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Are panoramic radiographs good enough to render correct angle and sector position in palatally displaced canines?
Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
Department of Maxillofacial Radiology, Postgraduate Dental Education Center, Örebro, Sweden.
Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
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2019 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 155, no 3, p. 380-387Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The early interceptive treatment of palatally displaced canines (PDCs) has for decades been based on their position in panoramic radiographs. In the 1990s, cone-beam computed tomography (CBCT) started to become popular in cases with PDCs. The aims of this prospective study were to evaluate the agreement of PDC sector position and angle to midline between panoramic radiographs and CBCT scans.

METHODS: PDC sector and angle to midline were measured in panoramic radiographs and CBCT scans in 58 consecutive patients with 64 PDCs. Kappa with linear weighting was used to assess the agreement between the measurements of PDC sector position and Bland-Altman limits of agreement to assess the agreement between the PDC angular measurements in the 2 methods.

RESULTS: PDC sector position and angle to midline had systematically higher values in panoramic radiographs compared with those in the CBCT scans. The agreement of sector position between the methods was fair: weighted kappa 0.36 (95% CI 0.24-0.49). The mean difference in angle was almost 7° (95% CI 5.9°-7.9°) higher in panoramic radiographs compared with CBCT.

CONCLUSIONS: Panoramic radiographs overestimate PDC sector and angle to midline position, compared with the use of CBCT scans, but clinically the differences are quite modest. Panoramic radiographs could be considered good enough for rendering PDC position when the need for 3D information is not crucial for treatment planning.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 155, no 3, p. 380-387
National Category
Surgery Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medicine; Radiology
Identifiers
URN: urn:nbn:se:oru:diva-83005DOI: 10.1016/j.ajodo.2018.05.015ISI: 000459767200013PubMedID: 30826041Scopus ID: 2-s2.0-85062150369OAI: oai:DiVA.org:oru-83005DiVA, id: diva2:1438991
Available from: 2020-06-11 Created: 2020-06-11 Last updated: 2021-09-06Bibliographically approved
In thesis
1. Open vs closed exposure of palatally displaced canines: clinical, patient-related outcomes and health economics
Open this publication in new window or tab >>Open vs closed exposure of palatally displaced canines: clinical, patient-related outcomes and health economics
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The maxillary permanent canine usually erupts in the mouth between the ages of 11 and 12 years. Sometimes the canines are displaced toward the palatal side of the dental arch and eruption is disturbed. Palatally displaced canines (PDCs) are a frequent dental anomaly, present in 2% of the young population. If untreated, there is risk of damage to the roots of the adjacent teeth and potential tooth loss. Thus, early interceptive treatment with extraction of the deciduous canine should be undertaken, with the aim to improve the PDC eruption path. If the eruption path does not improve within about a year, surgical exposure and orthodontic treatment is indicated.

The two different main techniques of surgical exposure in PDCs are the open and the closed techniques. Retrospective studies of the exposure techniques have shown differences in outcomes, which high-lights the need for evidence-based research.

The overall aim of this thesis was to compare outcomes of treatment duration, complications and side effects, patients’ perceptions and health economic aspects of the two surgical techniques, in PDCs. Moreover, a comparison of PDC position between the two radiographic methods commonly used in PDC cases; panoramic radiograph and CBCT, aimed to evaluate agreement between the actual measures. 

This thesis was based on a multicentre randomised controlled trial with two parallel groups, including 120 consecutive patients, aged 9 to 16 years, who were randomly allocated to open or closed surgical exposure. 

The following conclusions were drawn:

The agreement of PDC mesiodistal position was fair (weighted kappa 0.36 (95%CI0.24–0.49) and the mean difference in angle to midline was almost 7˚ (95%CI 5.9˚–7.9˚) higher in panoramic radiographs compared with CBCT. Surgery time, treatment time, root resorption or periodontal measures showed no clinically significant differences between the exposure groups. The open group reported higher pain intensity up to one week post surgery. A higher proportion of bilateral open group cases experienced complications, and weremore frequently wakened at night post surgery. The closed group reported higher pain and discomfort during the orthodontic traction. All PDCs were successfully aligned in the dental arch. A cost-minimization analysis showed no differences in healthcare or societal costs.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 124
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 244
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-90894 (URN)978-91-7529-395-0 (ISBN)
Public defence
2021-09-24, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
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Supervisors
Available from: 2021-04-07 Created: 2021-04-07 Last updated: 2021-09-06Bibliographically approved

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Björksved, MargithaBazargani, Farhan

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