Early incisor lesions and Equine Odontoclastic Tooth Resorption and Hypercementosis: Reliability of radiographic findings. (28th March 2022) - Albers, Louisa
Summary: Background: In clinical practice, early diagnosis of Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other resorptive incisor diseases is difficult to achieve. The radiographic appearance of subtle pathological changes has not been described in detail and might be confused with age‐related changes. Objectives: The study was performed to define typical radiographic signs of early incisor lesions and to evaluate the reliability of the radiographic findings. Study design: Descriptive and comparative study using post mortem clinical, radiographic, macroscopic and µCT examination. Methods: The incisor region of 20 cadaveric horse heads, divided into three different age groups, was examined visually and by palpation. Intraoral radiographs were taken. After extraction, each incisor was macroscopically evaluated. Micro‐computed tomography (µCT) scans were obtained. These scans were processed with Scry (v6.0, Kuchel & Sautter GbR) to obtain surface meshes which then were transferred to Meshlab (ISTI‐CNR, version 2016.12). Attached tissues were virtually removed and surface curvature was computed to visualise and evaluate the quantity of unevenness (roughness) of the teeth's surface. Scoring systems for each diagnostic modality were developed. Scores were compared to describe and evaluate the radiographic appearance of early incisor lesions. Results: The prevalence and severity of incisor lesions increased with age. Early, subtle lesions develop on the palatal/lingual side of incisors. While radiographically detected lesions were confirmed macroscopically and on the µCT scans, numerous teeth which were radiographically classified as healthy displayed lesions by macroscopic inspection (13.7%) and µCT analysis (58.1%). Main limitations: Cadavers were studied and dental history was unknown. Conclusions: The detection of early and subtle incisor lesions indicating first signs of EOTRH on dorsoventral intraoral radiographs is limited due to the typical localisation of the lesions on the palatal/lingual side of the incisors. 总结: 背景: 临床上对马齿碎屑吸收和牙骨质增生 (EOTRH) 以及其他吸收性切齿疾病的早期诊断比较困难。切齿早期病变的检测非常具有挑战性, 微小病变的x线片表现不能详细描述, 更可能与齿年龄相关的变化相混淆。 目的: 本研究旨在确定早期切齿病变的典型x线片特征, 并评估x线征象的可靠性。 研究设计: 采用尸检临床检查、x线片、大体检查以及µCT评价, 进行描述性和对比性研究。 方法: 对20例马尸体头部的切齿区进行视诊和触诊, 分为3个年龄组。拍摄口腔内x光片。拔除后对各门齿进行宏观大体检查。获得微计算机断层扫描(µCT)。这些扫描用Scry a 处理以获得表面网格, 然后转移到Meshlab b 。移除切齿表面附着的组织, 计算切齿表面曲率, 以可视化评估牙齿表面的均匀度 (粗糙程度)。 并为每种诊断模式开发了评分系统。将评分结果进行比较, 以描述和评价早期切齿病变的影像学特征。 结果: 切齿病变的发生率和严重程度随年龄的增长而增加。早期, 微小的病变通常在切齿腭/舌侧。虽然放射学检查发现的病变在大体检查和μCT扫描上得到了确认, 但放射学诊断显示健康的牙齿中也能检出病变: 大体检查 (13.7%) 和μCT(58.1%) 。 主要限制: 没有临床检查活马以及样本牙科历史未知。 结论: 由于病变的典型位置在切齿的腭/舌侧, 因此的口腔背腹侧x线片上发现微小的切齿病变提示早期EOTRH的功能具有局限性。