Localization of Ectopic Maxillary Canines — is CBCT more Accurate than Conventional Horizontal or Vertical Parallax?

Abstract

Objective

To compare the accuracy of cone-beam CT (CBCT) with conventional horizontal and vertical parallax for the localization of ectopic maxillary canines.

Design

Observational study.

Methods

A typodont was constructed using human teeth embedded in radio-dense impression material, containing a simulated ectopic canine. Image sets (vertical/horizontal parallax and CBCT scans) were obtained for nine positions. A photograph confirmed the true position of the canine. Six observers used horizontal (HP) and vertical (VP) parallax techniques with conventional radiographs and the axial, coronal and sagittal CBCT views to locate the canine tip. Images were manipulated as required using proprietary software (http://www.carestream.com and http://www.i-cat.com). Intra-observer reproducibility was calculated by one observer re-evaluating the image sets after 2 months. Individual observer validity was calculated in relation to the photographic position of the canine using weighted Kappa. Differences in the proportion of correct locations between CBCT and vertical/horizontal parallax were tested using McNemar tests (P<0·05).

Results

Intra- and inter-observer agreements were excellent (0·8985) and substantial (0·7528), respectively. Individual observer validity was substantial-excellent (0·7368–0·900). The canine position was correctly identified in 94% of cases located using CBCT, 83% using HP and 65% using VP. The differences between CBCT and vertical and horizontal parallax were highly statistically significant (P<0·01).

Conclusion

CBCT is more accurate than either horizontal or vertical parallax for the localization of ectopic maxillary canine teeth.

Keywords

CBCT horizontal parallax impacted canine vertical parallax

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References

Alqerban

, Jacobs

, Fieuws

, Willems

Comparison of two cone beam computed tomographic system versus panoramic imaging for localization of impacted maxillary canines and detection of root resorption. Eur J Orthod 2011; 33: 93–102.

Armstrong

, Johnston

, Burden

, Stevenson

Localizing ectopic maxillary canines – horizontal or vertical parallax?

Eur J Orthod 2003; 25: 585–589.

Botticelli

, Verna

, Cattaneo

, Heidmann

, Melsen

Two versus three dimensional imaging in subjects with unerupted maxillary canines. Eur J Orthod 2011; 33: 344–349.

Cohen

A coefficient of agreement for nominal scales. Educ Psych Meas 1960; 20: 37–46.

Fleiss

. Statistical Methods for Rates and Proportions. 2nd edn. Wiley Series in probability and mathematical statistics. New York: Wiley, John & Sons, 1981. Chapter 13, pp. 212–236.

Chaushu

, Chaushu

, Becker

The use of panoramic radiographs to localise displaced maxillary canines. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88: 511–516.

Clark

A method of ascertaining the position of unerupted teeth by means of film radiographs. Proc R Soc Med 1909; 3: 87–90.

Haney

, Gansky

, Lee

, Johnson

, Maki

, Miller

. 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: 590–597.

Hunter

. Treatment of the unerupted maxillary canine. Part 1 – Preliminary considerations and surgical methods. Br Dent J 1983; 154: 294–296.

10.

Keur

. Radiographic localization techniques. Aust Dent J 1986; 31: 86–90.

11.

Orton

, Garvey

, Pearson

. Extrusion of the ectopic maxillary canine using a lower removable appliance. Am J Orthod Dentofacial Orthop 1995; 107: 349–359.

12.

Landis

, Koch

. The measurement of observer agreement for categorical data. Biometrics 1977; 33:159–174.

13.

Mason

, Papadakou

, Roberts

. The radiographic localization of ectopic maxillary canines: a comparison of methods. Eur J Orthod 2001; 23: 25–34.

14.

Richards

. Roentgenographic localization of the mandibular canal. J Oral Surg 1952; 10: 325–329.

15.

Rossini

, Cavallini

, Cassetta

, Galluccio

, Barbato

Localization of impacted maxillary canines using cone beam computed tomography: review of the literature. MS Ann Stomatol (Roma) 2012; 3: 14–18.

16.

Sudhakar

, Patil

, Mahima

. Localisation of impacted permanent maxillary canine using single panoramic radiograph. Indian J Dent Res 2009; 20: 340–345.

17.

The SEDENTEXCT Project. Radiation Protection: Cone Beam CT for Dental and Maxillofacial Radiology. Evidence Based Guidelines. Luxembourg: European Commission, 2011. pp. 1–139.