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Title Information Gained From 3D Imaging Can Influence The Orthodontic Treatment Planning For Retained or Ectopically Erupting Maxillary Cuspids
Clinical Question Does 3D imagining of retained or ectopically erupting maxillary cuspids alter treatment planning?
Clinical Bottom Line 3D imaging provides at least two very important pieces of information needed for the treatment planning of ectopically erupting or impacted maxillary cuspids. 3D images can localize the cuspid’s buccal or palatal location in the maxilla as it is shown in 3 planes without overlap. The presence and extent of resorption on central and lateral incisor roots can be visualized.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16448268Bjerklin/200680 children with total of 113 retained maxillary cuspidsObservational study
Key results43.7% of the original treatment plans which were drawn up using 2D imaging were altered after the 3D images were investigated. This means 35 of the 80 children with a total of 113 retained maxillary permanent cuspids ended up with new treatment plans based on the additional information gained from the 3D images. 53.8% of the treatment plans of children with resorbed lateral incisor roots were changed. In the children with no resorption of the the lateral incisor roots 34.1% of the plans were changed.
#2) 20451777Haney/201018 patients with total of 25 impacted maxillary cuspidsObservational study
Key resultsThe evaluators made different decisions regarding the position of the maxillary cuspid depending on the x-ray method. The clinicians’ confidence in the accuracy of the diagnosis and treatment plan was statistically higher for the CBCT images (P<0.001) compared to the diagnosis and treatment plan from 2D images.
#3) 21270321Alquerban/201160 patients with impacted or ectopically erupting maxillary cuspidsObservational study
Key resultsThere was a highly significant difference between the 2D and 3D images in the width of the cuspid crown (P<0.001), canine location (P=0.0074), severity of root resorption of the lateral incisor (P=0.02) and detection of central incisor root resorption (P=0.045)
#4) 16448268Lui/2008210 impacted maxillary caninesObservational study
Key resultsThis was an analysis of 210 impacted maxillary cuspids using CBCT images. None of this information was compared to 2D imaging results. The location of impacted maxillary cuspids varies greatly in 3 planes. Root resorption of the permanent incisors was common ( 27.2% on the lateral and 23.4% of central incisors.) 94.3% of these resorptions occurred where the impacted cuspid was in close contact with the incisors.
Evidence Search "cone-beam computed tomography"[MeSH Terms] OR ("cone-beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone-beam computed tomography"[All Fields] OR ("cone"[All Fields] AND "beam"[All Fields] AND "computed"[All Fields] AND "tomography"[All Fields]) OR "cone beam computed tomography"[All Fields]) AND (("maxilla"[MeSH Terms] OR "maxilla"[All Fields] OR "maxillary"[All Fields]) AND ("cuspid"[MeSH Terms] OR "cuspid"[All Fields])) AND ("tooth, impacted"[MeSH Terms] OR ("tooth"[All Fields] AND "impacted"[All Fields]) OR "impacted tooth"[All Fields] OR "impaction"[All Fields])
Comments on
The Evidence
Early diagnosis is essential to recognize impacted maxillary cuspids. The results of delayed eruption or treatment of impacted canines may be severe resorption of the central and lateral incisors which will significantly affect treatment outcomes. Before 2000 orthodontists had to rely on 2D images to give them an idea about the buccal/palatal position of an impacted or ectopically erupting maxillary cuspid and any possible root resorption of the central or lateral incisors.It has been found that the additional information gained, first from CT and now CBCT has definite treatment planning advantages which should translate to better outcomes for the patient with ectopically erupting or impacted maxillary cuspids. The distinct advantages of 3D imaging compared to 2D imaging are: (1) no image distortion, the canine location is seen in the saggittal, axial and coronal planes without overlap, and (2) more accurate visualization of central and/or lateral root resorption.
Applicability Accurate treatment planning of impacted or ectopically erupting maxillary cuspids will influence the clinical results. In the 80% of straightforward crowding cases, a CBCT is not indicated as radiation exposure to a young population is always a great concern. However, the treatment of impacted maxillary cuspids is a much more complicated situation. The maxillary cuspid is in a highly demanding area both aesthetically and functionally. Also, it has the longest and most complicated eruption path of all the teeth. These studies point out how the additional information gained from 3D images altered a significant number of treatment plans and most likely the final treatment results.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Restorative Dentistry)
Keywords Orthodontic treatment, root resorption, CT, CBCT, Maxillary canine, Cuspid
ID# 2135
Date of submission: 10/12/2011spacer
E-mail robinsm@livemail.uthscsa.edu
Author Miriam Robins, DDS, MS
Co-author(s) e-mail
Faculty mentor/Co-author Marcel Noujeim, DDS, MS
Faculty mentor/Co-author e-mail Noujeim@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Sonia Hinojosa, Emilia Vega (San Antonio) on 11/28/2017
A PubMed search conducted in November 2017 found an observational study (Wriedt, 2012, PMID 22246048) of 21 patients with a total of 29 impacted maxillary canines that supports past findings that CBCT offers advantages over 2D images for evaluating apical regions of canine and incisor teeth and dilacerations, and more precisely assessing of the canine position in three planes. Improved evaluation of impacted cuspids was accompanied by a shift in the recommended therapy toward canine alignment. "Almost 52% of the canines recommended for extraction accorting to the OPG [panoramic X-ray] findings were recommended for alignment based on the CBCT findings. However, just under 9% of teeth recommended for alignment according to OPG were recommended for extraction based on CBCT findings (Table 4)." The PubMed search also found a systematic review of observational, experimental, and diagnostic accuracy studies (Eslami, 2017, PMID 28153153) that showed that CBCT is more accurate than conventional radiography for localizing maxillary impacted canines. However, there is no robust evidence that supports using CBCT routinely for maxillary canines.

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