Orthodontic radiology: development of a clinical practice guideline

Abstract

Objectives Radiographs are considered essential in orthodontics. However, their diagnostic value and indications for use are still uncertain, while exposure to radiation carries health risks. This study aimed to report on the development of a clinical practice guideline on orthodontic radiology. Methods A Guideline Development Taskforce was set up. The GRADE methodology was used for development and the RIGHT Statement for reporting of the guideline. We systematically reviewed articles to address the main clinical question: how different types of radiographs contribute to orthodontic diagnosis, treatment planning and post-treatment outcome evaluation. After a literature search and data extraction, we formulated conclusions and assessed the strength of the evidence according to the GRADE method. Both literature conclusions and the most important considerations, such as patient preferences, organizational matters and expert opinions were taken into account to finally issue recommendations. Results 7 clinical questions focused on orthopantomograms, lateral cephalograms, hand-wrist radiographs, peri-apical radiographs, bitewings, antero-occlusal radiographs, and cone-beam computer tomographic imaging. The literature search lead to 484 unique studies, of which 17 were included in the analysis. The strength of evidence of the conclusions was graded low or very low. We formulated considerations and took them into account when issuing the 13 clinical recommendations to address the clinical questions. Conclusions There was a considerable lack of scientific evidence on this topic. Nonetheless, this guideline provides clinicians with a tool for decision-making regarding radiographic records while enhancing patient radiation protection. More research of higher quality is recommended for a future update.

Precision of orthodontic cephalometric measurements on ultra low dose-low dose CBCT reconstructed cephalograms

“…The routine need of a lateral cephalogram for orthodontic diagnosis and treatment planning has been questioned because the availability of a cephalometric radiograph and analysis did not influence treatment decisions in adolescents with a class II division 1 malocclusion [23][24][25]. The diagnostic added value of CBCTs besides the traditional PAN and LC for orthodontic purposes is not yet clear and so far there is only evidence for its effectiveness in the diagnosis of impacted canines [1,3,[5][6][7]23]. On the other hand, as stated in the "Introduction" section of this paper, CBCTs in general contain more information with less over-projection than a single PAN, so visibility of structures is better on a CBCT than on a conventional PAN [2].…”

“…Until recently, only in selected cases, the need for more diagnostic information allowed the use of a small field of view cone beam computed tomography scan (CBCT) because it adds to the total radiological dose [1][2][3][4][5][6][7]. Several studies compared the effective doses of different digital radiographic methods with CBCT measured for different devices.…”

Interventions for impacted maxillary canines: A systematic review of the relationship between initial canine position and treatment outcome

“…A recent systematic review comparing CBCT and conventional radiography for localization of maxillary impacted canines concluded, though without strong evidence, that CBCT imaging is more effective in depicting the precise position of the impacted tooth in cases in which 2D imaging is insufficient 20 . De Grauwe et al and Kapetanovic et al agreed that the use of CBCT is justified only in cases in which conventional radiography fails to provide accurate diagnosis of pathology 43,44 . However, one should also consider that, in more than half of the cases, CBCT is not used for mere diagnosis.…”

“…However, one should also consider that, in more than half of the cases, CBCT is not used for mere diagnosis. In relation to canine impaction, CBCT is used more to assess complications (canine ankylosis and root resorption of neighbouring teeth) and allow for minimally invasive surgery 43,44 …”

“…20 De Grauwe et al and Kapetanovic et al agreed that the use of CBCT is justified only in cases in which conventional radiography fails to provide accurate diagnosis of pathology. 43,44 However, one should also consider that, in more than half of the cases, CBCT is not used for mere diagnosis. In relation to canine impaction, CBCT is used more to assess complications (canine ankylosis and root resorption of neighbouring teeth) and allow for minimally invasive surgery.…”