is important for avoiding root resorption, dehiscence, and fenestration. This study aimed to analyze the configurational relationships among maxillary incisors, the alveolar border, and the incisive canal by cone-beam computed tomography (CBCT). Methods Cone-beam CT images of 93 orthodontic patients were evaluated for length of the incisive canal (L); angles between the palatal plane and the maxillary alveolar border (θ1), the incisive canal (θ2), and maxillary incisor (θ3); distance from the left maxillary incisor to the incisive canal (D); and cross-sectional areas of the incisive canal (CSAs) at three vertical levels. Comparison of variables between male and female patients was performed with the two-sample t test. Correlations between parameters were examined by Pearson’s correlation analysis and Bonferroni correction for multiple comparisons. Results Male patients exhibited significantly greater values of L than female patients. There were significant positive correlations between θ1 and θ2, θ2 and θ3, and θ3 and θ1. While the value of D was the lowest at the oral opening, that of the cross-sectional area of the incisive canal (CSA) was the greatest at the incisal root apex. Conclusions This study demonstrated that the incisive canal had large inter-individual variability, and the proximity between the incisive canal and the incisal root could not be precisely predicted by the conventional cephalograms. Therefore, pre-treatment CBCT examination should be recommended when a large amount of maxillary anterior retraction and/or intrusion is planned in orthodontic diagnosis.
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Affiliation(s)
- Tomonari Matsumura
- Orthodontic Science, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yuji Ishida
- Orthodontic Science, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Ayako Kawabe
- Orthodontic Science, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Takashi Ono
- Orthodontic Science, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Authors' response. Am J Orthod Dentofacial Orthop 2016; 149:10-1. [PMID: 26718370 DOI: 10.1016/j.ajodo.2015.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022]
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