Haney E, Gansky SA, Lee JS, et al. Comparative analysis of traditional radiographs and cone-beam computed tomography volumetric images in the diagnosis and treatment planning of maxillary impacted canines
In this prospective study, we compared differences in the diagnosis and treatment planning of impacted maxillary canines between 2 imaging modalities.
Twenty-five consecutive impacted maxillary canines were identified from the pool of patients seeking orthodontic treatment. The first set of radiographs consisted of traditional 2-dimensional (2D) images including panoramic, occlusal, and 2 periapical radiographs. The second set comprised prints of 3-dimensional (3D) volumetric dentition images obtained from a cone-beam computed tomography (CBCT) scan. Seven faculty member completed a questionnaire for every impacted canine and diagnostic radiographic modality (2D and 3D).
The data show that the judges produced different decisions regarding localization depending on the x-ray method. There were 21% disagreement (or discordance) in the perceived mesiodistal cusp tip position and 16% difference in the perceived labiopalatal position. In the perception of root resorption of adjacent teeth, there was 36% lack of congruence. Twenty-seven percent of the teeth that were planned to be left, recovered, or extracted with the 2D radiographs had different treatment plans when the judges viewed the 3D CBCT images (McNemar test, chi-square, 4.45; P = 0.035). The clinicians' confidence of the accuracy of diagnosis and treatment plan was statistically higher for CBCT images (P <0.001).
These results showed that 2D and 3D images of impacted maxillary canines can produce different diagnoses and treatment plans.
Available from: Ali Alqerban
- "Previous investigations have compared treatment planning differences between use of 2D images and CBCT images. The results in two studies showed that there was a difference in treatment planning. However, it has been found that the treatment proposal for impacted canines did not differ whether based on 2D or 3D information, which is in agreement with our findings. "
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To investigate the added-value of using CBCT in the orthodontic treatment method of maxillary impacted canines and treatment outcome.
Materials and Methods:
The sample consisted of 118 treated patients. The CBCT group (n = 58) (39 females/19 males with the mean age of 14.3 years) included those with conventional treatment records consisting of panoramic and cephalometric radiographs, intra-and extra-oral photographs, and dental casts and complemented with a CBCT scan for additional diagnostic information. The conventional group (n = 60) (31 females/29 males with mean age 13.1 years) included those with similar conventional treatment records but without CBCT imaging.
There were significant differences in the canine-related variables between both groups. The CBCT group had the higher level of difficulty and more severely displaced canines when compared with the conventional group. However, no significant difference was found between groups either in the number of treatment methods used or in the use of interceptive methods combined with other treatment modalities or choice of extraction versus non-extraction. In terms of treatment success and interval duration, no significant differences were found. However, treatment duration was significantly (4 months) shorter in the CBCT group compared with the conventional group (P = 0.023).
CBCT has been used in cases with more severe symptoms of maxillary canine impaction. The use of CBCT improved the diagnostic capabilities and improved the chances of success in the more difficult cases to a level similar to that of simpler cases treated on the basis of 2D information.
Available from: Paul Serrant
- "A recent review (Rossini et al., 2012) suggested that CBCT and horizontal/vertical (HP/VP) image sets may produce different results and noted a lack of evidence regarding the diagnostic accuracy and effectiveness of CBCT in the localization of maxillary impacted teeth. Haney et al. (2010) and Botticelli et al. (2011) evaluated the potential for CBCT, HP and VP to accurately locate ectopic maxillary canines, but did not compare the location with that of the true position of the ectopic tooth (Table 1). Alqerban et al. (2011) compared the use of the magnification technique utilizing a single panoramic radiograph with two different CBCT systems . "
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ABSTRACT: Objective: To compare the accuracy of cone-beam CT (CBCT) with conventional horizontal and vertical parallax for the localization of ectopic maxillary canines. Design: Observational study. Methods: A typodont was constructed using human teeth embedded in radio-dense impression material, containing a simulated ectopic canine. Image sets (vertical/horizontal parallax and CBCT scans) were obtained for nine positions. A photograph confirmed the true position of the canine. Six observers used horizontal (HP) and vertical (VP) parallax techniques with conventional radiographs and the axial, coronal and sagittal CBCT views to locate the canine tip. Images were manipulated as required using proprietary software (http://www.carestream.com and http://www.i-cat.com). Intra-observer reproducibility was calculated by one observer re-evaluating the image sets after 2 months. Individual observer validity was calculated in relation to the photographic position of the canine using weighted Kappa. Differences in the proportion of correct locations between CBCT and vertical/horizontal parallax were tested using McNemar tests (P<0·05). Results: Intra- and inter-observer agreements were excellent (0·8985) and substantial (0·7528), respectively. Individual observer validity was substantial-excellent (0·7368-0·900). The canine position was correctly identified in 94% of cases located using CBCT, 83% using HP and 65% using VP. The differences between CBCT and vertical and horizontal parallax were highly statistically significant (P<0·01). Conclusion: CBCT is more accurate than either horizontal or vertical parallax for the localization of ectopic maxillary canine teeth.
Available from: Anne Marie Kuijpers-Jagtman
- "Only 4 studies were scored as having a low risk of bias and a low concern regarding applicability (Table 5) , , , . In their study on treatment planning, Han et al.  sequentially added documentation to the record set: first, study models were presented to 5 orthodontists; second, facial photographs were added to the set of records; third, a panoramic photograph (OPT) was added; fourth, a lateral cephalogram (LHP); and finally, a tracing was presented to the orthodontists to be used in planning an orthodontic treatment plan. "
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ABSTRACT: Traditionally, dental models, facial and intra-oral photographs and a set of two-dimensional radiographs are used for orthodontic diagnosis and treatment planning. As evidence is lacking, the discussion is ongoing which specific records are needed for the process of making an orthodontic treatment plan.
To estimate the contribution and importance of different diagnostic records for making an orthodontic diagnosis and treatment plan.
An electronic search in PubMed (1948-July 2012), EMBASE Excerpta Medica (1980-July 2012), CINAHL (1982-July 2012), Web of Science (1945-July 2012), Scopus (1996-July 2012), and Cochrane Library (1993-July 2012) was performed. Additionally, a hand search of the reference lists of included studies was performed to identify potentially eligible studies. There was no language restriction.
THE PATIENT, INTERVENTION, COMPARATOR, OUTCOME (PICO) QUESTION FORMULATED FOR THIS STUDY WAS AS FOLLOWS: for patients who need orthodontic treatment (P), will the use of record set X (I) compared with record set Y (C) change the treatment plan (O)? Only primary publications were included.
Independent extraction of data and quality assessment was performed by two observers.
Of the 1041 publications retrieved, 17 met the inclusion criteria. Of these, 4 studies were of high quality. Because of the limited number of high quality studies and the differences in study designs, patient characteristics, and reference standard or index test, a meta-analysis was not possible.
Cephalograms are not routinely needed for orthodontic treatment planning in Class II malocclusions, digital models can be used to replace plaster casts, and cone-beam computed tomography radiographs can be indicated for impacted canines. Based on the findings of this review, the minimum record set required for orthodontic diagnosis and treatment planning could not be defined.
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