Συχνότητα του οστικού παραθύρου σε ελληνικό υποπληθυσμό- Αξιολόγηση με υπολογιστική τομογραφία κωνικής δέσμης
Creators: name: Καλαϊτζόγλου, Μαρία-Ελπίδα Α.
Publisher: name: Aristotle University of Thessaloniki
Year: 2020
Subjects: Υπολογιστική Τομογραφία Κωνικής Δέσμης
Οστικό παράθυρο
Cone Beam Computed Tomography
Root fenestration

description: Σκοπός: Η αξιολόγηση της συχνότητας του οστικού παραθύρου (ΟΠ) σε υγιή, ακέραια δόντια και η ανάλυση των χαρακτηριστικών του σε ελληνικό υποπληθυσμό με τη χρήση υπολογιστικής τομογραφίας κωνικής δέσμης (ΥΤΚΔ). Υλικά &amp; Μέθοδος: Αξιολογήθηκαν 432 υψηλής ανάλυσης ανώνυμα αντίγραφα σαρώσεων ΥΤΚΔ (203 άνω και 229 κάτω γνάθοι) και τα αντίστοιχα ιστορικά των ασθενών. Περιπτώσεις με γναθοπροσωπικό τραύμα, συγκλεισιακές ανωμαλίες και ιστορικό ορθοδοντικής θεραπείας αποκλείονταν από το δείγμα. Μόνο υγιή και ακέραια δόντια περιλαμβάνονταν στην καταγραφή των αποτελεσμάτων. 5486 δόντια (2436 άνω και 3050 κάτω) αξιολογήθηκαν για την παρουσία ΟΠ στο εγκάρσιο και μετωπιαίο επίπεδο. 25 περιστατικά επαναξιολογήθηκαν για τον έλεγχο της ενδοβαθμολογικής αξιοπιστίας. Καταγράφηκαν ο επιπολασμός και η κατανομή του ΟΠ σε κάθε γνάθο, η οδοντική ομάδα, καθώς και το φύλο και η ηλικία του ασθενούς. Τα ΟΠ αξιολογήθηκαν ως προς την συμμετρική τους κατανομή στον ίδιο ασθενή και κατηγοριοποιήθηκαν σύμφωνα με το τριτημόριο της ρίζας στο οποίο εμφανίζονταν. Εξετάστηκε και η ύπαρξη συσχέτισης του επιπολασμού του ΟΠ με το φύλο και την ηλικία του ασθενούς. Αποτελέσματα: Ο συνολικός επιπολασμός του ΟΠ στο δείγμα ήταν 3.35% (3.28% για την άνω και 3.41% για την κάτω γνάθο). Σχετικά με την άνω γνάθο, ο επιπολασμός ανά οδοντική ομάδα κυμαινόταν από 0.57% (κεντρικός τομέας) έως 7.18% (πρώτος προγόμφιος), ενώ στην κάτω γνάθο από 0.48% (δεύτερος προγόμφιος) έως 10.79% (πλάγιος τομέας). Τα ΟΠ καταγράφηκαν κυρίως στην παρειακή/προστομιακή επιφάνεια του οστού. Δε βρέθηκε στατιστικά σημαντική διαφορά στη συχνότητα των ΟΠ μεταξύ δοντιών των δύο ημιμορίων και για τις δύο γνάθους, αλλά ούτε και συμμετρική κατανομή του ΟΠ στο δείγμα. Στους περισσότερους ασθενείς που εκδηλώθηκε το φαινόμενο, καταγράφηκαν ένα ή δύο ΟΠ και για τις δύο γνάθους. Οι τύποι Ι και IV (ΟΠ ακρορριζίου) ήταν πιο συχνοί στην άνω γνάθο, ενώ οι τύποι III, II και V (ΟΠ επιφάνειας της ρίζας) ήταν πιο συχνοί στην κάτω γνάθο. Και στις δύο γνάθους, δε βρέθηκε στατιστικά σημαντική διαφορά μεταξύ των διαφορετικών φύλων και ηλικιακών κατηγοριών. Η ενδοβαθμολογική αξιοπιστία ήταν πάρα πολύ υψηλή. Συμπεράσματα: Στην άνω γνάθο, τα ΟΠ παρατηρούνται κυρίως στο ακρορριζικό τριτημόριο των δοντιών και εμφανίζονται συχνότερα στους πρώτους προγομφίους, ενώ στην κάτω γνάθο παρουσιάζονται κυρίως το μέσο και το αυχενικό τριτημόριο της ρίζας, με υψηλότερη συχνότητα στους πλάγιους τομείς.
description: Introduction: Root fenestration (RF) is a type of alveolar defect, which due to its frequency, is considered a non-pathological condition. It is defined as a window-like opening or defect in the alveolar plate of bone, not involving the alveolar margin, frequently exposing a portion of the root. Clinically, it can present itself through a wide range of symptoms, as patients can be asymptomatic, or experience persistent pain. RF is a condition which is difficult to be diagnosed in clinical practice, since it cannot be depicted in intraoral radiographs, which is the standard of radiologic examination in dental offices. If left undiagnosed, its unexpected presence may complicate and jeopardize a routine dental procedure. Cone-beam computed tomography (CBCT) is a well-documented imaging modality, which produces three-dimensional representation of the maxillofacial skeleton. It is considered the only technique that provides the necessary details to evaluate the thickness and integrity of the cortical plates, as well as the presence of RF. The aim of the present study was to assess the frequency of RF in healthy, intact teeth and analyze their features in a Greek subpopulation using CBCT. Materials &amp; Methods: Anonymous copies of high resolution CBCT scans and corresponding patient records of 432 (203 maxillae and 229 mandibles) patients were assessed; those with trauma, malocclusions and history of orthodontic treatment were excluded. Only healthy and intact teeth were included in the analysis. 5486 (2436 maxillary and 3050 mandibular) teeth were evaluated for the prevalence of RF in the axial and coronal planes .25 of the scans were reassessed to evaluate the intra-rater reliability. CBCT images were captured by a CBCT scanner at 110 kV, 4.77- 29.84 mA. The voxel size and slice thickness of the images was 0.125 mm. Image acquisition was performed in accordance with standardized procedures by a trained radiology technician. Αn expert panel composed of experienced on CBCT interpretation dentists determined assessment guidelines for the presence of RF in the CBCT scans, through consideration of the available literature. Prior to conducting the study, the primary investigator was trained on the assessment guidelines of RF by practicing on the guidelines’ application on at least 20 cases of RF. The primary investigator evaluated the rest of the cases in assessment sessions of 90 min with 2-days intervals between them. When in doubt, the case was evaluated along with the expert panel, until consensus was reached. The prevalence, distribution of RF in each jaw, tooth type and patient age and gender were recorded. RFs were evaluated to establish the symmetry between right and left side of the same patient and were categorized according to the surface of the root which was affected according to six types: Type I: Protrusion of the apical one-third of the root regardless of whether the apical foramen or anatomical apex is involved; Type II: Protrusion of the middle one-third of the root; Type III: Protrusion of the coronal one-third of the root but excluding the alveolar margin; Type IV: Protrusion of the apical and middle parts of the root regardless of whether the apical foramen or apical apex is involved but excluding the coronal one-third of the root; Type V: Protrusion of the middle and coronal part of the root without involvement of the alveolar margin but excluding the apical one-third of the root; Type VI: Protrusion of the whole root but excluding the alveolar margin. The effects of age and gender on the prevalence of RFs were also examined. Results The overall prevalence of RF was 3.35% (3.28% for the maxilla and 3.41% for the mandible). Regarding the maxilla, the prevalence ranged from 0.57% (central incisor) to 7.18% (first premolar) and the mandible from 0.48% (second premolar) to 10.79% (lateral incisor). Out of 26 (7.18%) maxillary first premolars with RF, one was three-rooted and a RF was located in the mesiobuccal root. Out of 14 (4.22%) maxillary first molars with RF, 11 involved the mesiobuccal and 3 the distobuccal root. Out of 6 (1.75%) maxillary second molars with RF, 4 involved the distobuccal root, 1 the palatal and there was one rare case of RF of a third buccal root which was located between the other two. For the mandibles, 49 (10.79%) lateral incisors presented with RF and in 7 of them the root protruded from the lingual side of the bone. Two (0.49%) mandibular first molars showed RF and in both it occurred in the mesial root. Four (0.97%) mandibular second molars presented RF and in all of them it occurred in the mesial root, which protruded from the lingual side of the bone. RFs were mainly found in the buccal/labial aspect of the bone. No statistical difference was detected in the frequency of RFs between the two halves for both jaws, without a symmetrical occurrence of RF. Most patients with RF, presented with one or two defects in both jaws. Types I and IV (root apical fenestrations) were the most prevalent in the maxilla, while Types III, II and V (root surface fenestrations) were the most prevalent in the mandible. In both jaws, no statistical difference could be detected between different genders and age groups. The intra-rater reliability was excellent. Conclusions The CBCT assessment of healthy, intact teeth in a Greek subpopulation revealed that RF exists as a primary condition, which must be carefully evaluated, as it can change individual tooth prognosis and the treatment plan. For the maxillae, RFs were found mainly at the root apex of the teeth and were most prevalent in first premolars, while in the mandibles, RFs occurred more frequently as root surface fenestrations and occurred most often in lateral incisors.