Three-dimensional assessment of the alveolar bone defect in unilateral cleft lip and palate patients

Transcription

1 Three-dimensional assessment of the alveolar bone defect in unilateral cleft lip and palate patients Poster No.: C-2009 Congress: ECR 2015 Type: Educational Exhibit Authors: D. Haba, Y. Deçolli, A. Nemtoi, S. Susanu, I. Simion, M. S. C. Haba, R. M. Vreme, A. Petcu; Iasi/RO Keywords: Computer Applications-3D, Cone beam CT, Head and neck, Education and training DOI: /ecr2015/C-2009 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Learning objectives Using CBCT scans to explore the cleft region, its relation with the adjacent structures, and to achieve volumetric assessment of the alveolar bone defect in cleft lip and palate patients. Background 1 Cleft lip and palate (CLP) are among the most common craniofacial malformations. This heterogeneous group of pathologies offers various clinical presentations and 2 requires a multidisciplinary medical approach. CLP patients often undergo several surgical procedures and orthodontic treatment to reconstruct the alveolar arch. With the advancement of maxillofacial imaging, cone beam computed tomography (CBCT) 3,4 has become the three-dimensional imaging procedure of choice for CLP patients. It provides essential information in the preoperative assessment, as well as in the outcome evaluation of various treatment stages by allowing assessing the size, position and the 5 structures involved by the cleft. Findings and procedure details Through the means of imaging software, CBCT scans may be displayed in 3 orthogonal planes (coronal, sagittal and axial) and in a three-dimensional (3D) view that can be moved and rotated (fig. 1). Snapshots of all views may be created and saved as a two-dimensional image (fig. 2). The orientation lines in each slice view may indicate the relations between the orthogonal planes, using their respective colors. This feature helps the evaluation of the structures involved by the cleft, while linear measurements allow assessing its position related to the adjacent structures. One of the most important adjacent structures is the cleft-side maxillary canine (fig. 3). Its position influences the timing of the alveolar bone grafting 6 and the planning of the following orthodontic treatment. Most frequently, the cleft-side lateral incisor congenitally absence is observed (fig. 4). If the cleft-side lateral incisor is present, its development and its position related to the cleft area must be evaluated 7,8,9. Page 2 of 12

3 The Soft Tissue Filter and the Proface option (Romexis Imaging Software, Planmeca, Finland) allow examining the relation between hard and soft tissues involved by the cleft (fig. 5, 6). The Region Grow tool enables the assessment of the estimative volume of the alveolar defect. A cube or an ellipsoid may be drawn, including the limits of the alveolar cleft inside this three-dimensional shape. The measurement of the estimative volume may be calculated, while coloring the area and highlighting its shape (fig. 7, 8). The estimative volume of the alveolar bone defect helps determining the quantity of bone necessary to 10 the alveolar grafting procedure and it may influence the choice of the optimal donor site. Images for this section: Page 3 of 12

4 Fig. 1: Rotated volume in 3D view helps exploring the size of the alveolar defect. Page 4 of 12

5 Fig. 2: Snapshot showing the alveolar bone defect in axial view. Page 5 of 12

6 Fig. 3: Evaluation of the cleft-side maxillary canine proximity to the alveolar cleft using the orientation lines. Page 6 of 12

7 Fig. 4: Congenital absence of the cleft-side lateral incisor in patient with unilateral CLP. Page 7 of 12

8 Fig. 5: Snapshot showing the alveolar bone defect in 3D view with soft tissue filter. Page 8 of 12

9 Fig. 6: Proface image of a CLP patient. Fig. 7: The steps of using the Region Grow tool in measuring the volume of the alveolar bone defect (Romexis Imaging Software, Planmeca, Finland). Page 9 of 12

10 Fig. 8: Estimative volume of the alveolar defect in a patient with unilateral CLP. Page 10 of 12

11 Conclusion CBCT data allow detailed evaluation of the cleft area and a three-dimensional volumetric assessment of the alveolar bone defect, providing essential information to the surgeon and to the orthodontist involved in the reconstruction of the alveolar arch. Personal information References 1. Mossey PA, Little J, Dixon MJ, Shaw WC. Cleft Lip and Palate. The Lancet, Vol. 374, Nov. 21, 2009, pp Vander Kolk CA. Plastic Surgery: Indications, Operations, and Outcomes (Vol. II). St. Louis, Mosby, 2000; pp Oberoi S, Chigurupati R, Gill P, Hoffman WY, Vargervik K. Volumetric assessment of secondary alveolar bone grafting using cone beam computed tomography. Cleft Palate Craniofac J Sep;46(5): doi: / Nemtoi A, Czink C, Haba D, Gahleitner A. Cone beam CT: a current overview of devices. Dentomaxillofac Radiol. 2013;42(8): doi: /dmfr PubMed PMID: ; PubMed Central PMCID: PMC Zhang W, Shen G, Wang X, Yu H, Fan L. Evaluation of alveolar bone grafting using limited cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Apr; 113(4): Yilmaz S, Kilic AR, Keles A, Efeoglu E. Reconstruction of an alveolar cleft for orthodontic tooth movement. American Journal of Orthodontics and Dentofacial Orthopedics 2000; 117 (2): Nouri M, Abdolazimi Z, Badiee MR. Orthodontic treatment of a patient with unilateral cleft lip and palate and congenitally missing maxilary left lateral incisor. Iranian Journal of Orthodontics 2011; 6: Hussein E, van Aalst J, Aksoy A, Mowais MA, Wilson L, Abughazaleh K, Watted N. Cleft lip and palate: the multidisciplinary management 2012; 7(4): Page 11 of 12

12 9. Graber L, Vanarsdall R, Vig K. Orthodontics current principles and tehniques, 5 edition, Elsevier. 2011; th 10. Pinsky H, Dyda S, Pinsky RW, Misch KA, Sarment DP: Accuracy of three-dimensional measurements using CBCT. Dentomaxillofac Radiol 2006:35; Page 12 of 12