Comparison between periapical radiography and cone beam computed tomography for the diagnosis of anterior maxillary trauma in children and adolescents.

BACKGROUND/AIMS: Under-estimating the damage caused by trauma to the dental structures may delay treatment. Timely and accurate diagnosis remains challenging in clinical practice. Radiography is an important modality for the diagnosis of traumatic injuries. The aim of this study was to compare the efficacy of periapical radiography and cone beam computed tomography for the diagnosis of trauma to the anterior maxillary dentoalveolar region in children and adolescents. MATERIAL AND METHODS: Images of patients who underwent both periapical radiography and cone beam computed tomography simultaneously because of trauma to the anterior maxillary region between January 2016 and January 2020 were analyzed retrospectively. Pairwise comparison between the receiver operating characteristic curves was performed to statistically compare the two methods for the diagnosis of crown fractures, root fractures, alveolar bone fractures and luxations, tooth resorption, and periapical radiolucencies. RESULTS: A total of 190 patients met the inclusion criteria. There were 120 (63.2%) males and 70 (36.8%) females, with a mean age of 11.1 years (range: 6-17 years). A crown fracture was observed in 144 teeth, while a root fracture was observed in 71 teeth. Alveolar fracture and luxation were observed in 44 incisors. During follow-up, tooth resorption and periapical radiolucencies were observed in 25 and 33 teeth, respectively. Pairwise receiver operating characteristic curve analysis revealed that cone beam computed tomography was significantly superior to periapical radiography for the diagnosis of root fractures, alveolar fractures and luxations, and tooth resorption (p < .05). However, no significant differences were found for the diagnosis of crown fractures and periapical radiolucencies (p > .05). CONCLUSIONS: Cone beam computed tomography in the low-dose mode was better for diagnosing root and bone fractures and resorption, but no different to periapical radiographs for crown fractures and periapical radiolucencies in pediatric patients.

Three-dimensional evaluation of maxillary sinus and maxilla for adolescent patients with unilateral cleft lip and palate using cone-beam computed tomography.

BACKGROUND AND OBJECTIVE: Maxillary sinus disease is frequently observed in patients with unilateral cleft lip and palate (UCLP). The anatomical variations of maxillary sinus and maxilla may play a role in the high incidence of sinusitis. The aims of this study were to evaluate and compare the three-dimensional (3D) structural features of maxillary sinus and maxilla in UCLP adolescent patients between the defect and non-defect sides, and investigate the morphological relationship between the maxillary sinus and maxilla on the defect side by using cone-beam computed tomography (CBCT). METHODS: CBCT images were acquired from 42 UCLP adolescent patients. Maxillary sinus and maxilla on the defect and non-defect sides were segmented respectively and assessed three dimensionally, and the comparison was performed by paired t-test. A multiple linear regression was conducted to investigate the morphological relationship between the maxillary sinus and maxilla on the defect side. RESULTS: No statistically significant difference was observed in any parameter of the maxillary sinus between the defect and non-defect sides (P > 0.05). Significant differences were observed in the length, anterior width, anterior height, and volume of the maxilla between the defect side and non-defect sides (P < 0.05). The parameters of maxillary sinus were significant related to the posterior width and height of maxilla on the defect side. CONCLUSION: Adolescent patients with UCLP present similar 3D structural features of the maxillary sinus on both sides. Significant differences of the maxilla between the defect and non-defect sides were displayed in the area adjacent to the defect but not showed in the posterior portion of maxilla. Certain structures of the posterior portion of maxilla contribute to the variability of maxillary sinus.

Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults.

This study evaluated the occurrence of degenerative temporomandibular joint (TMJ) changes in adolescents and young adults with recent on-set disc displacement without reduction (DDw/oR) using high-resolution cone beam computed tomography (CBCT). The associations between types of osteoarthrosis (OA) changes and clinical factors including disease duration were also examined. CBCT and clinical data of 300 patients (84.70% females, mean age 20.93 ± 4.77 years) diagnosed with unilateral DDw/oR (≤12 months) based on RDC/TMD were acquired. CBCT images of both symptomatic and contralateral asymptomatic TMJs were independently evaluated and scored by two radiologists. Associations between OA changes and gender, age, mouth opening and duration of DDw/oR were analyzed statistically. Condylar OA changes were present in 59.30% of the joints with DDw/oR. Early-stage OA changes (loss of continuity of articular cortex and/or surface destruction) constituted most (45.67%) of the alterations. Prevalence of early-stage OA increased from 24% to about 60% one month after TMJ closed-lock occurred. Logistic regression analysis showed the risk of developing early-stage OA changes was 5.33 times higher one month after onset of DDw/oR. A high prevalence of degenerative TMJ changes was observed with recent on-set DDw/oR in adolescents and young adults. Early diagnosis and intervention of DDw/oR is therefore prudent.

Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement.

OBJECTIVE: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints) on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR), using magnetic resonance imaging (MRI). MATERIAL AND METHODS: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females) and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1), anterior repositioning splint position (Position 2), and stabilization splint position (Position 3). Disc/condyle coordinate measurements and disc condyle angles were determined and compared. RESULTS: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was -13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7%) than Position 3 (20/60, 33.3%). In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. CONCLUSIONS: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement

Abstract Objective: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints) on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR), using magnetic resonance imaging (MRI). Material and Methods: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females) and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1), anterior repositioning splint position (Position 2), and stabilization splint position (Position 3). Disc/condyle coordinate measurements and disc condyle angles were determined and compared. Results: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was −13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7%) than Position 3 (20/60, 33.3%). In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. Conclusions: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.