Influence of lateral cephalometric radiographs on extraction decision in skeletal class I patients

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Abstract

Background

Radiographic examination is considered ‘justified’ only when detection of a condition that would change the mechanisms and timing of treatment is possible. Radiographic safety guidelines have restricted the indication of lateral cephalometric radiographs (LCRs) to presence of distinct skeletal Class II or Class III. However, they are taken routinely in clinical practice and considered to be part of the ‘gold’ standard for orthodontic diagnosis. Therefore, the aim of this study was to test the null hypothesis that lateral cephalometric radiograph (LCR) evaluation would not alter the extraction/non-extraction decision in orthodontic treatment planning of skeletal Class I patients.

Materials and methods

Intraoral and extraoral photographs, dental casts and extraoral radiographs of 60 skeletal Class I patients were prepared digitally for assessment using a presentation software. One experienced (EO) and inexperienced orthodontist (IO) was asked to decide on extraction or non-extraction on a Likert-type linear scale for treatment planning. This procedure was repeated 4 weeks later with a mixed order of patients and the LCRs being omitted. Kappa, Weighted Kappa (WK) and McNemar scores were computed to test decision consistency and Bland-Altman plots together with 95% limits of agreement were used to determine measurement accuracy and presence of systematic bias.

Results

Both EO (WK = 0.67) and IO (WK = 0.64) had good level of decision agreement with and without LCR evaluation. EO did not present a shift towards extraction nor non-extraction with LCR evaluation (McNemar = 0.999) whereas IO showed a tendency to extraction (McNemar = 0.07) with LCR data. Including LCR evaluation created a systematic inconsistency between EO and IO (Line of equality = 0.8, Confidence interval = 0.307-0.707).

Conclusions

Lateral cephalometric radiograph evaluation did not influence the extraction decision in treatment planning of skeletal Class I patients. Reconsidering the necessity of lateral cephalograms in orthodontic treatment of skeletal Class I patients may reduce the amount of ionizing radiation. Key words: Lateral cephalometric radiograph, extraction, treatment planning, skeletal Class I.

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Most cited references 19

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Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.

Amy Berrington de Gonzalez, Sarah Darby (2004)

Diagnostic X-rays are the largest man-made source of radiation exposure to the general population, contributing about 14% of the total annual exposure worldwide from all sources. Although diagnostic X-rays provide great benefits, that their use involves some small risk of developing cancer is generally accepted. Our aim was to estimate the extent of this risk on the basis of the annual number of diagnostic X-rays undertaken in the UK and in 14 other developed countries. We combined data on the frequency of diagnostic X-ray use, estimated radiation doses from X-rays to individual body organs, and risk models, based mainly on the Japanese atomic bomb survivors, with population-based cancer incidence rates and mortality rates for all causes of death, using life table methods. Our results indicate that in the UK about 0.6% of the cumulative risk of cancer to age 75 years could be attributable to diagnostic X-rays. This percentage is equivalent to about 700 cases of cancer per year. In 13 other developed countries, estimates of the attributable risk ranged from 0.6% to 1.8%, whereas in Japan, which had the highest estimated annual exposure frequency in the world, it was more than 3%. We provide detailed estimates of the cancer risk from diagnostic X-rays. The calculations involved a number of assumptions and so are inevitably subject to considerable uncertainty. The possibility that we have overestimated the risks cannot be ruled out, but that we have underestimated them substantially seems unlikely.

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Condylar volume and condylar area in class I, class II and class III young adult subjects

Matteo Saccucci, Michele D’Attilio, Daria Rodolfino … (2012)

Aim Aim of this study was to compare the volume and the shape of mandibular condyles in a Caucasian young adult population, with different skeletal pattern. Material and methods 200 Caucasian patients (15–30 years old, 95 male and 105 females) were classified in three groups on the base of ANB angle: skeletal class I (65 patients), skeletal class II (70 patients) and skeletal class III (65 patients). Left and right TMJs of each subject were evaluated independently with CBCT (Iluma). TMJ evaluation included: condylar volume; condylar area; morphological index (MI). Condylar volumes were calculated by using the Mimics software. The condylar volume, the area and the morphological index (MI) were compared among the three groups, by using non-parametric tests. Results The Kruskal-Wallis test and the Mann Whitney test revealed that: no significant difference was observed in the whole sample between the right and the left condylar volume; subjects in skeletal class III showed a significantly higher condylar volume, respect to class I and class II subjects (p < 0.05); significantly lower condylar volume was observed in class II subjects, respect to class I and class III (p < 0.05). In the whole sample condylar volume (699.8 ± 63.07 mm3 in males and 663.5 ± 81.3 mm3 in females; p < 0.01) as well as condylar surface (423.24 ± 63.03 mm2 in males and 389.76 ± 61.15 mm2 in females; p < 0.01) were significantly higher in males than in females. Conclusion Skeletal class appeared to be associated to the mandibular condylar volume and to the mandibular condylar area in the Caucasian orthodontic population.

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Consistency of orthodontic treatment decisions relative to diagnostic records.

U Han, Sérgio Kowalski, H Weintraub … (1991)

The purpose of this study was to evaluate how incremental information obtained from different types of diagnostic records contributes to the determination of orthodontic treatment decisions. Pretreatment records of 57 orthodontic patients were assessed by five orthodontists who were part-time faculty members and also in private practice. This sample consisted of dental school orthodontic patients who had Class II malocclusions and included patients at three different dental developmental stages. The following diagnostic records were used: study models (S), facial photographs (F), a panoramic radiograph (P), a lateral cephalogram (C), and its tracing (T). Five combinations of diagnostic records were presented to the orthodontists in the following sequence: (1) S; (2) S + F; (3) S + F + P; (4) S + F + P + C; and (5) S + F + P + C + T. The simultaneous interpretation of all diagnostic records (S + F + P + C + T) was used as the "diagnostic standard." There was a diagnostic standard for each of the patients and for each of the orthodontists. The diagnostic standard was achieved: (1) S = 54.9%, (2) S + F = 54.2%, (3) S + F + P = 60.9%, and (4) S + F + P + C = 59.9%. Thus, in a majority of cases (55%), study models alone provided adequate information for treatment planning, and incremental addition of information from other types of diagnostic records made small differences.

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Author and article information

Contributors

Banu Dinçer

Enver Yetkiner

Isil Aras

Thomas Attin

Rengin Attin

Journal

Journal ID (nlm-ta): Head Face Med

Journal ID (iso-abbrev): Head Face Med

Title: Head & Face Medicine

Publisher: BioMed Central

ISSN (Electronic): 1746-160X

Publication date Collection: 2013

Publication date (Electronic): 4 December 2013

Volume: 9

Page: 36

Affiliations

[1 ]Department of Orthodontics, Faculty of Dentistry, University of Ege, Izmir, Turkey

[2 ]Center of Dental Medicine, Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zürich, Zürich, Switzerland

[3 ]Center of Dental Medicine, Department of Orthodontics and Pediatric Dentistry, University of Zürich, Zürich, Switzerland

Article

Publisher ID: 1746-160X-9-36

DOI: 10.1186/1746-160X-9-36

PMC ID: 3932141

PubMed ID: 24304887

SO-VID: af648d4f-a829-4397-96b2-7806c1a5afdd

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Influence of lateral cephalometric radiographs on extraction decision in skeletal class I patients

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Abstract

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Materials and methods

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Orthopedics

Most cited references 19

Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.

Condylar volume and condylar area in class I, class II and class III young adult subjects

Consistency of orthodontic treatment decisions relative to diagnostic records.

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