Dataset Information

Cone-beam computed tomography-based diagnosis and treatment simulation for a patient with a protrusive profile and a gummy smile.

ABSTRACT: For patients with bimaxillary protrusion, significant retraction and intrusion of the anterior teeth are sometimes essential to improve the facial profile. However, severe root resorption of the maxillary incisors occasionally occurs after treatment because of various factors. For instance, it has been reported that approximation or invasion of the incisive canal by the anterior tooth roots during retraction may cause apical root damage. Thus, determination of the position of the maxillary incisors is key for orthodontic diagnosis and treatment planning in such cases. Cone-beam computed tomography (CBCT) may be useful for simulating the post-treatment position of the maxillary incisors and surrounding structures in order to ensure safe teeth movement. Here, we present a case of Class II malocclusion with bimaxillary protrusion, wherein apical root damage due to treatment was minimized by pretreatment evaluation of the anatomical structures and simulation of the maxillary central incisor movement using CBCT. Considerable retraction and intrusion of the maxillary incisors, which resulted in a significant improvement in the facial profile and smile, were achieved without severe root resorption. Our findings suggest that CBCT-based diagnosis and treatment simulation may facilitate safe and dynamic orthodontic tooth movement, particularly in patients requiring maximum anterior tooth retraction.

SUBMITTER: Uesugi S

PROVIDER: S-EPMC5932321 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Cone-beam computed tomography-based diagnosis and treatment simulation for a patient with a protrusive profile and a gummy smile.

Uesugi Shunsuke S Imamura Toshihiro T Kokai Satoshi S Ono Takashi T

Korean journal of orthodontics 20180420 3

For patients with bimaxillary protrusion, significant retraction and intrusion of the anterior teeth are sometimes essential to improve the facial profile. However, severe root resorption of the maxillary incisors occasionally occurs after treatment because of various factors. For instance, it has been reported that approximation or invasion of the incisive canal by the anterior tooth roots during retraction may cause apical root damage. Thus, determination of the position of the maxillary incis ...[more]

PMID: 29732305

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Project description:PurposeAnastomosis between posterior superior alveolar artery and infraorbital artery can go through bony canal in the lateral wall of the maxilla. This artery is called alveolar antral artery. It can complicate lateral sinus lift procedure by bleeding and hemosinus formation or bone graft wash out. The artery can also go in soft tissues where is not visible on cone beam computed tomography. In previous studies, the relation of this artery to sinus floor or alveolar process was measured. These structures are highly unstable during lifetime and after tooth loss. The aim of this study is to study presence and relations of bony canal in the lateral maxillary wall, to characterize the group of patients which is more likely to have bone canal in the lateral maxilla. The aim and the novelty of this study is the describing of the relationship of the bony canal to the more stable structure of hard palate and describing the relation of presence of bony canal on width of maxillary sinus, and to facilitate the prediction of presence of the alveolar antral artery.MaterialsThe cone beam computed tomography scans of the patients (251 in number) of the university hospital were examined for presence of alveolar antral artery (148 was fulfilled inclusion criteria), patient were characterized by gender, age, and sinus type (wide, average, narrow). The diameter of the bony canal and its relation to the level of sinus floor and hard palate were measured.ResultsThe cone beam computed tomography scans of 148 patients, out of it 55 man (37,2%) and 93 women (62,8%). Bony canal containing alveolar anastomosis was found in 69 cases (57,0%). Presence of the bony canal in the lateral wall of maxillae showed statistical probability depending on age with p = 0, 064 according to Mann-Whitney test. The older patients have more likely the bony canal. The presence of the alveolar antral artery was found more likely in the wide sinuses. The hard palate level can serve as a prediction point of alveolar antral artery only in first molar and second premolar region. In accordance with previous studies the width of bony canal is significantly higher in group of man (p = 0, 015). There was found a correlation between smaller distance of bony canal from sinus floor in the presence of teeth (p = 0, 067). After tooth loss the distance between sinus floor and bony canal increases, but the distance of bony canal to hard palate level stays constant. This can be explained hypothetically so that periodontal ligaments and root surface acts as a barrier for sinus pneumatization.ConclusionLateral sinus lifting in some cases can be unenviable, the knowledge about alveolar antral artery anatomy can reduce the risk of arterial bleeding. The cone-beam computed tomography is a routine examination prior to augmentation surgery and therefore the data obtained from it has an impact on clinical practice.

Project description:ObjectivesThis study aimed to describe and compare CBCT imaging prescription in clinical practice among orthodontists from five countries in Europe and America. Additionally, it investigated factors associated with the prescribing and the use of guidelines for CBCT imaging.Materials and methodsA cross-sectional survey was carried out using an online questionnaire sent to all registered orthodontists in Belgium, Brazil, Canada, Romania, and the United States of America (USA). The data were analyzed by descriptive statistics, bivariate tests, and Poisson regression.ResultsThe final sample consisted of 1284 participants. CBCT was prescribed by 84.4% of the participants for selected cases (84.9%), mainly for impacted teeth (92.4%), presurgical planning (54.1%), and root resorption (51.9%). High cost was most frequently the limiting factor for CBCT prescription (55.4%). Only 45.2% of those who were using CBCT imaging reported adhering to guidelines. CBCT imaging prescription was associated with the orthodontists' countries (p < .009, except for Belgium, p = .068), while the use of guidelines was associated with the respondents' country and additional training on CBCT imaging (p < .001).ConclusionsOrthodontists refer patients for CBCT for selected indications (impacted teeth, root resorption, presurgical planning, dentofacial deformities, as suggested by the international guidelines, and also for upper airway and temporomandibular joint evaluation). Many do not adhere to specific guidelines. There are substantial variations between the countries about the orthodontists' referral for CBCT and guideline usage, irrespective of gender. CBCT prescription may be limited by financial barriers, adhering to specific guidelines and prior CBCT training.Clinical relevanceCBCT prescription among orthodontists must be based on prescription criteria and current guidelines. It is advised to improve CBCT education and training to enhance CBCT selection, referral, analysis, and interpretation in orthodontic practice.

Dataset Information

Cone-beam computed tomography-based diagnosis and treatment simulation for a patient with a protrusive profile and a gummy smile.

Publications

Cone-beam computed tomography-based diagnosis and treatment simulation for a patient with a protrusive profile and a gummy smile.

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