articol3_2021_nr2
www.stomaeduj.com
ORTHODONTICS
CONE BEAM TOMOGRAPHY AND PANORAMIC
Original Articles
RADIOGRAPHY IN LOCALIZATION OF IMPACTED
MAXILLARY CANINE AND DETECTION OF ROOT
RESORPTION
Seden Akan1a* , Husamettin Oktay2b
1
Department of Orthodontics, Faculty of Dentistry, Altınbaș University, Bakırköy / İstanbul, Turkey
2
Department of Orthodontics, İstanbul Medipol University Faculty of Dentistry, İstanbul, Turkey
DDS, PhD, Assistant Professor; e-mail: sedenakandt@hotmail.com; ORCIDiD: https://orcid.org/0000-0001-7955-3086
a
DDS, PhD, Professor; e-mail: hoktay@medipol.edu.tr; ORCIDiD: https://orcid.org/0000-0001-7862-2983
b
ABSTRACT https://doi.org/10.25241/stomaeduj.2021.8(2).art.3
Introduction The aim of this study was to evaluate cases of impacted maxillary canines (IMC) using cone
beam tomography (CBCT) and panoramic images in an attempt to assess if panoramic radiographs can
provide information compatible with CBCT results regarding canine position and root resorption.
Methodology Fifty-six impacted maxillary canines from 48 patients were radiographically evaluated. The
positions of the canine teeth were classified by Sector localization on panoramic radiographs and the same
teeth were also analyzed by KPG on CBCT. Root resorptions in maxillary lateral incisors were also evaluated
on CBCT. The relationships between panoramic and CBCT findings were compared by Chi-square test and
Fischer’s exact test.
Results Statistically significant correlations were found between panoramic Sectors and KPG indexes
(p<0.001). KPG index values of 1, 3 and 4 corresponded to the panoramic Sectors 1, 4 and 5, respectively;
but KPG index 2 matched the panoramic Sectors 3 and more often 2. Mid-alveolar impaction generally
coincided with score 1 for both KPG index and panoramic Sector. In palatally IMC, this score value was
generally 2 or 3 for the KPG index and 4 for the panoramic Sector (p≤0.001). Root resorptions in maxillary
lateral incisors showed significant differences according to Sector localization and KPG index (p<0.05),
namely they coincided with 2 and 3 in Sector evaluation and 2, 3 and 4 in KPG index.
Conclusions Sector location on OPG is found to be related to KPG index on CBCT, and it can help evaluate
mainly certain positions of impacted canines; thus, unnecessary CBCT scans are not requested.
KEYWORDS
Impacted Canine; KPG Index; Radiography Dental; Digital Radiography Panoramic; Sector Classification.
1. INTRODUCTION The determination of impacted canine positions
is critical for the planning of orthodontic-surgical
Maxillary canines play important roles in facial treatment. The panoramic radiographic evaluation
esthetics, dental arch development, and oral is the most common clinical approach used by or-
cavity functions. Non-erupted maxillary canines are thodontists for this procedure. It should be known,
relatively common because these teeth develop however, that panoramic radiographs have some
deep within the maxilla and follow a longer path limitations in evaluating the labiopalatal positions
to erupt into the oral cavity when compared to of impacted canines [5]. In addition, it is difficult
other teeth [1]. An impacted tooth can be defined to localize and determine the root resorptions of
as the tooth that has failed to erupt into the proper adjacent teeth with this radiographic method
position in the dental arch within the normal because of the superimposition of the related
period of growth, and maxillary canines are the most structures, leading to a difficulty in distinguishing
common teeth suffering from impaction except many significant details [6].
third molars. The prevalence of their impaction ran- Many studies have been carried out to overcome these
ges from 1% to 3% in the general population [2-4]. shortcomings regarding panoramic radiographic
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Akan S, Oktay H. Cone beam tomography and panoramic radiography in localization of impacted maxillary canine and detection of root
resorption.Stoma Edu J. 2021;8(2):106-112.
Received: December 18, 2020; Revised: January 10, 2021; Accepted: January 21, 2021; Published: January 25, 2021
*Corresponding author: Dr. Seden Akan; Altınbaş Üniversitesi Diş Hekimliği Fakültesi Zuhuratbaba Mahallesi, İncirli Caddesi, No:11-A 34147 Bakırköy,
İstanbul, Turkey.
Tel/Fax: 0090535 5113760; e-mail: sedenakandt@hotmail.com
Copyright: © 2021 the Editorial Council for the Stomatology Edu Journal.
106 Stoma Edu J. 2021;8(2): 106-112 pISSN 2360-2406; eISSN 2502-0285
Akan S, et al.
www.stomaeduj.com
Original Articles
Figure 1. Modified Sector classification according to the mesiodistal Figure 2. KPG index is calculated by summing the scores (0 to 5 scores) of
position of the canine cusp tip on OPG. the canine cusp tip and root tip on x, y and z planes.
evaluations [7-11]. One of them belonged to Ericson was seen in 8 patients, while 40 of them had unilater-
and Kurol [8] who proposed some measurements on al impaction. After a routine panoramic radiograph-
panoramic radiographs to predict the possible im- ic evaluation, CBCT scans were needed in order to
paction of maxillary canines in relation to the adja- obtain more detailed information on the impacted
cent lateral incisors. canines for button operation. Panoramic records
Their sector classification was then modified by
(OPG) were obtained by Carestream (Kodak) OPG
Leonardi et al [12] and Bacetti et al [13] and gained
Dental Machine (Carestream, Canada). CBCT scans
popularity among the orthodontists and dental
radiologists [14,15]. were taken by I-CAT Next Generation & i-Cat VisionQ
Cone-beam computed tomography (CBCT) used for machine, (Imaging Sciences International, LLC,
three-dimensional visualization has gained more Hatfield, PA) at a setting of 120 kVp and 3.7 m.
popularity in dental clinics during the last 3 de- Both the OPG records and CBCT images of the 56
cades [16] and at present, it has been accepted as impacted canines were analyzed. The mesiodistal
the most accurate method in impacted tooth local- positions of the canine crowns were determined
ization [17] although CBCT gives more radiation to on panoramic radiographs and classified by the
the patients than conventional radiographs. In order Sector classification method, which was modified by
to develop evidence-based guidelines on the use of
Leonardi et al [12] and Bacetti et al [13] (Fig. 1).
CBCT in dental and maxillofacial imaging, a project
The KPG index, a novel index based on 3D CBCT
named SEDENTEXCT was accomplished between
2008-2011 in Europe [17]. According to this project, images, was calculated by summing the scores
CBCT records may be indicated only in cases where (0 to 5 scores) of the canine cusp tip and root tip
inadequate information is obtained from conven- on x, y and z planes (Fig. 2). The total KPG scores
tional radiographs about impacted canines and their between 0 and 9 were classified as follows: 10 as
localizations. easy, 14 as moderate, 15 and 19 as difficult and 20
CBCT presents a reliable guidance of the used and above as extremely difficult. These categories
mechanics, force, and treatment style to move the were named as 1, 2, 3, and 4 beginning from the easy
impacted canines efficiently with lower complica- group in order to make the comparison with the
tions. To standardize the classification of impacted Sector groups easy. The root resorptions of adjacent
maxillary canines and to predict treatment difficulty,
maxillary lateral incisors and labiopalatal positions
KPG index was introduced by Kau et al [18] in 2009.
of the impacted canines were also evaluated on
The aims of the present study were to investigate if
the panoramic radiographs can provide information CBCT. The labiopalatal positions of the impacted
related with CBCT results regarding canine position canines were classified as labial, mid-alveolar, and
and root resorption. palatal. Root resorptions were settled as yes or no.
The labiopalatal positions of the impacted canines
2. SUBJECTS AND METHODS and resorptions at lateral incisors were correlated
with the KPG indexes and Sector classifications.
This retrospective radiographic study, being appro- Panoramic and CBCT images were scored twice by
ved by the institutional ethical board (108400987- one author (S.A.) at a two-week interval. Intraobserv-
97-86), was carried out on the diagnostic records of
er reliability was assessed by Kappa coefficient.
48 patients applied at the Orthodontic Department
The relationships between panoramic and CBCT
of the Dental School at Istanbul Medipol University;
the patients complained of maxillary canine impac- findings were investigated by Chi-square and Fish-
tion. The age of the subjects ranged between 12-34 er’s exact tests. The data analysis was performed
and the mean age was 18.31±4.99 years. The patients using SPSS 16.0 software package (SPSS Inc.,
having any syndrome, tooth aplasia, or undeveloped Chicago, IL, USA). P values lower than 0.05 were ac-
canine root were excluded. Bilateral canine impaction cepted as statistically significant.
Stoma Edu J. 2021;8(2): 106-112 pISSN 2360-2406; eISSN 2502-0285 107
CBCT and panoramic radiography in impacted canines
www.stomaeduj.com
Original Articles Table 1. Relationships between Sector classification and KPG index.
Sector Classification
KPG Index
1 2 3 4 5 Total
1 11 0 0 2 0 13
2 1 10 9 5 0 25
3 1 1 5 8 1 16
4 0 0 0 0 2 2
Total 13 11 14 15 3 56
p<0.001
Table 2. Relationships among KPG index, Sector classification and CBCT findings.
KPG Index Sector Classification
1 2 3 4 Total 1 2 3 4 5 Total
Lateral incisor
contact No contact 12 6 6 2 26 12 2 2 8 2 26
Contact 1 19 10 0 30 1 9 12 7 1 30
No resorption 13 11 8 2 34 13 4 6 9 2 34
Lateral incisor
root resorption Resorption 0 14 8 0 22 0 7 8 6 1 22
Bukkal 2 3 5 0 10 3 0 6 1 0 10
Labiopalatal Mid-alveolar 9 4 0 0 13 9 4 0 0 0 13
position
Palatal 2 18 11 2 33 1 7 8 14 3 33
Root resorption of the maxillary lateral incisors was found more in score 2 of the KPG index (p=0.004) and in score 3 of the Sector classification
(p=0.011). The indicative scores were 2 or 3 in KPG index and; 2, 3 and 4 in panoramic Sectors for palatally impacted canines (p≤0.001).
3. RESULTS tions in adjacent teeth, to schedule ortho-surgical
procedures, and to give an opinion about orthodon-
Kappa coefficients showing intraobserver reliability tic treatment time. It has been stated that one of
were high for both panoramic and CBCT images: the major reasons for treatment failure of impacted
0.748 for lateral incisor root resorption and 0.858 for canines is mistaken location anddirectional of trac-
labiopalatal position of the impacted canine. Table I tion (40.5%) [19]. The main objectives of the present
shows a statistically significant association between
study were to assess therelation between 2D and
Sector classification and KPG index (p<0.001). KPG
3D visualization of impacted maxillary canines, to
indexes 1, 3, and 4 corresponded to panoramic Sec-
tors 1, 4, and 5, respectively, while KPG index 2 related estimate abiopalatal positions of impacted canines
to panoramic Sectors 2 and 3. The results regarding from panoramic radiographs, which were routinely
the labiopalatal positions of the impacted canines used in orthodontic clinics, and to evaluate root
and resorptions at the lateral incisors are shown resorptions in lateral incisors by CBCT. CBCT is the
in Table II. As can be seen from these tables, mid- bestcontemporary method to diagnose and localize
alveolar impaction generally coincided with score 1 the impacted canines and their possible complica-
in both KPG and Sector evaluations. The indicative tions [6,20,21]. It has excellent image quality and
scores were 2 or 3 in the KPG index and; 2, 3 and 4 high diagnostic accuracy for many tasks, such as the
in panoramic Sectors for palatally impacted canines detection of bone defects, implant treatment
(p≤0.001). In labially impacted canines, the indicative planning, impacted third molar and canine teeth,
score was 3 for both KPG index and the panoramic and root re sorption evaluation.
sector. The root resorption of maxillary lateral incisors In the present study, KPG index values obtained
showed significant differences according to Sector
according to CBCT were gathered in more localized
localization and KPG index (p<0.05). Resorption was
categories than Sector classification made according
found more in scores 2 and 3 in both KPG and Sector
evaluations. to Panoramic radiograph. For example, while lateral
tooth contact and root resorption appear only at 2
4. DISCUSSION and 3 in the KPG index, they are evaluated in almost
all classes in the Sector classification. This result may
The determination of impacted maxillary canine suggest once again that the diagnostic capability of
positions is very important to prevent root resorp- the CBCT may be clearer.
108 Stoma Edu J. 2021;8(2):106-112 pISSN 2360-2406; eISSN 2502-0285
Akan S, et al.
www.stomaeduj.com
According to the radiation dose which is the Sector location on OPG. Olive [29] stated that there
Original Articles
main disadvantage of the CBCT, although the was a significant relationship between the mesiodis-
CBCT exposure dose is relatively low compared tal position of impacted canines and the treatment
with that of conventional CT, it is up to 10 times time. Canines impacted in Sector 4 emerged after 21
higher than that of intraoral and extraoral radi- months of treatment and canines in Sectors 2 and 3
ography used in dentistry [22,23]. To give a more emerged after 8 months of treatment.
practical example, it has been revealed that the In literature, there are studies [21,28,30-34] compa-
average effective radiation dose of panoramic ring the localization of impacted canine by means
radiography is relatively lower, ranging from 4.1 to of 2D and 3D indexes. Sosars et al [30] evaluated
36 μSv (2-3 days of natural background radiation 106 palatally displaced maxillary canines and they
level), whereas that of CBCT ranges from 19 to 368 concluded that panoramic measurements were
μSv (11 days of natural background radiation level) not reliable predictors of resorptions, except for
[24, 25]. Thus, a reason for an examination and opti- severe resorptions, of the neighbor teeth. Khan
mization of this radiographic technique are strongly Mohammed et al [31] stated that CBCT showed
needed [26]. It is accepted that CBCT scans should an increased accuracy of 31% compared to
only be requested when there is a potential for CBCT Panoramic radiography in localizing impacted
images to provide new information not provided by maxillary canines. Haney et al [32] compared
conventional radiograph [17]. The cases in which the differences between 2 imaging modali-
diagnosis of impacted teeth is made in initial ties regarding diagnosis and treatment planning
conventional orthodontic records, CBCT might be ofimpacted maxillary canines. Two and three di-
requested as a compliment [17]. Should that be the mensional images of 25 impacted canines were
case, CBCT scan protocols should include a partial evaluated by 7 of their faculty members, and
field of view comprising the maxilla or the mandible, significant disagreement was observed among
only. In the light of this information, the present the evaluators. As a result, they concluded that
study attends to define a correlation between 2D three-dimensional volumetric imaging might
and 3D qualitative analyses, at least when unnece-
provide more accurate information for diagno-
ssary CBCT scans are not requested.
sis and treatment plans. In a similar study carried
The KPG index, introduced in 2009, presents an
out by Alqerban et al [21], OPG and CBCT images
opportunity to localize the impacted canines us-
were obtained from 60 consecutive patients who
ing CBCT. Kau et al [27] carried out a study in 2013
had impacted or ectopically erupting maxillary
to determine the level of agreement of orthodon-
canines, and these images were analyzed by 11
tists in the management of impacted maxillary
examiners. The results of that study showed
canines, and found that the KPG index showed a good
that CBCT was more sensitive than conventional
level of agreement with the clinician’s perception of
radiography for both canine localization and
difficulty. Dalessandri et al [28] investigated the
agreement between OPG based 2D measurements identification of root resorption of adjacent teeth.
and the KPG index on 105 impacted maxillary Altough recent studies have shown that CBCT is
canines. These authors stated that KPG index had the most sensitive and reliable technique in the
higher intra- and interrater agreement than those evaluation of craniofacial structures, as stated
of the 2D index, and that yhe KPG index allows previously, it gives higher radiation doses to the
clinicians to exactly evaluate the position of patients than the conventional radiographs, thus
impacted canines [28]. As for panoramic radiograph, it has not come into use routinely in orthodontic
OPG has been accepted as a standard record in clinics [33]. For this reason, it was necessary to detect
orthodontics. In addition to the clinical examina- possible relationships between Sector classification
tion of the palatal lump, radiographic evaluation is on OPG and 3D KPG index. If a strong relationship
generally needed to identify the positions of is detected between them, OPG can be used safely
impacted canines. With a low radiation dose, OPG in impacted canine cases. The results of the present
provides an overview of all dentoskeletal structures, study showed that KPG indexes 1, 3, and 4 mostly
but several factors, such as superimposition of the matched panoramic Sectors 1, 4, and 5, respective-
structures and inadequate visualization of anterior ly, and that KPG index 2 matched Sector 2 and 3.
maxilla in horizontal and vertical planes, affect the According to these results, it could be said that the
image quality of the panoramic radiograph. Sector Sector analysis is largely compatible with the KPG
classification, carried out on OPG, is a very important index.
diagnostic tool used in the evaluation of impact- The accurate diagnosis of exact canine position, po-
ed canines [10,13,29]. Jung et al [15] showed that tential contacts, and root resorptions of the adjacent
labially impacted canines were frequently in teeth may reduce complications during treatment.
Panoramic Sectors 1, 2, and 3, mid-alveolus impacted Jung et al [15] found root resorption in the adjacent
canines in Sector 4, and palatally impacted canines in teeth only in Sectors 3, 4, and 5. Ericson and Kurol [8]
Sector 5. According to these authors, the labiopalatal stated that canines in the Sectors 3, 4, and 5 com-
positions of impacted canines can be predicted by prised 65% of the related root resorptions.
Stoma Edu J. 2021;8(2):106-112 pISSN 2360-2406; eISSN 2502-0285 109
CBCT and panoramic radiography in impacted canines
www.stomaeduj.com
In the present study, all of the root resorptions • KPG indexes 1, 3, and 4 corresponded to panoramic
Original Articles were in Sectors 2, 3, and 4 and in KPG index 2 and Sectors 1, 4, and 5, respectively, while KPG index 2 is
3. There was no resorption case in Sector 5. As related to panoramic Sectors 2 and 3,
can be seen from Table 1, only 3 teeth of 56 im- • Lateral incisor root resorption was seen predomi-
pacted canine teeth were in sector 5, and 2 of nantly in KPG index 2 and 3, and in Sectors 2, 3, and 4.
them matched KPG index 4. This means that the • Score 1 and 2 for both KPG index and Sector cla-
canines in Sector 5 have a deep localization. But it ssification showed mid-alveolar impaction; score
should not be passed on without being told; these 3 showed labial impaction for both evaluation
are a rather small numbers for drawing reliable groups; and score 2 and 3 in KPG index and 2, 3, and
conclusions about these scores. This fact may
4 in Sector classification were related to palatally
explain the difference between the results of the
impacted canines.
present study and those of Jung et al [15] and
Ericson and Kurol [8]. These results showed that • OPG could help the evaluation of impactedmaxi-
the Sector classification of the impacted canines llary canine cases by providing information related
may help to detect root resorptions at the adjacent to CBCT results.
teeth. If Sector evaluation on OPG is 2 or above,
CONFLICT OF INTEREST
root resorption may have been at the adjacent
The authors declare no conflict of interest.
lateral incisors, and thus CBCT evaluation should
be recommended for detailed examination. The
ACKNOWLEDGMENTS
determination of the labiopalatal positions of the
canine cusp tips was an important issue in the None
diagnosis and treatment planning of impacted
canine cases. This evaluation can be made by FUNDING
Sector classification on OPG or KPG index on The authors declare that they have not received any funding.
CBCT [10,15]. Jung et al [15] evaluated 73 im-
pacted maxillary canines of 63 patients by OPG
COMPETING INTERESTS
and CBCT, and classified them by sector location.
The authors declare that they have no competing interests and
According to their results, 26 out of the 30 labially
impacted canines were located in Sectors 1, 2, and revised the article critically. All authors read and approved the
3, while 15 out of the 23 mid-alveolus impacted final manuscript.
canines and 17 out of the 20 palatally impacted
canines were in Sectors 4 and 5. In the present study, ETHICS APPROVAL AND CONSENT TO PARTICIPATE
roughly half of the labially impacted canines had 3 Written informed consent containing all the information about
KPG and Sector scores. All mid-alveolar impacted
records and usage for study was obtained from all patients. All
canines had scores 1 and 2 in both KPG index and
Sector classification. Of the 33 palatally impacted procedures in this study were approved by the Ethical Board of
canines, 29 teeth were in the KPG index 2 and 3 and the Istanbul Medipol University (108400987-97-86) and com-
in Sectors 2, 3, and 4. These results suggest that plied with the Code of Ethics of the World Medical Association
sector location on OPG could help to predict the (Declaration of Helsinki).
labiopalatal positions of the impacted canines as it is
done by KPG index on CBCT. AUTHOR CONTRIBUTIONS
SA: contributed to the concept and design of the study, to the
5. CONCLUSIONS
acquisition, analysis and interpretation of the data and drafting
The results of the present study can be summarized the article. HO: participated by critically revising the article. All
as follows: authors read and approved the final manuscript.
REFERENCES
1. da Silva Santos LM, Bastos LC, Oliveira-Santos C, et al. Cone- tomographs. J Orofac Orthop. 1999;60 (3):177-184. https://doi.
beam computed tomography findings of impacted upper org/10.1007/bf01365264
canines. Imaging Sci Dent. 2014;44 (4):287-292. https://doi. PubMed Full Text Links Cross Ref Google Scholar Scopus
org/10.5624/isd.2014.44.4.287 6. Almuhtaseb E, Mao J, Mahony D, et al. Three-dimensional
PubMed Google Scholar localization of impacted canines and root resorption assessment
2. Thilander B, Jakobsson SO. Local factors in impaction of using cone beam computed tomography. J Huazhong Univ Sci
maxillary canines. Acta Odontol. Scand. 1968;26(2):145-168. Technolog Med Sci. 2014;34 (3):425-430. https://doi.org/10.1007/
https://doi.org/10.3109/00016356809004587 s11596-014-1295-z
PubMed Full Text Google Scholar Scopus PubMed Full Text Links CrossRef Google Scholar Scopus WoS
3. Walker L, Enciso R, Mah J. Three-dimensional localization of 7. Stewart JA, Heo G, Glover KE, Williamson PC, Lam EW, Major
maxillary canines with cone-beam computed tomography. Am PW. Factors that relate to treatment duration for patients with
J Orthod Dentofacial Orthop. 2005;128 (4):418-423. https://doi. palatally impacted maxillary canines. Am J Orthod Dentofacial
org/10.1016/s0084-3717(08)70464-1 Orthop. 2001;119 (3):216-225. https://doi.org/10.1067/
PubMed Full Text Cross Ref Google Scholar Scopus WoS mod.2001.110989
4. Rossini G, Cavallini C, Cassetta M, et al. Localization of
PubMed Full Text Links CrossRef Google Scholar Scopus WoS
impacted maxillary canines using cone beam computed
8. Ericson S, Kurol J. Early treatment of palatally erupting
tomography. Review of the literature. Ann. Stomatol. (Roma).
2012;3 (1):14-18. https://doi.org/10.1016/j.tripleo.2007.01.030 maxillary canines by extraction of the primary canines. Eur
PubMed Full Text Links Google Scholar WoS J Orthod. 1988;10 (4):283-295. https://doi.org/10.1093/
5. Freisfeld M, Dahl IA, Jager A, et al. X-ray diagnosis of impacted ejo/10.4.283
upper canines in panoramic radiographs and computed PubMed Full Text Links CrossRef Google Scholar Scopus WoS
110 Stoma Edu J. 2021;8(2):106-112 pISSN 2360-2406; eISSN 2502-0285
Akan S, et al.
www.stomaeduj.com
9. Crescini A, Nieri M, Buti J, et al. Orthodontic and periodontal (DAP) in dentistry. Dentomaxillofac Radiol. 2014;43(5):20130439.
Original Articles
outcomes of treated impacted maxillary canines. Angle Orthod. https://doi.org/10.1259/dmfr.20130439
2007;77(4):571-577. https://doi.org/10.2319/080406-318.1 PubMed Full Text Links CrossRef Google Scholar WoS
PubMed CrossRef Google Scholar WoS 24. Kadesjö N, Lynds R, Nilsson M, Shi XQ. Radiation dose from
10. Lindauer SJ, Rubenstein LK, Hang WM, et al. Canine impaction X-ray examinations of impacted canines: cone beam CT vs two-
identified early with panoramic radiographs. J Am Dent Assoc. dimensional imaging. Dentomaxillofac Radiol. 2018;47:20170305.
1992;123(3):91-92, 95-97. https://doi.org/10.1259/dmfr.20170305
https://doi.org/10.14219/jada.archive.1992.0069 PubMed Full Text Links Google Scholar
PubMed Full Text Links CrossRef Google Scholar Scopus WoS
25. Lee CYS, Koval TM, Suzuki JB. Low-dose radiation risks of
11. Warford JH, Jr., Grandhi RK, Tira DE. Prediction of maxillary
canine impaction using sectors and angular measurement. Am computerized tomography and cone beam computerized
J Orthod Dentofacial Orthop. 2003;124(6):651-655.https://doi. tomography: Reducing the Fear and Controversy. J Oral
org/10.1016/s0889-5406(03)00621-8 Implantol. 2015; 41(5): e223–e230. https://doi.org/10.1563/AAID-
PubMed Full Text Links CrossRef Google Scholar Scopus WoS JOI-D-13-00221
12. Leonardi M, Armi P, Franchi L, Baccetti T. Two interceptive PubMed Full Text Links CrossRef Google Scholar Wos
approaches to palatally displaced canines: a prospective 26. Sonawane AU, Sunil Kumar JV, Singh M, Pradhan AS.
longitudinal study. Angle Orthod. 2004;74(5):581-586. https://doi: Suggested diagnostic reference levels for paediatric X-ray
10.1043/0003-3219(2004)074<0581:TIATPD>2.0.CO;2. examinations in India. Radiat Prot Dosimetry. 2011;147(3):423-
PubMed Google Scholar Scopus WoS 428. https://doi.org/10.1093/rpd/ncq458
13. Baccetti T, Leonardi M, Armi P. A randomized clinical study of PubMed Full Text Links CrossRef Google Scholar Scopus WoS
two interceptive approaches to palatally displaced canines. Eur J 27. Kau CH, Lee JJ, Souccar NM. The validation of a novel index
Orthod. 2008;30(4):381-385. https://doi.org/10.1093/ejo/cjn023 assessing canine impactions. Eur J Dent. 2013;7(4):399-404.
PubMed Full Text Links CrossRef Google Scholar ScopusWoS https://doi.org/10.4103/1305-7456.120648
14. Alessandri Bonetti G, Zanarini M, Danesi M, et al. Percentiles PubMed Full Text Links CrossRef Google Scholar Scopus
relative to maxillary permanent canine inclination by age: a 28. Dalessandri D, Migliorati M, Visconti L, et al. KPG index
radiologic study. Am J Orthod Dentofacial Orthop. 2009;136
versus OPG measurements: a comparison between 3D and
(4):486 e481-486; discussion 486-487.https://doi.org/10.1016/j.
ajodo.2009.01.022 2D methods in predicting treatment duration and difficulty
PubMed Full Text Links CrossRef Google Scholar Scopus WoS level for patients with impacted maxillary canines. Biomed Res
15. Jung YH, Liang H, Benson BW, et al. The assessment of Int. 2014;2014:537620.https://doi.org/10.1155/2014/537620
impacted maxillary canine position with panoramic radiography PubMed Full Text Links CrossRef Google Scholar Scopus WoS
and cone beam CT. Dentomaxillo fac Radiol. 2012;41(5):356-360. 29. Olive RJ. Factors influencing the non-surgical eruption of
https://doi.org/10.1259/dmfr/14055036 palatally impacted canines. Aust Orthod J. 2005;21(2):95-101.
PubMed Full Text Links CrossRef Google Scholar Scopus WoS PubMed Google Scholar Scopus
16. Mah JK, Danforth RA, Bumann A, Hatcher D. Radiation 30. Sosars P, Jakobsone G, Neimane L, Mukans M. Comparative
absorbed in maxillofacial imaging with a new dental computed analysis of panoramic radiography and cone-beam computed
tomography device. Oral Surg Oral Med Oral Pathol Oral Radiol tomography in treatment planning of palatally displaced
Endod. 2003;96(4):508-513. https://doi.org/10.1016/s1079- canines. Am J Orthod Dentofacial Orthop. 2020;157(5):719-727.
2104(03)00350-0 doi: 10.1016/j.ajodo.2019.12.012.
Pubmed Full Text Links CrossRef Google Scholar Scopus WoS PubMed Full Text Links Google Scholar
17. The SEDENTEXCT Project. Radiation Protection: Cone Beam CT 31. Mohammed AK, Sravani G, Vallappareddy D, et al. Localization
for Dental and Maxillofacial Radiology. Evidence Based Guidelines. of impacted canines - a comparative study of computed
Luxembourg: European Commission; 2011:1-139.
tomography and orthopantomography.
18. Kau CH, Pan P, Gallerano RL, English JD. A novel 3D
classification system for canine impactions--the KPG index. Int J J Med Life. 2020;13(1):56-63. doi: 10.25122/jml-2020-0001.
Med Robot. 2009;5(3):291-296. https://doi.org/10.1002/rcs.260 PubMed Full Text Links Google Scholar
PubMed CrossRef Google Scholar Scopus WoS 32. Wriedt S, Jaklin J, Al-Nawas B, Wehrbein H. Impacted upper
19. Becker A, Chaushu G, Chaushu S. Analysis of failure in the canines: examination and treatment proposal based on 3D
treatment of impacted maxillary canines. Am J Orthod Dentofacial versus 2D diagnosis. J Orofac Orthop. 2012;73(1):28-40. https://
Orthop. 2010;137(6):743-754. https://doi.org/10.1016/j. doi.org/10.1007/s00056-011-0058-8
ajodo.2008.07.022 PubMed Full Text Links CrossRef Google Scholar Scopus
PubMed Full Text Links CrossRef Google Scholar Scopus WoS 33. Pittayapat P, Willems G, Alqerban A, et al. Agreement between
20. Botticelli S, Verna C, Cattaneo PM, et al. Two- versus three- cone beam computed tomography images and panoramic
dimensional imaging in subjects with unerupted maxillary radiographs for initial orthodontic evaluation. Oral Surg Oral
canines. Eur J Orthod. 2011;33(4):344-349. https://doi. Med Oral Pathol Oral Radiol. 2014;117(1):111-119.https://doi.
org/10.1093/ejo/cjq102 org/10.1016/j.oooo.2013.10.016
PubMed Full Text Links CrossRef Google Scholar Scopus WoS PubMed Full Text Links CrossRef Google Scholar
21. Alqerban A, Jacobs R, Fieuws S, Willems G. Comparison of two 34. Haney E, Gansky SA, et al. Comparative analysis of traditional
cone beam computed tomographic systems versus panoramic radiographs and cone-beam computed tomography volumetric
imaging for localization of impacted maxillary canines and
images in the diagnosis and treatment planning of maxillary
detection of root resorption. Eur J Orthod. 2011;33(1):93-102.
https://doi.org/10.1093/ejo/cjq034 impacted canines. Am J Orthod Dentofacial Orthop. 2010;137
PubMed Full Text Links CrossRef Google Scholar Scopus WoS (5):590-597.https://doi.org/10.1016/j.ajodo.2008.06.035
22. Roberts JA, Drage NA, Davies J, Thomas DW. Effective dose PubMed Full Text Links CrossRef Google Scholar Scopus WoS
from beam CT examinations in dentistry. Br J Radiol. 2009;82 35. Serrant PS, McIntyre GT, Thomson DJ. Localization of ectopic
(973):35-40. https://doi.org/10.1259/bjr/31419627 maxillary canines -- is CBCT more accurate than conventional
PubMed Full Text Links CrossRef Google Scholar Scopus WoS horizontal or vertical parallax? J Orthod. 2014;41(1):13-18.https://
23. Shin HS, Nam KC, Park H, et al. Effective doses from panoramic doi.org/10.1179/1465313313y.0000000076
radiography and CBCT (cone beam CT) using dose area product PubMed CrossRef Google Scholar
Stoma Edu J. 2021;8(2): 106-112 pISSN 2360-2406; eISSN 2502-0285 111
CBCT and panoramic radiography in impacted canines
www.stomaeduj.com
Original Articles Seden AKAN
Department of Orthodontics
Faculty of Dentistry
Altınbaș University
Bakırköy / İstanbul, Turkey
CV
Seden Akan graduated from the Hacettepe University, Faculty of Dentistry, Ankara, Turkey in 2003. She enrolled on her PhD
degree in 2004 and she was awarded her PhD degree by the Hacettepe University in 2010. Since 2018, she has been working as
an assistant professor at the Department of Orthodontics within the Faculty of Dentistry of the Altınbaș University.
Questions
1. Which is the most common clinical approach used by orthodontists to determine the
impacted canine position?
qa. Panoramic radiography;
qb. CBCT;
qc. Periapical radiography;
qd. Bite wing radiography.
2. According to the SEDENTEXT Project, in which cases it is indicated to have a CBCT
records?
qa. In every impacted canine patient;
qb. In case inadequate information is obtained from conventional radiographs about impacted canines;
qc. Only adult patients with impacted canine;
qd. Answers a-d are correct.
3. The aim of the present study to evaluate?
qa. The efficiency of the CBCT to determine the impacted canine position;
qb. The efficiency of the Panoramic radiographs to determine the impacted canine position;
qc. The capacity of the impacted canine to resorb the root of the lateral tooth;
qd. Thecorrelation between effectiveness of KPG index and sector classification.
4. According to the present study results, in which common regions was the lateral tooth
root resorption found in the KPG and Sector analysis?
qa. 1;
qb. 2 and 3;
qc. 4;
qd. 1 and 2.
112 Stoma Edu J. 2021;8(2):106-112 pISSN 2360-2406; eISSN 2502-0285