INCIDENTAL FINDINGS IN CONVENTIONAL AND CT DENTAL RADIOGRAPHIC IMAGING IN CHILDREN AND ADOLESCENTS

Abstract

Dental imaging is the most frequent type of radiological procedure and even though the applied individual radiation doses are low, the collective doses cannot be ignored due to the high volume of procedures. In children specifically, the radiation risk is higher, since it is age-dependent. However, radiographs taken during regular treatment of children and adolescents can be used for scientific research purposes through studying variables not intended to be investigated during treatment, without exposing the patients to additional radiation. This thesis deals with the evaluation of the incidental findings in dental radiological procedures of children in three different fields: Field 1 examines whether the extraction of mandibular premolars influences the inclination and development of the mandibular third molars using post-treatment orthopantomograms (OPGs), through a retrospective cohort study (Chapter 2). A total of 120 patients were included, treated orthodontically with either no premolar extractions, or extraction of first or second mandibular premolars. The mesio-distal angulation of the lower third molars in relation to that of the second permanent lower molars as well as the third molars’ developmental stage were statistically evaluated at the significance level of 0.05. No statistically significant difference in the mandibular third molar angulation was observed between the premolar extraction and non-extraction groups but it is suggested that premolar extraction treatment might influence the development/ mineralization of the mandibular right third molar. Field 2 examines the frequency and type of incidental findings in cone beam computed tomographies (CBCTs) of children and adolescents, analyzed through a systematic review (Chapter 3). Systematic literature searches in 8 databases were undertaken and ten studies covering a total of 1818 patients were included. The prevalence of incidental findings ranged from 6.6% to 80.3%, but high heterogeneity was seen between studies. Incidental findings were most often related to airways, followed by bone, teeth, spine and temporomandibular joints. However, several methodological issues existed with included studies (incomplete reporting of patient- or CBCT-related details, small sample sizes, and research transparency issues), which might have introduced bias in the results. Incidental findings can often be found in the CBCTs of patients below 18 years of age, but do not always require treatment. However, when a CBCT image is justified for children or adolescents, it should be adequately assessed for incidental findings by a professional with appropriate training and experience. Field 3 examines through a retrospective cohort study the volumetric comparison of the maxillary sinus between the affected side and the unaffected side of children with unilateral cleft lip palate (UCLP) using CBCTs which were taken during the routine collection of records for the surgical treatment (Chapter 5). A total of 20 young patients with UCLP were included. The mean volume as well as the linear measurements of the maxillary sinuses were statistically evaluated at the significance level of 0.05. The maxillary sinus volume was significantly smaller on the cleft-side of the patients with UCLP. This difference concerned the anterior part of the maxillary sinus, whereas the posterior part was not significantly affected by the cleft. Additionally, an existing imbalance in the vertical development of the anterior part of maxillary sinus between the two sides in children with UCLP was observed.

Date of Award	3 Jul 2025
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Tanya Walsh (Main Supervisor) & Nick Silikas (Co Supervisor)