## 4 Discussion
Additionally, [PERSON] et al. (2014) [15] and [PERSON] et al. (2021) [16] discuss the associations between anterior arch hypertrophy and the congenital nonunion of the posterior arch, illustrating the complex interplay of structural variations within the C1 vertebra. Clinical presentations such as cervical myelopathy, as detailed by [PERSON] et al. (2012) [17] and [PERSON] et al. (2009) [18], highlight the importance of early recognition and management to prevent neurological sequelae. Despite the generally benign nature of certain anomalies, as noted by [PERSON] et al. (2007) [19], individualized treatment approaches are essential based on the specific characteristics and clinical context of each case. While Type A APAD is often asymptomatic, conservative management, including physical therapy and pain relief, is effective when symptoms arise. Surgical intervention, such as excision of the defective posterior arch, may be considered for persistent or significant symptoms. This approach can provide relief and prevent further complications [20; 21; 22; 23; 24; 25; 26]. \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Case** & **Age** & **Type of APAD** & **Presence of Ponticulus Posticus** & **Symptoms** & **Management** & **Outcome** \\ \hline
6 & 55 years & Partial APAD & None & Occasional discomfort in neck & Managed with physical therapy; regular follow-up & Symptoms improved; condition stable \\ \hline
7 & 28 years & Partial APAD & None & Mild symptoms; no significant impact & Monitoring; conservative care if symptoms arise & No progression; stable condition \\ \hline
8 & 37 years & Partial APAD & None & Occasional pain; no significant neurological symptoms & Physical therapy and monitoring & Condition stable; no significant changes \\ \hline
9 & 46 years & Partial APAD & None & Mild discomfort; no significant symptoms & Regular follow-up; conservative management if symptoms develop & Stable; no major changes noted \\ \hline
10 & 53 years & Partial APAD & None & Mild neck stiffness; no significant symptoms & Routine monitoring; conservative management & Symptoms stable; no progression observed \\ \hline
11 & 26 years & Partial APAD & None & Minimal symptoms; no impact on daily activities & Regular follow-up; conservative care if needed & Condition stable; no notable progression \\ \hline
12 & 29 years & Partial APAD & None & No significant symptoms & Monitoring; conservative management if symptoms arise & Stable; no significant changes during follow-up \\ \hline
13 & 51 years & Partial APAD & None & Mild neck stiffness; no significant symptoms & Monitoring; conservative management if symptoms arise & Stable; no significant changes during follow-up \\ \hline \hline \end{tabular}
\end{table} 
Table 3: _Cont._Dental professionals play a critical role in the initial detection of APAD, particularly through the use of CBCT. Dental radiographic examinations, which are routine in orthodontic and other dental assessments, may reveal incidental findings of APAD. Awareness of these anomalies among dental practitioners is crucial for timely referral and management [21; 25; 27]. CBCT offers detailed imaging of the atlas arch morphology, allowing for the accurate identification of APAD variants and their associated anomalies. This capability enhances diagnosis and treatment planning, especially in cases where traditional radiographic techniques may be inconclusive. Compared to traditional CT, CBCT uses lower radiation doses while providing high-quality imaging. This reduction in radiation exposure is advantageous for pediatric patients and those requiring repeated imaging. In orthodontic practice, CBCT is commonly used for treatment planning and the assessment of craniofacial structures. Detection of APAD on CBCT can influence orthodontic treatment decisions, ensuring the safety and efficacy of interventions. The effective management of APAD requires collaboration between dental and medical professionals.