Ponticles of the atlas

Elastodontic Appliances for the Interception of Malocclusion in Children: A Systematic Narrative Hybrid Review

BACKGROUND

Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to provide an overview of the clinical indications for the use of EAs according to the available evidence and to identify potential research areas for unexplored applications.

MATERIALS AND METHODS

To assess the available literature on the subject, selective database searches were performed between July 2023 and September 2023. With the assistance of a health sciences librarian, a search strategy that utilized terms related to elastodontic therapy was developed. Embase, Scopus, PubMed, and Web of Science were the databases used.

RESULTS

The current literature addressing the usability of EAs is scarce and mostly limited to case reports and case series. After 2168 citations were found through the searches, 13 studies were ultimately included. In this regard, information about the clinical use and effectiveness of EAs are reported in a narrative form, defining specific domains of the application that are clinically oriented, including sagittal and transversal discrepancies, atypical swallowing, teeth malposition, two-phase orthodontics and a lack of teeth retention.

CONCLUSIONS

Within the intrinsic quality limitation of the available literature, it seems that EAs may represent a promising treatment alternative for managing mild-to-moderate malocclusion in children as an adjuvant therapy to the interruption of spoiled habits.

Prevalence of ponticulus posticus on the posterior arch of the atlas in symptomatic and asymptomatic patients

OBJECTIVE

To calculate the prevalence of ponticulus posticus and its association with headache.

METHODS

The presence and types of ponticulus posticus were investigated on 640 digital lateral cephalograms. Patients with complete or partial ponticulus posticus were further evaluated and questioned for a history of cervicogenic headache. Dissemination of attain values was analyzed using a Chi-Square test, and p values < 0.05 were considered statistically significant.

RESULTS

The prevalence of ponticulus posticus in our study was 9.8%, with complete form in 45 (7%) patients of which 29 (64.5%) were male and 16 (35.5%) were female. Partial ponticulus posticus was found in 18 (2.8%) of patients, of which 12 (66.6%) patients were male and six (33.33%) were female. In patients with the complete form of ponticulus posticus, 37 (82.22%) were symptomatic. Among these 37 patients, 22 (59.45%) were male and 15 (40.54%) were female. In complete ponticulus posticus patients, symptoms were slightly worse in males than females. Whereas in partial ponticulus posticus, 13 (72.22%) patients were found to be symptomatic. Of these 13 patients, seven (53.84%) were male and six (46.15%) were female. Of the 72 patients with a history of cervical pain, 50 (69.44%) showed ponticulus posticus on a lateral cephalogram. Of the 568 patients with no history of cervical pain, only 13 (2.2%) showed ponticulus posticus on the lateral cephalogram.

CONCLUSION

This study examination showed that ponticulus posticus is a common anatomic variation often associated with tension-type headaches.

Frequency and type of ponticulus posticus in a longitudinal sample of nonorthodontically treated patients: relationship with gender, age, skeletal maturity, and skeletal malocclusion

OBJECTIVES

The aim of this study was to assess the frequency and type of ponticulus posticus and to evaluate its relationship to gender, chronologic age, skeletal maturity, and skeletal malocclusion.

STUDY DESIGN

The sample included the longitudinal lateral cephalograms of 734 patients (378 males and 356 females) retrieved from the American Association of Orthodontists Craniofacial Growth Legacy Collection. The presence of ponticulus posticus (complete and partial forms) was assessed by visual inspection, and the cervical vertebral maturation method was used to determine the skeletal maturation stage. The presence and type (complete or partial) of ponticulus posticus were assessed by gender, age at first appearance of ponticulus posticus, skeletal maturation stage as determined by the cervical vertebral maturation method, and skeletal malocclusion.

RESULTS

The overall prevalence of ponticulus posticus was 12.6% (93 of 734) with complete and partial forms observed respectively in 8.7% (64 of 734) and 3.9% (29 of 734) of the sample. Both forms of ponticulus posticus occurred mainly in the age range of 7 to 13 years (P = .04). No differences were found in groups based on gender, skeletal maturity stages, or skeletal malocclusion (P > .05). However, approximately 90% of ponticulus posticus occurred before and after the circumpubertal stage.

CONCLUSIONS

Ponticulus posticus should be expected mainly during childhood and the pubertal age. This may support the theory of a genetic cause of this vertebral anomaly.

Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects

OBJECTIVE

The foramen arcuale (FA) is a bony bridge located over the vertebral artery on the posterior arch of the atlas. The presence of an FA can pose a risk during neurosurgery by providing a false impression of a broader posterior arch. The aim of this study was to provide the most comprehensive investigation on the prevalence of the FA and its clinically important anatomical features.

METHODS

Major electronic databases were searched to identify all studies that reported relevant data on the FA and the data were pooled into a meta-analysis.

RESULTS

A total of 127 studies (involving 55,985 subjects) were included. The overall pooled prevalence of a complete FA was 9.1% (95% CI 8.2%–10.1%) versus an incomplete FA, which was 13.6% (95% CI 11.2%–16.2%). The complete FA was found to be most prevalent in North Americans (11.3%) and Europeans (11.2%), and least prevalent among Asians (7.5%). In males (10.4%) the complete FA was more common than in females (7.3%) but an incomplete FA was more commonly seen in females (18.5%) than in males (16.7%). In the presence of a complete FA, a contralateral FA (complete or incomplete) was found in 53.1% of cases.

CONCLUSIONS

Surgeons should consider the risk for the presence of an FA prior to procedures on the atlas in each patient according to sex and ethnic group. We suggest preoperative screening with computerized tomography as the gold standard for detecting the presence of an FA.

Simultaneous lateral ponticle with facet-like depression and epitransverse process of the atlas

The lateral ponticle and epitransverse process are rare anatomical variations found on the atlas vertebra of the cervical spine. When a lateral ponticle occurs, an abnormal bony bridge extends from the superior articular facet to the transverse process. This bony bridge bisects the transverse foramen wherein the vertebral artery normally lies. In this case report, we describe a C1 specimen from an adult male with a lateral ponticle on the right side and an epitransverse process on the left side. Additionally, an articular facet-like structure was also found on the lateral ponticle's surface. Relevant literature regarding the lateral ponticle across age groups, sex, race, and species is also reviewed. We postulate that genesis of the lateral ponticle of the atlas occurs in utero, specifically during the lateral ossification of the ventral sclerotomes. To our knowledge, an articular facet-like structure on such a ponticle has not been reported previously. Moreover, simultaneous occurrence of a lateral ponticle and contralateral epitransverse process has, to our knowledge, not been reported before.

Prevalence and Morphologic Characteristics of Ponticulus Posticus: Analysis Using Cone-Beam Computed Tomography

OBJECTIVE

This study evaluated the prevalence and morphologic characteristics of ponticulus posticus (PP) by using cervical 3-dimensional (3-D) cone-beam computed tomography (CBCT) scan images.

METHODS

This was a retrospective study conducted by selecting cervical 3-D CBCT images of 698 patients, which were examined for the presence and types of PP.

RESULTS

In 257 patients, 438 PPs, complete or partial, bilateral or unilateral, were identified on the 698 cervical 3-D CBCT scans; therefore, the prevalence was 36.8%. Bilateral complete PP and partial PP were observed in 6.3% and 16.2% of subjects, respectively. There was a significant difference in the prevalence between males and females (P = .001) and between the right and left sides between males and females, but not between age groups.

CONCLUSION

Ponticulus posticus is a relatively common anomaly in this Turkish sample, which may have implications for those who perform clinical procedures on the upper cervical spine.

A cone beam CT investigation of ponticulus posticus and lateralis in children and adolescents

OBJECTIVES

To determine the prevalence and pathogenesis of ponticulus posticus (PP) and ponticulus lateralis (PL) in children and adolescents.

METHODS

Cone beam CT scans of 576 patients were examined for PP and PL. The patients were divided into three age groups: 10 years and younger, 11-13 years and 14 years and older. Ponticulus formation was categorized as absent, partial or complete. Gender, race and location (right, left or bilateral) were recorded. Data were analysed with the χ(2) test, with significance at p < 0.050. Institutional review board approval was granted.

RESULTS

Overall prevalence of PP was 26.2%, with complete lesions in 10.4%. The frequency of PP was greater in patients aged 14 years and older (p ≤ 0.038). The occurrence of complete PP was greater in patients aged 11 years and older (p = 0.028). Lesions were more common in males (p = 0.014) and in blacks compared with other non-white races (p = 0.035). Bilateral PP was more common than right-sided lesions (p = 0.008) and more frequent in the oldest cohort (p = 0.006). Overall prevalence of PL was 6.1% (3.0% complete), with no differences between age groups, genders, races or by location.

CONCLUSIONS

PP is not uncommon even in the first decade and increases in frequency, completeness of calcification and numbers in mid-adolescence. It appears to be more common in males and in blacks. PP may be a congenital osseous anomaly of the atlas that mineralizes at various times. PL is less frequent with no demographic predilections.