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Mestrado Integrado em Medicina Dentria

Faculdade de Medicina da Universidade de Coimbra

Anlise comparativa de caninos superiores inclusos:

Radiografia Panormica Vs Tomografia Computadorizada de Feixe

Cnico

Catarina Lus Pico

Orientadora: Professora Doutora Snia Alves

Co-Orientador: Professor Doutor Francisco do Vale

Coimbra, 2015

II

Integrated Masters in Dentistry Faculty of Medicine, University of Coimbra

Comparative analysis of impacted upper canines:

Panoramic radiograph Vs Cone Beam Computed Tomography

Pico C1, Vale F2, Alves S2

1 5th Grade Student, Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra,

Portugal.

2 MS,DDS, PhD, Department of Orthodontics, Dentistry Area, Faculty of Medicine, University

of Coimbra, Coimbra, Portugal .

rea de Medicina Dentria, FMUC, Coimbra - Portugal

Avenida Bissaya Barreto, Blocos de Celas

3000-075 Coimbra

Tel.: +351 239 484 183

Fax.: +351 239 402 910

Email: catarina_pico@hotmail.com

mailto:catarina_pico@hotmail.com

III

Index

Index of Figures.................................................................................................................... IV

Index of Tables ..................................................................................................................... IV

Index of Annexes .................................................................................................................. IV

Abbreviations List .................................................................................................................. V

Resumo ................................................................................................................................ VI

Abstract .............................................................................................................................. VIII

Introduction ............................................................................................................................ 1

Material and Methods ............................................................................................................. 7

Results ................................................................................................................................. 10

1) Canine localization in three orthogonal planes ..................................................13

2) Adjacent tooth resorption ...................................................................................16

3) Image information ..............................................................................................17

4) Prognosis ..........................................................................................................18

5) Treatment Plan ..................................................................................................18

6) Orthodontic Treatment Duration ........................................................................19

7) Difficulty of the case ..........................................................................................21

Discussion ............................................................................................................................ 22

Conclusion ........................................................................................................................... 25

Acknowledgements .............................................................................................................. 26

Bibliography ......................................................................................................................... 27

Annex ................................................................................................................................... 32

IV

Index of Figures

Figure 1: Example of panoramic reconstruction obtained from iCATVision ............... 8

Figure 2: Example of images data set obtained from iCATVision software ................ 8

Figure 3: Study sample distribution according to gender. .........................................10

Figure 4: Patients age distribution ............................................................................11

Figure 5: Answers given by observers about the vertical tip cusp position in relation

to the long axis of the lateral incisor to each case of group B images. ..................................15

Figure 6: Pie chart indicating the answers obtained for the image information for

group A (left) and group B (right). .........................................................................................17

Index of Tables

Table I: Range of values considered for Cronbach's alpha statistics and Kappa

statistics. ..............................................................................................................................11

Table II: Summary of the results of the inter-rater reliability between panoramic

(Group A) and CBCT (Group B) images separately. .............................................................12

Table III: Summary of the results of the agreement between panoramic and CBCT

images. ................................................................................................................................12

Table IV: Crosstabulation for the M-D tip cusp position. ...........................................13

Table V: Crosstabulation for the M-D apex position. .................................................14

Table VI: Crosstabulation for the vertical cusp tip position ........................................14

Table VII: Crosstabulation for the L-P cusp position. ................................................16

Table VIII: Crosstabulation for adjacent tooth resorption. .........................................16

Table IX: Crosstabulation for the image information. ................................................17

Table X: Crosstabulation for prognosis. ....................................................................18

Table XI: Crosstabulation for treatment plan. ............................................................19

Table XII: Crosstabulation for treatment duration. .....................................................20

Table XIII: Crosstabulation for treatment duration (excluding the NA answers). .....20

Table XIV: Crosstabulation for difficulty of the case. .................................................21

Index of Annexes

Annex 1 (Table 1): Systemic and local conditions leading to tooth impaction ...........32

Annex 2 (Table 2): Comparison between CBCT, CT and traditional radiographs. ....33

Annex 3: Questionnarie. ...........................................................................................34

V

Abbreviations List

CBCT: Cone Beam Computed Tomography

IMC: Impacted Maxillary Canine

CT: Computed Tomography

OPG: Orthopantomography

TMJ: Temporomandibular Joint

2D: Two-Dimensional

3D: Three-Dimensional

FOV: Field of View

mA: Milliamperage

kVp: Kilovoltage

AAOM: American Academy of Oral and Maxillofacial

ALARA: As Low As Reasonably Achievable

ROI: Region of Interest

DDFMUC: Department of Dentistry, Faculty of Medicine, University of Coimbra

DICOM: Digital Imaging and Communications in Medicine

JPEG: Joint Photographic Experts Group

M-D: Mesio-Distal

L-P: Labio-Palatal

https://www.google.pt/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CC4QFjAB&url=https%3A%2F%2Fpt.wikipedia.org%2Fwiki%2FJoint_Photographic_Experts_Group&ei=NO6FVYiNDsuuU8z_gqgH&usg=AFQjCNHmZmLAUfAZzc9naN4y44sFDE_lkw&sig2=tIQjbvercM-Ch-OX7BGDow

VI

Resumo

Introduo: A utilidade da Tomografia Computadorizada de Feixe Cnico (TCFC)

est bem comprovada e documentada na literatura em diversas reas da Medicina Dentria,

incluindo na rea da ortodontia. Vrios estudos tm demonstrado a sua eficcia no

diagnstico e localizao de caninos superiores inclusos, proporcionando um melhor

tratamento cirrgico e ortodntico.

Objetivo: Comparar e concluir de que forma a opinio relativamente localizao de

caninos superiores inclusos, reabsoro radicular dos dentes adjacentes, prognstico,

informao da imagem, plano de tratamento, durao de tratamento e grau de dificuldade do

caso varia quando se observa uma imagem panormica em comparao com a observao

de um conjunto de reconstrues de TCFC.

Materiais e Mtodos: Vinte doentes (10 homens e 10 mulheres) com um total de 28

caninos inclusos foram identificados na base de dados da rea de Medicina Dentria, da

Faculdade de Medicina da Universidade de Coimbra. Para cada canino foram

disponibilizados dois diferentes tipos de imagens, uma imagem panormica e um conjunto

de reconstrues da TCFC, sendo que a cada conjunto correspondeu um grupo. Depois de

uma distribuio aleatria das imagens de ambos os grupos, nove mdicos dentistas ps-

graduados em ortodontia preencheram um questionrio onde foram solicitados a avaliar,

para cada caso, a posio do dente, a reabsoro radicular dos dentes adjacentes, o

prognstico, a i

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