Quantitative Analysis of the Relationship between Maxillary Incisors and the Incisive Canal by Cone-Beam Computed Tomography in an Adult Population of Mangaluru

Vaishnavi D; Harshitha V; Kishore K

Research Article

Austin J Dent. 2021; 8(2): 1156.

Quantitative Analysis of the Relationship between Maxillary Incisors and the Incisive Canal by Cone-Beam Computed Tomography in an Adult Population of Mangaluru

Vaishnavi D*, Harshitha V and Kishore K

Department of Orthodontics, A J Institute of Dental Sciences, Mangaluru, India

*Corresponding author: D Vaishnavi, A J Institute of Dental Sciences, Mangaluru, A J Resident hostel, kuntikana, Mangaluru PC: 575004, India

Received: June 04, 2021; Accepted: July 09, 2021; Published: July 16, 2021

Abstract

Background: Maxillary anterior teeth play a crucial role in aesthetics, phonetics, and mastication. For successful orthodontic treatment evaluating the morphology of the alveolar bone and incisive canal would help in avoiding root resorption, dehiscence, and fenestration. This study is aimed to research the configurational relationships among maxillary incisors, alveolar bone, and incisive canal through Cone Beam Computerated Tomography (CBCT).

Methods: CBCT images of 35 orthodontic patients were evaluated for length of the canal (L); angles between the palatal plane and the maxillary alveolar border (01),the incisive canal (02), and maxillary incisor (03); distance from the right maxillary incisor to the incisive canal (D). All the measurements were performed on sagittal plane with the exception of (D) which was made on axial plane. Statistical analysis was performed on the above parameters using two sample test and Pearson’s correlation analysis.

Results: There was no statistically significant difference between males and females for all the variables although there were large interindividual variation. There was a positive moderate correlation between 01 and 02 (0.480), 01 and 03 (0.487), 02 and 03 (0.345). The mean value for L and D were 10.38mm and 4.14mm respectively.

Conclusion: There exists a large interindividual variability for incisive canal, proximity of incisors with that of incisive canal which could not be precisely predicted by the conventional cephalograms. The results of the study could be helpful clinically in planning orthodontic treatment for significant intrusion and retraction of maxillary incisors.

Introduction

While not specifically in the Hippocratic Oath, primum non nocere is believed to be derived from it and means first, do no harm or above all else, do no harm. In other words, before you do anything to a patient, make sure that you are not making matters worse. What good does it do to straighten teeth if in doing so you cause the patient to lose them? [1].With regard to maxillary incisor movement, Ackerman et al. presented the concept of “envelope of discrepancy” [2], which describes the limitations of the range of orthodontic movement of the maxillary incisor [3]. Contact with hard tissue structures, such as the labial, palatal, or incisive canal cortical plates, is a risk factor for apical root resorption in the maxillary incisor [4-6], and it is one of the iatrogenic complications of orthodontic treatment. The incisive canal is an anatomic structure that runs posterior and more close to the roots of the central incisors in the median plane of the palatine process of the maxilla, surrounded by thick cortical bone [5,6]. It connects the floor of the nasal cavity with the palate and opens into the oral cavity as incisive foramen. It runs parallel to the maxillary central incisors and transmits nasopalatine vessels and nerves, branches of the maxillary division of the trigeminal nerve, and the maxillary artery [7]. Because of proximity of incisive canal to the maxillary incisors, the surgical invasion and its complications of the incisive canal during dental procedures in maxillary incisor region can cause nonosseointegration of dental implants or sensory dysfunction [8,9]. The precise location of incisive canal in reference to the maxillary incisors isn’t well documented within the orthodontic literature due to the difficulties in detecting incisive canal morphology using conventional twodimensional radiographs.

The objective of this study was to evaluate the morphologic features and the relationship between roots of maxillary incisors and the incisive canal using Cone Beam Computed Tomography (CBCT).

Materials and Methods

Subjects

The study was carried out on the patients visiting the outpatient section of the Department of Orthodontics and Dentofacial Orthopaedics, AJ Institute of dental sciences, Mangaluru. CBCT scans were taken for those who required CBCT for diagnosis and treatment planning. The inclusion criteria include patients having lateral cephalogram, normal anteroposterior skeletal relationship (ANB of 0°- 4°), normal overjet and overbite with Class I molar relationship. The exclusion criteria were history of orthodontic treatment, missing or supernumerary maxillary incisors, prosthesis in relation to maxillary incisors, history of trauma to maxillary incisors, and congenital anomalies like cleft lip and palate. Based on the inclusion and exclusion criteria, 35 subjects were selected.

Methods

The data was obtained using NewTom GiANO NNT Scanner with the patient in upright position and head positioned along the Frankfort horizontal plane, running parallel to the floor. All the scans were taken using the same machine by the same operator. The operating parameters were set at 3mA and 90kV, dose of 80- 100 μSv and the scan time of 9 seconds. All CBCT images were taken using a large dentoalveolar field of view. It was determined that the sagittal plane was perpendicular to the axial plane and parallel to the plane passing through anterior nasal spine and posterior nasal spine.

CBCT images of 35 orthodontic patients were evaluated for the following measurements

• Length of the canal (L).

• Angles between the palatal plane and the maxillary alveolar border (01) the incisive canal (02) the maxillary incisor (03).

• Distance from the right maxillary incisor to the incisive canal (D) (Figure 1).

Figure 1:

    
    
    Figure 1:

Results

Mean values of the variables (descriptive statistics)

See Table 1.

Table 1:




  
    
    Mean
    Std. Deviation
  
  
    theta1
    136.388
    7.86421
  
  
    theta2
    108.105
    10.81246
  
  
    theta3
    114.666
    10.43686
  
  
    Length of incisive canal
    10.3857
    3.11015
  
  
    distance of the right maxillary incisor to the    incisive canal
    4.1486
    0.86581



Table 1:

Table 2:




  
    
    Correlation coefficient
    ‘p’ value
  
  
    theta 1 vs theta 2
    0.48
    0.004
  
  
    theta 1 vs theta 3
    0.487
    0.003
  
  
    theta 2 vs theta 3
    0.345
    0.043



Table 2:

Pearson’s correlation test:

• Correlation between theta 1 and theta 2 is highly statistically significant (p=0.004). There is a positive moderate correlation between theta 1 and theta 2 (0.480).

• Correlation between theta 1 and theta 3 is highly statistically significant (p=0.003). There is a positive moderate correlation between theta 1 and theta 3 (0.487).

• Correlation between theta 2 and theta 3 is statistically significant (p=0.043). There is a positive moderate correlation between theta 2 and theta 3 (0.345) (Table 1 and Figure 2,3).

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Citation: Vaishnavi D, Harshitha V and Kishore K. Quantitative Analysis of the Relationship between Maxillary Incisors and the Incisive Canal by Cone- Beam Computed Tomography in an Adult Population of Mangaluru. Austin J Dent. 2021; 8(2): 1156.

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Quantitative Analysis of the Relationship between Maxillary Incisors and the Incisive Canal by Cone-Beam Computed Tomography in an Adult Population of Mangaluru

Abstract

Introduction

Materials and Methods

Subjects

Methods

Results

Mean values of the variables (descriptive statistics)

Discussion

Conclusion

References