UTILIZATION OF CEPHALOMETRIC 2D AND 3D ANALYSIS DURING DIAGNOSIS, TREATMENT PLAN AND CASE MONITORING OF IMPACTED TEETH-CASE REPORT

Daniela Srbinoska; Vesna Trpevska; Elizabeta Cadikovska

Daniela Srbinoska Department of Orthodontics, University Dental Clinical Centre St. Panteleimon, Skopje, Republic of North Macedonia,
Vesna Trpevska Department of Orthodontics, University Dental Clinical Centre St. Panteleimon, Skopje, Republic of North Macedonia,
Elizabeta Cadikovska Institute of anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia.

Abstract

RTG projections are essential for diagnosis, treatment plan, follow up and treatment outcomes. Three-dimensional(3D) cephalometry, which is done using a cone beam computerized tomography (CBCT) exam, allows more detailed evaluation of the craniofacial hard and soft tissue structure than 2D radiograph. The justification for using 3D analyses in diagnostic and treatment planning in orthodontics are more than necessary in cases with impacted teeth, cleft lip, skeletal discrepancies requiring surgical interventions. CBCT has come into wider usage in other situations as root resorption, temporomandibular joint (TMJ) morphology and pathology, supernumerary teeth, alveolar boundary conditions and asymmetries; maxillary transverse dimensions and maxillary expansion; vertical malocclusion and obstructive sleep apnoea. The present descriptive study aims to explore possible applications of 3D technologies during the diagnosis, treatment plan, case monitoring and result assessment in orthodontics including their advantages and disadvantages. Utilisation of 3D technique was more than necessary in diagnostic and treatment planning in this case because of presence of more than one impacted tooth. The fixed appliances, the surgical exposure, cortectomy and orthodontic traction were done. The tooth movement and positioning to the dental arch started six months ago. The impacted tooth is already seen and the treatment continues. The severity of this case is indication for utilization of control 2D and 3D radiographs in manner following the positioning of the central incisor on the appropriate place. 3D technique is less prone to error and can improve the clinicians’ workflow.

Keywords: Diagnosis, Treatment plan, 2D radiograph, CBCT, Cortectomy.

References

1.Broadbent BH. A new x-ray technique and its application to orthodontia. Angle Orthod 1931; 51:93–114.
2. Adams GL, Gansky SA, Miller A, Harrell WE, Hatcher DC. Comparison between traditional 2-dimensional cephalometry and a 3-dimensional approach on human dry skulls. Am J Orthod Dentofacial Orthop 2004; 126:397–409.
3. American Dental Association Council on Scientific Affairs (2006). The use of dental radiographs: update and recommendations. Journal of the American Dental Association (1939), 137(9), 1304–1312. https://doi.org/10.14219/jada.archive.2006.0393.
4. European Commission. Item 4.2. The developing dentition in protection radiation No. 172. Cone beam CT dental maxillofacial radiology (evidence-based guidelines). 2011.
5. Janssens A, Horner K, Rushton V, Walker A, Tsikakis K, Hirschman PN, et al. Radiation protection: European guidelines on radiation protection in dental radiology. The safe use radiographs dental practice. 2004.
6. SEDENTEXCT. Chapter 4. Justification and referral criteria. The developing dentition. Radiation protection: cone beam CT for dental and maxillofacial radiology (evidence-based guidelines). 2011.
7. Kapila S. Contemporary concepts on cone-beam computed tomography in orthodontics. In: Kapila S, ed. Cone beam computed tomography in orthodontics: indications, insights and innovations. Hoboken, NJ: Wiley-Blackwell; 2014. pp. 5–42.
8. Pittayapat P, Limchaichana-Bolstad N, Willems G, Jacobs R. Three-dimensional cephalometric analysis in orthodontics: a systematic review. Orthod Craniofacial Res 2014; 17: 69–91. doi: 10.1111/ocr.12034.
9. Rischen RJ, Breuning KH, Bronkhorst EM, Kuijpers-Jagtman AM. Records needed for orthodontic diagnosis and treatment planning: a systematic review. PLOS One 2013; 8: e74186. doi: 10.1371/journal.pone.0074186.
10. Moshiri M, Scarfe WC, Hilgers ML, Scheetz JP, Silveira AM, Farman AG. Accuracy of linear measurements from imaging plate and lateral cephalometric images derived from cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2007; 132: 550–60.
11. Jung YJ, Kim MJ, Baek SH. Hard and soft tissue changes after correction of mandibular prognathism and facial asymmetry by mandibular setback surgery: three-dimensional analysis using computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 763–71. e8.
12. Kim YI, Jung YH, Cho BH, Kim JR, Kim SS, Son WS, et al. The assessment of the short- and long-term changes in the condylar position following sagittal split ramus osteotomy (SSRO) with rigid fixation. J Oral Rehabil 2010; 37: 262–70. doi: 10.1111/j.1365-2842.2009. 02056. X.
13. Hajati A-K, Cevidanes LHS, Iwasaki L, Nickel J, Kapila SD. Application of 3D TMJ imaging to TMJDs, TMJ functional analyses and orthodontic treatment outcomes. In: Kapila S, ed. Cone beam computed tomography in orthodontics: indications, insights and innovations. Hoboken, NJ: Wiley-Blackwell; 2014. pp. 247–72.
14. Kim Y-J, Park Y-H, de Paula LK, Conley RS. 3D assessment of orthognathic surgical treatment outcomes. In: Kapila S. (ed). Cone beam computed tomography in Orthodontics: indications, insights and innovations. Hoboken, NJ: Wiley-Blackwell; 2014. pp. 463–83.
15. Paniagua B, Cevidanes L, Zhu H, Styner M. Outcome quantification using SPHARM-PDM toolbox in orthognathic surgery. Int J Comput Assist Radiol Surg 2011; 6: 617–26. doi: 10.1007/s11548-010-0539-z.
16. Nguyen T, Cevidanes L, Paniagua B, Zhu H, Koerich L, De Clerck H. Use of shape correspondence analysis to quantify skeletal changes associated with bone-anchored Class III correction. Angle Orthod 2014; 84: 329–36. doi: 10.2319/041513-288.1.
17. Katheria BC, Kau CH, Tate R, Chen JW, English J, Bouquot J. Effectiveness of impacted and supernumerary tooth diagnosis from traditional radiography versus cone beam computed tomography. Pediatr Dent 2010; 32: 304–9.
18. Botticelli S, Verna C, Cattaneo PM, Heidmann J, Melsen B. Two- versus three-dimensional imaging in subjects with unerupted maxillary canines. Eur J Orthod 2011; 33: 344–9. doi: 10.1093/ejo/cjq102.
19. Chaushu S, Becker T, Becker A. Impacted central incisors: factors affecting prognosis and treatment duration. Am J Orthod Dentofacial Orthop 2015; 147: 355-362.
20.Grover PS, Lorton L. The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol. 1985; 59:420-5.
21.Magnusson C, Kjellberg H. Impaction and retention of second molars: Diagnosis, treatment and outcome. A retrospective follow-up studies. Angle Orthod. 2009; 79:422-7.
22. Lagravàre MO, Hansen L, Harzer W, Major PW. Plane orientation for standardization in 3-dimensional cephalometric analysis with computerized tomography imaging. Am J Orthod Dentofacial Orthop 2006; 129:601–614.
23. Silva MA, Wolf U, Heinicke F, Bumann A, Visser H, Hirsch E. Cone-beam computed tomography for routine orthodontic treatment planning: a radiation dose evaluation. Am J Orthod Dentofacial Orthop 2008; 133:640. e1–640.e5.
24. Botticelli S, Verna C, Cattaneo PM, Heidmann J, Melsen B. Two- versus three-dimensional imaging in subjects with unerupted maxillary canines. Eur J Orthod 2011; 33: 344–9. doi: 10.1093/ejo/cjq102.
25. Haney E, Gansky SA, Lee JS, Johnson E, Maki K, Miller AJ, et al. Comparative analysis of traditional radiographs and cone-beam computed tomography volumetric images in the diagnosis and treatment planning of maxillary impacted canines. Am J Orthod Dentofacial Orthop 2010; 137: 590–7. doi: 10.1016/j.ajodo.2008.06.035.