Evaluation of Alveolar Bony Trabecular Pattern in Subjects with Crossbite Malocclusion using Intraoral Periapical Radiographs: A Cross-sectional Study

Abstract

Introduction: Trajectories of force determines the trabecular pattern of bone. In transverse malocclusions, force trajectories are altered which can affect the trabecular pattern. Hence, it is important to study the trabecular pattern associated with transverse malocclusions. Aim: Assessment of trabecular pattern changes on Intraoral Periapical Radiographs (IOPA) in subjects with dental crossbites using fractal analysis. Materials and Methods: This cross-sectional study was conducted in Department of Orthodontics at Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India, from October 2021 to December 2021. The study involved 30 IOPAs in 15 patients with unilateral first mandibular molar teeth in crossbite. The sample was divided into two groups. Group A has 15 IOPAs of mandibular molars in crossbite side, group B has 15 IOPAs of mandibular molars not in crossbite. A Region of Interest (ROI) of 256×256 pixels were selected between the roots of the premolar and mandibular molars and converted into an 8-bit image with image J software. Fractal dimensional analysis with box counting was used to assess trabecular perimeter and the trabecular number. Normality of the data was assessed by Shapiro-Wilk test and an Independent t-test was carried out to find intergroup differences. Results: The IOPAs of 15 subjects (9 males and 6 females) were included in the study with mean age of 27±8 years with unilateral mandibular first molar in crossbite. Shapiro-Wilk tests p-values was not significant (p-value >0.05) for both groups ensuring normality of data. The mean fractal dimensions measured were 0.867 (group A) and 1.213 (group B). The mean trabecular perimeter in group A was 86.37±29.31 whereas in group B it was 194.62±43.26 and the intergroup difference was significant (p-value <0.001). Conclusion: Fractal analysis of IOPAs revealed that the alveolar bone surrounding the teeth in crossbite presented with significant reduction in the trabecular perimeter and number when compared with teeth not in crossbite.

Keywords

• fractal method
• malalignment
• periapical views
• trabecular arrangement
• transverse discrepancies