Vol 77, No 1 (2018)
Original article
Published online: 2017-08-22
Ponticulus posticus in a cohort of orthodontic children and adolescent patients with different sagittal skeletal anomalies: a comparative cone beam computed tomography investigation
Abstract
Background: The objective of this study was to evaluate the prevalence and characteristics of ponticulus posticus (PP) in groups with sagittal skeletal anomalies in a Turkish population using cone beam computed tomography (CBCT).
Materials and methods: A total of 181 CBCT images were evaluated according to gender, side and characteristics of PP in the three different sagittal skeletal groups.
Results: The average age of the patients was 13.88 ± 2.99 years (ranging 8–18 years). The study population consisted of 104 (57.5%) females and 77 (42.5%) males. PP was detected in 66 (36.5%) patients. Unilateral and bilateral PP was identified in 29 (43.9%) and 37 (56.1%) patients, respectively. The prevalence of PP in the atlas vertebrae was found to be higher in males than in females and this was statistically significant (p ≤ 0.05). PP was most frequently detected in class III patients (25, 13.8%). Statistically significant differences between the different sagittal skeletal groups were observed (p ≤ 0.05).
Conclusions: Ponticulus posticus is a common anomaly in Turkish populations and is associated with different sagittal skeletal patterns. The highest frequency of PP was found in angle class III patients. (Folia Morphol 2018; 77, 1: 65–71)
Keywords: ponticulus posticusmalocclusionscone beam computed tomography
References
- Adisen MZ, Misirlioglu M. Prevalence of ponticulus posticus among patients with different dental malocclusions by digital lateral cephalogram: a comparative study. Surg Radiol Anat. 2017; 39(3): 293–297.
- Afrand M, Ling CP, Khosrotehrani S, et al. Anterior cranial-base time-related changes: A systematic review. Am J Orthod Dentofacial Orthop. 2014; 146(1): 21–32.e6.
- Afsharpour S, Hoiriis KT, Fox RB, et al. An anatomical study of arcuate foramen and its clinical implications: a case report. Chiropr Man Therap. 2016; 24: 4.
- Bayrakdar IS, Miloglu O, Altun O, et al. Cone beam computed tomography imaging of ponticulus posticus: prevalence, characteristics, and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118(6): e210–e219.
- Buyuk SK, Sekerci AE, Benkli YA, et al. A survey of ponticulus posticus: Radiological analysis of atlas in an orthodontic population based on cone-beam computed tomography. Niger J Clin Pract. 2017; 20(1): 106–110.
- Chen CH, Chen YK, Wang CK. Prevalence of ponticuli posticus among patients referred for dental examinations by cone-beam CT. Spine J. 2015; 15(6): 1270–1276.
- Chitroda PK, Katti G, Baba IA, et al. Ponticulus posticus on the posterior arch of atlas, prevalence analysis in symptomatic and asymptomatic patients of gulbarga population. J Clin Diagn Res. 2013; 7(12): 3044–3047.
- D'Attilio M, Epifania E, Ciuffolo F, et al. Cervical lordosis angle measured on lateral cephalograms; findings in skeletal class II female subjects with and without TMD: a cross sectional study. Cranio. 2004; 22(1): 27–44.
- Elgafy H, Pompo F, Vela R, et al. Ipsilateral arcuate foramen and high-riding vertebral artery: implication on C1-C2 instrumentation. Spine J. 2014; 14(7): 1351–1355.
- Elliott RE, Tanweer O. The prevalence of the ponticulus posticus (arcuate foramen) and its importance in the Goel-Harms procedure: meta-analysis and review of the literature. World Neurosurg. 2014; 82(1-2): e335–e343.
- Faruqui S, Fida M, Shaikh A. Cervical vertebral anomalies in skeletal malocclusions: a cross-sectional study on orthodontic patients at the Aga Khan University Hospital, Pakistan. Indian J Dent Res. 2014; 25(4): 480–484.
- Festa F, Tecco S, Dolci M, et al. Relationship between cervical lordosis and facial morphology in Caucasian women with a skeletal class II malocclusion: a cross-sectional study. Cranio. 2003; 21(2): 121–129.
- Friedrich RE. Ponticulus posticus is a frequent radiographic finding on lateral cephalograms in nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome). Anticancer Res. 2014; 34(12): 7395–7399.
- Geist JR, Geist SMRY, Lin LM. A cone beam CT investigation of ponticulus posticus and lateralis in children and adolescents. Dentomaxillofac Radiol. 2014; 43(5): 20130451.
- Gibelli D, Cappella A, Cerutti E, et al. Prevalence of ponticulus posticus in a Northern Italian orthodontic population: a lateral cephalometric study. Surg Radiol Anat. 2016; 38(3): 309–312.
- Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery. 2002; 51(6): 1351–1357.
- Goel A. Screws, facets, and atlantoaxial instability. World Neurosurg. 2013; 80(5): 514–515.
- Kamak H, Yildırım E. The distribution of cervical vertebrae anomalies among dental malocclusions. J Craniovertebr Junction Spine. 2015; 6(4): 158–161.
- Kendrick GS, Biggs NL. Incidence of the ponticulus posticus of the first cervical vertebra between ages six to seventeen. Anat Rec. 1963; 145: 449–453.
- Kim KH, Park KW, Manh TH, et al. Prevalence and morphologic features of ponticulus posticus in koreans: analysis of 312 radiographs and 225 three-dimensional CT scans. Asian Spine J. 2007; 1(1): 27–31.
- Kim SH, Shin HC, Shin DAh, et al. Early clinical experience with the mobi-C disc prosthesis. Yonsei Med J. 2007; 48(3): 457–464.
- Koletsis DD, Halazonetis DJ. Cervical vertebrae anomalies in orthodontic patients: a growth-based superimpositional approach. Eur J Orthod. 2010; 32(1): 36–42.
- Koutsouraki E, Avdelidi E, Michmizos D, et al. Kimmerle's anomaly as a possible causative factor of chronic tension-type headaches and neurosensory hearing loss: case report and literature review. Int J Neurosci. 2010; 120(3): 236–239.
- Krishnamurthy A, Nayak SR, Khan S, et al. Arcuate foramen of atlas: incidence, phylogenetic and clinical significance. Rom J Morphol Embryol. 2007; 48(3): 263–266.
- Lamberty BG, Zivanović S. The retro-articular vertebral artery ring of the atlas and its significance. Acta Anat (Basel). 1973; 85(1): 113–122.
- Leonardi R, Santarelli A, Barbato E, et al. Atlanto-occipital ligament calcification: a novel sign in nevoid basal cell carcinoma syndrome. Anticancer Res. 2010; 30(10): 4265–4267.
- Segatto E, Segatto A, Braunitzer G, et al. Sagittal spinal posture in relation to craniofacial morphology. Angle Orthod. 2006; 76(4): 625–631.
- Paraskevas G, Papaziogas B, Tsonidis C, et al. Gross morphology of the bridges over the vertebral artery groove on the atlas. Surg Radiol Anat. 2005; 27(2): 129–136.
- Pyo J, Lowman RM. The ponticulus posticus of the first cervical vertebra. Radiology. 1959; 72(6): 850–854.
- Pękala PA, Henry BM, Pękala JR, et al. Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects. J Neurosurg Spine. 2017; 27(3): 276–290.
- Sabir H, Kumbhare S, Rout P. Evaluation of ponticulus posticus on digital lateral cephalograms and cone beam computed tomography in patients with migraine and healthy individuals: a comparative study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118(3): 348–354.
- Sekerci AE, Soylu E, Arikan MP, et al. Is there a relationship between the presence of ponticulus posticus and elongated styloid process? Clin Imaging. 2015; 39(2): 220–224.
- Sekerci AE, Soylu E, Arikan MP, et al. Prevalence and morphologic characteristics of ponticulus posticus: analysis using cone-beam computed tomography. J Chiropr Med. 2015; 14(3): 153–161.
- Sharma V, Chaudhary D, Mitra R. Prevalence of ponticulus posticus in Indian orthodontic patients. Dentomaxillofac Radiol. 2010; 39(5): 277–283.
- Silva MB, Gois BC, Sant'Anna EF. Evaluation of the reliability of measurements in cephalograms generated from cone beam computed tomography. Dental Press J Orthod. 2013; 18(4): 53–60.
- Sonnesen L. Associations between the cervical vertebral column and craniofacial morphology. Int J Dent. 2010; 2010: 295728.
- Takaaki M, Masanori O, Hidenori U, et al. Ponticulusponticus: Its clinical significance. Acta Med Kinki Univ. 1979; 4: 427–430.
- Zhang XL, Huang DG, Wang XD, et al. The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients. Eur Spine J. 2017; 26(4): 1058–1063.
