Background: This study aimed
to show the osteoarthritic changes of atlanto-axial joint by aging in
asymptomatic subjects with CBCT as first in literature.Methods: Study
group of 120 patients randomly selected and grouped according to six age
categories. In images atlanto-dental joint interval was measured and decreasing
of joint space, ankylosis, subchondral sclerosis and cyst, erosion, osteophyte,
ligament calcification findings were recorded. Measurements and evaluations
were made on software of CBCT system (Romexis 4.3.0V). Data were analyzed with
IBM SPSS Statistics 21.0 package programme. For statistical significance, p
&lt;0.05 was accepted.Results: Mean
atlanto-dental interval (ADI) values were significantly different between age
groups (p&lt;0.001). The presence of the decreasing of joint space, ankylosis,
subchondral sclerosis and cyst, erosion, osteophyte findings were found
significantly different between age groups (for each p&lt;0.05). The mean
interval values of patients with ankylosis, subchondral cyst, erosion and
ligament calcification were statistically different from patients without these
findings (for each, p&lt;0.05).Conclusion: Our study showed increase of osteoarthritic changes and decrease of
ADI with age. CBCT provides useful information on the evaluation of hard tissue
changes in the cervical spine.KEYWORDS









Atlanto-Axial Joint, osteoarthritis, cone-beam computerized tomography,
computed tomography, X-Ra

Elif Bilgir

Esra Yeşilova

Selcuk Dental Journal

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    274 SS51   Atlantoaksiyal eklemin konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi    Esra Yeşilova(0000-0003-1800-9583), Elif Bilgir(0000-0001-9521-4682)α   Selcuk Dent J, ODMFR 2019 Kongre Kitapçığı Özel Sayısı  INTRODUCTION  The integration of 3D imaging systems to oral and maxillofacial radiology enables not only visualization of bimaxillary anatomical structures but also surrounding ones such as cervical region with low dose radiation. Cervical maturation was used in orthodontic treatment procedures in teenage groups.1 Like this, osteoarthritic changes of vertebraes can also be visualized on CBCT images. Arthritis of atlanto-axial joint has been documented as a potential risk for dens fractures in older age group and generally studied with computed tomography. 2,3 This study aimed to show osteoarthritic changes by aging in asymptomatic patients with CBCT as first in literature.                                                            Eskişehir Osmangazi University, Faculty Of Dentistry, Oral And Maxillofacial Radiology Department, Eskişehir ÖZ Atlantoaksiyal eklemin konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi Amaç: Bu çalışmada literatürde ilk kez KIBT ile asemptomatik bireylerde yaşlanmayla birlikte atlanto-aksiyel eklemde meydana gelen osteoartritik değişimlerin gösterilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışma grubunu oluşturmak üzere 120 hasta rastgele seçildi ve altı farklı yaş kategorisine göre gruplandırıldı. İmajlarda atlanto-dental eklem aralığı ölçüldü ve eklem boşluğunda azalma, ankiloz, subkondral skleroz ve kist, erozyon, osteofit, ligament kalsifikasyonu bulguları kaydedildi. Ölçümler ve değerlendirmeler KIBT sistemine ait program üzerinde yapıldı (Romexis 4.3.0V). Veriler IBM SPSS Statistics 21.0 paket program analiz edildi. İstatistiksel anlamlılık için p<0.05 kabul edildi. Bulgular: Ortalama atlanto-dental aralık (ADI) değerleri yaş grupları arasında anlamlı derecede farklı idi (p<0.001). Eklem boşluğunda azalma, ankiloz, subkondral skleroz ve kist, erozyon, osteofit bulgularının varlığı yaş grupları arasında anlamlı derecede farklı bulundu (her biri için p<0.05). Anklioz, subkondral kist, erozyon ve ligament kalsifikasyonu olan hastaların ortalama eklem aralığı değerleri bu bulguları olmayanlardan istatistiksel olarak farklı bulundu (her biri için p<0.05). Sonuç: Çalışmamız yaşla birlikte osteoartrik değişimlerin arttığını ve ADI’nın azaldığını gösterdi. KIBT servikal spinada sert doku değişimlerinin değerlendirilmesinde yararlı bilgiler sağlamaktadır. ANAHTAR KELİMELER Atlanto-aksiyel eklem, osteoartrit, konik ışınlı bilgisayarlı tomografi, bilgisayarlı tomografi, X ışını                           Başvuru Tarihi: 24 Ocak 2019                   Yayına Kabul Tarihi: 11 Şubat 2019 ABSTRACT The evaluation of atlanto-axial joint with cone beam computed tomography (CBCT) Background: This study aimed to show the osteoarthritic changes of atlanto-axial joint by aging in asymptomatic subjects with CBCT as first in literature. Methods: Study group of 120 patients randomly selected and grouped according to six age categories. In images atlanto-dental joint interval was measured and decreasing of joint space, ankylosis, subchondral sclerosis and cyst, erosion, osteophyte, ligament calcification findings were recorded. Measurements and evaluations were made on software of CBCT system (Romexis 4.3.0V). Data were analyzed with IBM SPSS Statistics 21.0 package programme. For statistical significance, p <0.05 was accepted. Results: Mean atlanto-dental interval (ADI) values were significantly different between age groups (p<0.001). The presence of the decreasing of joint space, ankylosis, subchondral sclerosis and cyst, erosion, osteophyte findings were found significantly different between age groups (for each p<0.05). The mean interval values of patients with ankylosis, subchondral cyst, erosion and ligament calcification were statistically different from patients without these findings (for each, p<0.05). Conclusion: Our study showed increase of osteoarthritic changes and decrease of ADI with age. CBCT provides useful information on the evaluation of hard tissue changes in the cervical spine. KEYWORDS Atlanto-Axial Joint, osteoarthritis, cone-beam computerized tomography, computed tomography, X-Ray Selcuk Dent J. 2019                                                                                                                                                                                          Yeşilova E, Bilgir E     275 MATERIALS AND METHODS This retrospective study was approved by the institutional review board (No: 25.12.18/19). CBCT images were selected from archive of Oral and Maxillofacial Radiology Department. Study group of 120 patients consisted according to six age categories (20-29, 30-39, 40-49, 50-59, 60-69 and older than 70) at equal numbers. Patients had no congenital and metabolic bone disease, connective tissue disease, torticollis and trauma recorded in patient management system. Age and genders of patients were documented. CBCT images were in high image quality, without artefact, 20.0 x 20.0 x 10.2 cm FOV and 0.400 mm voxel size (Planmeca Promax 3D Mid; Helsinki FİNLAND). In images; 1. Atlanto-dental joint interval (ADI) was measured as distance intercepted from the segment line linking the center of atlas tubercule with that of posterior tubercule.4 2. Decreasing of joint space, ankylosis, subchondral sclerosis and cyst, erosion, osteophyte and ligament calcification findings were recorded. Measurement and evaluations were made on software of CBCT system (Romexis 4.3.0V). Statistical Analysis;  Description of continuous data/categoric data expressed in means±SD/frequency and percentages. After Shapiro Wilk, Kruskal Wallis H test were performed. The analysis of osteoarthritic degenerative findings and genders according age groups were tested with Pearson and Pearson Exact Data were analyzed with IBM SPSS Statistics 21.0 package programme. For statistical significance, p <0.05 was accepted. RESULTS  Measurement value; Mean atlanto-dental interval values were significantly different between age groups (p<0.001). Values decreased from youngest to oldest age groups (Table 1). Table 1. The differences of atlanto-dental interval values between age groups  Measurement Values p Multiple Comparison Mean  ± SD Median (Q1 – Q3) Age Groups 20-29 (1) 20 1.36 ± 0.30 <0.001 3-6: 0.015 2-6: <0.001 1-6: <0.001 5-2: 0.015 5-1: 0.001 4-2: 0.016 4-1: 0.002 30-39 (2) 20 1.28 ± 0.30 40-49 (3) 20 1.10 ± 0.42 50-59 (4) 20 0.88 ± 0.30 60-69 (5) 20 0.84 ± 0.36 70+ (6) 20 0.60 ± 0.37  Osteoarthritic changes; The presence of the decreasing of joint space, ankylosis, subchondral sclerosis and cyst, erosion, osteophyte findings were found significantly different between age groups (for each p<0.05). Ankylosis was observed after fifth decade. The presence of subchondral cyst and erosion increased at 40 and older ages. The increase of osteophyte cases was seen after fourth decade. Subchondral sclerosis and the presence of decreasing of joint space were not associated to increase of age. All age groups had different risk for them (Table 2). The mean Atlantoaksiyal eklemin konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi                                                                                      Özel Sayı       276 interval values of patients with ankylosis, subchondral cyst, erosion and ligament calcification were statistically different from patients without these findings (for each, p<0.05) (Table 3). Table 2. The osteoarthritic changes between age groups  Age Groups p 20-29 30-39 40-49 50-59 60-69 70+ Gender Male 10 (%50.0) 10 (%50.0) 10 (%50.0) 10 (%50.0) 10 (%50.0) 10 (%50.0) 1.000 Female 10 (%50.0) 10 (%50.0) 10 (%50.0) 10 (%50.0) 10 (%50.0) 10 (%50.0) Ankylosis Absent 20 (%100.0) 20 (%100.0) 19 (%95.0) 17 (%85.0) 19 (%95.0) 14 (%70.0) 0.005 Present 0 (%0.0) 0 (%0.0) 1 (%5.0) 3 (%15.0) 1 (%5.0) 6 (%30.0) Subchondral Sclerosis Absent 11 (%55.0) 4 (%20.0) 5 (%25.0) 10 (%50.0) 3 (%15.0) 4 (%20.0) 0.017 Present 9 (%45.0) 16 (%80.0) 15 (%75.0) 10 (%50.0) 17 (%85.0) 16 (%80.0) Subchondral Cyst Absent 14 (%70.0) 17 (%85.0) 10 (%50.0) 9 (%45.0) 9 (%45.0) 7 (%35.0) 0.015 Present 6 (%30.0) 3 (%15.0) 10 (%50.0) 11 (%55.0) 11 (%55.0) 13 (%65.0) Erosion Absent 11 (%55.0) 11 (%55.0) 5 (%25.0) 4 (%20.0) 2 (%10.0) 4 (%20.0) 0.004 Present 9 (%45.0) 9 (%45.0) 15 (%75.0) 16 (%80.0) 18 (%90.0) 16 (%80.0) Osteophyte Absent 10 (%50.0) 4 (%20.0) 4 (%20.0) 4 (%20.0) 1 (%5.0) 5 (%25.0) 0.033 Present 10 (%50.0) 16 (%80.0) 16 (%80.0) 16 (%80.0) 19 (%95.0) 15 (%75.0) Ligament Calcification Absent 20 (%100.0) 20 (%100.0) 20 (%100.0) 18 (%90.0) 18 (%90.0) 19 (%95.0) 0.421 Present 0 (%0.0) 0 (%0.0) 0 (%0.0) 2 (%10.0) 2 (%10.0) 1 (%5.0) Decreasing Joint Space Absent 18 (%90.0) 13 (%65.0) 14 (%70.0) 15 (%75.0) 10 (%50.0) 9 (%45.0) 0.032 Present 2 (%10.0) 7 (%35.0) 6 (%30.0) 5 (%25.0) 10 (%50.0) 11 (%55.0)         Selcuk Dent J. 2019                                                                                                                                                                                          Yeşilova E, Bilgir E     277 Table 3. The differences of mean interval values in osteoarthritic changes              Figure 1. ADI measurement  Figure 2. Subchondral Cyst-Osteophyte Measurement Values Mean ± SD Median (Q1 – Q3) p Absence Presence Ankylosis 1.07 ± 0.39 1.20(0.80-1.20) 0.40 ± 0.35 0.40(0.00-0.80) <0.001 Subchondral Sclerosis 1.11 ± 0.35 1.20(0.80-1.20) 0.96 ± 0.45 0.80(0.80-1.20) 0.078 Subchondral Cyst 1.12 ± 0.46 1.20(0.80-1.60) 0.87 ± 0.35 0.80(0.80-1.20) 0.002 Erosion 1.13 ± 0.35 1.20(0.80-1.40) 0.95 ± 0.45 0.80(0.80-1.20) 0.017 Osteophyte 1.11 ± 0.35 1.20(0.80-1.20) 0.97 ± 0.45 0.80(0.80-1.20) 0.107 Ligament Calcification 1.02 ± 0.43 1.20(0.80-1.20) 0.64 ± 0.21 0.80(0.40-0.80) 0.024 Decreasing Joint Space 1.07 ± 0.39 1.20(0.80-1.20) 0.88 ± 0.48 0.80(0.60-1.20) 0.080 Atlantoaksiyal eklemin konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi                                                                                      Özel Sayı       278  Figure 3. Subchondral Osteosclerosis DISCUSSION Osteoarthritic changes of cervical spine are associated with aging process, long-lasting, low-level lifelong trauma and postural instability. Due to the unbalanced distribution of these charges to the spine; joint space narrowing, cortical thickening, subchondral sclerosis and cyst formation, ligament calcification occurs. People with atlanto-axial arthritis complaint of increased head and neck pain with head movements.5,6,7 Computed tomography (CT) is usually used in the examination of the osteoarthritic changes of cervical spine.5,6 However, recently CBCT provides useful information equivalent to CT in various studies.8,9 In this study, CBCT was chosen for the evaluation of osteoarthritic changes in atlanto-dental joints, low cost and radiation dose. The joint space narrowing is one of the radiographic signs of osteoarthritis. Several studies have shown that joint space decreases with age in the literature.4,6,7 Liu et al.4 and Betsch et al.3 reported that ADI measurements decreased with increasing age. In this study, ADI was observed to decrease with age in accordance with their work. Betsch et al. 3 reported that subchondral cyst formation usually started in the fifth and sixth year of life, and synovitis began in the second and third decades of life. They also found that the prevalence of intraosseous cysts and calcific synovitis increased with age. Liu et al.4 reported that mild osteoarthritis appeared at the earliest at age 19.6 years, moderate osteoarthritis in at earliest at age 24.2 years and severe osteoarthritis at the earliest at age 48.5 years. We have found that the presence of subchondral cyst and erosion increased at 40 and older ages. The increase of osteophyte cases was seen after fourth decade.  Selcuk Dent J. 2019                                                                                                                                                                                          Yeşilova E, Bilgir E     279 CONCLUSION To our knowledge, this is the first study about CBCT and atlanto-axial joint in literature. Osteoarthritic changes increase and ADI decreases with age. CBCT provides useful information for evaluation of osteoarthritic changes in atlanto-axial joint. In the view of these findings, we recommended that; *Oral and maxillofacial radiologists have to examine and report radiologic changes of this region even if patients have no complaint, *Oral and maxillofacial radiologists must take into consideration osteoarthritic changes of atlanto-axial joint in patients who have referred cervical pain for differential diagnosis of temporomandibular joint and related muscle disorders.    REFERENCES 1. Kim S, Choi Y, Shin SM, et al. The estimation of skeletal maturity of patients with cleft lip and palate using statistical shape analysis: a preliminary study. Dentomaxillofac Radiol 2017; 46: 20160491. 2. Shinseki MS, Zusman NL, Hiratzka J, et al. Association between advanced degenerative changes of the atlanto-dens joint and presence of dens fracture. J Bone Joint Surg Am 2014; 96: 712-717. 3. Betsch MW, Blizzard SR, Shinseki MS, et al. Prevalence of degenerative changes of the atlanto-axial joints. Spine J 2015; 15: 275-80. 4. Liu K, Xie F, Wang D, et al. Reference ranges for atlantodental interval in adults and its variation with age and gender in a large series of subjects on multidetector computed tomography. Acta Radiol 2015; 56: 465-70. 5. Liu K, Lu Y, Chang D, et al. The prevalence of osteoartritis of the atlanto-odontoid joint in adults using multidetector computed tomography. Acta Radiol 2014; 55: 95-100. 6. Badve SA, Bhojraj S, Nene A, et al. Occipito-atlanto-axial osteoarthritis: a cross sectional clinico-radiological prevalence study in high risk and general population. Spine 2010; 35: 434-8. 7. Zapletal J, Hekster R, Wilmink J, et al. Atlantoodontoid osteoarthritis: comparison of lateral cervical projection and CT. Eur J Spine 1995; 4: 238-41. 8. Patcas R, Tausch D, Pandis N, et al. Illusions of fusions: Assessing cervical vertebral fusion on lateral cephalograms, multidetector computed tomographs, and cone-beam computed tomographs. Am J Orthod Dentofacial Orthop 2013; 143: 213-20. 9. Takahata M, Yamada K, Akira I, et al. A novel technique of cervical pedicle screw placement with a pilot screw under the guidance of intraoperative 3D imaging from C-arm cone-beam CT without navigation for safe and accurate insertion. Eur J Spine 2018; 27: 2754-62.  

Atlantoaksiyal eklemin konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi

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Atlantoaksiyal eklemin konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendirilmesi

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