Mandibular asymmetry: A proposal of radiographic analysis with public domain software

Abstract

ObjectiveThis preliminary study aimed to propose a new analysis of digital panoramic radiographs for a differential diagnosis between functional and morphological mandibular asymmetry in children with and without unilateral posterior crossbite.MethodsAnalysis is based on linear and angular measurements taken from nine anatomic points, demarcated in sequence directly on digital images. A specific plug-in was developed as part of a larger public domain image processing software (ImageJ) to automate and facilitate measurements. Since panoramic radiographs are typically subject to magnification differences between the right and left sides, horizontal linear measurements were adjusted for greater accuracy in both sides by means of a Distortion Factor (DF). In order to provide a preliminary assessment of proposed analysis and the developed plug-in, radiographs of ten patients (5 with unilateral posterior crossbite and 5 with normal occlusion) were analyzed.ResultsConsiderable divergence was found between the right and left sides in the measurements of mandibular length and position of condyles in patients with unilateral posterior crossbite in comparison to individuals with normal occlusion.ConclusionAlthough there are more effective and accurate diagnostic methods, panoramic radiography is still widespread, especially in emerging countries. This study presented initial evidence that the proposed analysis can be an important resource for planning early orthodontic intervention and, thus, avoid progression of asymmetries and their consequences.

TMD symptoms and vertical mandibular symmetry in young adult orthodontic patients in North Sumatra, Indonesia: a cross-sectional study

“…However, there was no significant difference (p=0.502) in TMD symptoms based on the presence or absence of vertical mandibular symmetry ( Table 3) since TMD the etiology of TMD is multidimensional 35 and asymmetry of condylar width, height and length as common features in TMD based on 3D-computed tomography 36, 37 . Indonesia, as a developing country, still uses panoramic digital radiography as initial evidence for planning early orthodontic intervention and avoiding the progression of asymmetries 38 .…”

The influence of crossbite in early development of mandibular bone asymmetries in paediatric patients

“…There are few studies in the literature that evaluate asymmetry and possible quantifiable skeletal changes at an early age using routine x-ray projections such as orthopantomography (10,21). Some research done on children does not specify their real age (10,15).…”

“…Different authors have tried to evaluate and determine the precision of images and measurements of the mandible using orthopantomography (6-10). They have also studied the possibility of using these images as an aid in diagnosing pathologies such as hyperplasia of the coronoid process and condylo-mandilbular asymmetry, among others (10-16).…”

“…They have also studied the possibility of using these images as an aid in diagnosing pathologies such as hyperplasia of the coronoid process and condylo-mandilbular asymmetry, among others (10-16). …”

Prevalencia de Asimetrías Mandibulares en Radiografías Panorámicas de Población de Bogotá-Colombia

“…Algunos autores han atribuido las asimetrías en la rama y cón-dilo en los niños y adolescentes, al déficit de crecimiento en el lado que presenta trastornos de la articulación temporomandibular (Ramirez-Yañez et al), mientras que en aquellos con mordidas cruzadas posteriores, se evidencia que existen diferencias derechas e izquierdas, en las mismas medidas tomadas en este estudio (Lemos et al, 2014). En los adultos, las mediciones verticales de cóndilo y rama mandibular, utilizando la misma fórmula de Bezuur con punto de corte entre +3 % y -3 %, probaron asimetría solamente en 8 de 100 cráneos analizados radiográficamente, concluyendo que la diferencia en las medidas condilares puede ser una de las principales causas de la patología del aparato estomatognático (Boratto et al) y es evidente que el desbalance oclusal, puede inducir a cambios morfológicos condilares, como una respuesta adaptativa de la mandíbula, resultado del remodelado óseo y la función muscular (Wang et al, 2011).…”