A Retrospective Study on the Calcification of the Atlanto-occcipital Ligament (Ponticulus Posticus) in Orthodontic Patients

Maria O’Connor^*
*Correspondence: Maria O’Connor, Department of Dentistry, University of São Paulo, Ribeirão Preto, 14040-904, Brazil, Email:

Introduction

The calcification of the atlanto-occipital ligament, commonly referred to as the Ponticulus Posticus (PP), is a condition of considerable interest in both medical and dental fields. This unique anatomical feature, which manifests as a bony bridge over the vertebral artery groove of the atlas vertebra, has garnered attention due to its implications in diagnostic imaging, orthodontic treatment, and overall patient health. Despite its frequent incidental discovery during radiographic assessments, the clinical significance of PP remains a subject of debate. This article delves into a retrospective study exploring the prevalence, potential implications, and mechanisms of PP calcification in orthodontic patients, shedding light on its relevance in contemporary orthodontics [1].

Radiographic imaging, a cornerstone of orthodontic diagnosis and treatment planning, often reveals anatomical anomalies or variations that might otherwise go unnoticed. Among these, the Ponticulus Posticus is a notable findin. Characterized by a partial or complete bony bridge over the posterior arch of the atlas, PP is considered an anatomical variation rather than a pathological anomaly. However, its presence raises questions about its etiology, prevalence, and clinical implications. The retrospective study aimed to evaluate the occurrence of PP among orthodontic patients, identify potential contributing factors, and discuss its significance in the context of orthodontic care. The calcification of the atlanto-occipital ligament leading to the formation of PP is thought to result from genetic predisposition, mechanical stress, or age-related ossification processes. Studies suggest that the ossification of this ligament could be an adaptive response to biomechanical forces exerted on the cervical spine [2].

Description

Orthodontic patients, particularly those undergoing treatments involving headgear or other appliances, may experience altered cervical biomechanics, potentially influencing the development of such calcifications. The retrospective nature of this study provided a valuable opportunity to analyze data from a diverse orthodontic population, encompassing various ages, treatment modalities, and demographic factors. The findings of the study highlighted the variability in the prevalence of PP among orthodontic patients. Some patients presented with complete calcification, forming a full bony bridge, while others exhibited partial calcification. This variation underscores the complex interplay of genetic and environmental factors in the development of PP. Moreover, the study noted a higher prevalence of PP in certain demographic groups, suggesting potential hereditary influences. Gender-specific trends were also observed, with some studies reporting a slightly higher prevalence in males, although the differences were not statistically significant in all cases [3].

Understanding the clinical implications of PP in orthodontic patients is essential for effective treatment planning. While the presence of PP is often asymptomatic, it may occasionally be associated with symptoms such as headaches, neck pain, or vertigo, likely due to compression of the vertebral artery or nerve irritation. These symptoms, albeit rare, warrant attention, particularly in patients with predisposing factors such as a history of cervical trauma or vascular anomalies. For orthodontists, recognizing the presence of PP during diagnostic evaluations is crucial, as it may influence appliance selection, treatment mechanics, or patient management strategies. The retrospective study also emphasized the importance of interdisciplinary collaboration in managing cases involving PP. Orthodontists often work closely with radiologists, neurologists, and other specialists to ensure comprehensive care for patients with this anatomical variation [4].

Advanced imaging modalities, such as Cone-Beam Computed Tomography (CBCT), play a pivotal role in accurately identifying PP and assessing its extent. CBCT imaging offers a three-dimensional view of the craniofacial and cervical anatomy, enabling clinicians to evaluate the relationship between PP and adjacent structures with greater precision. In addition to its clinical implications, the study highlighted the potential evolutionary and biomechanical significance of PP. Some researchers suggest that the calcification of the atlanto-occipital ligament may represent an evolutionary adaptation to increased cervical spine loads or specific functional demands. This perspective opens avenues for further research into the biomechanical and genetic factors contributing to the formation of PP. Understanding these factors could provide valuable insights into the broader context of cervical spine development and its variations [5].

Conclusion

The findings of the study also have implications for future research in the field of orthodontics and craniofacial anatomy. Longitudinal studies are needed to explore the natural history of PP, including its progression, potential complications, and response to various treatment modalities. Additionally, genetic studies could help identify specific markers associated with PP development, paving the way for personalized approaches to patient care.

In conclusion, the retrospective study on the calcification of the atlantooccipital ligament in orthodontic patients provides valuable insights into the prevalence, mechanisms, and clinical implications of Ponticulus Posticus. While often incidental and asymptomatic, PP warrants attention in orthodontic practice due to its potential impact on diagnostic imaging, treatment planning, and patient management. The study underscores the importance of accurate radiographic evaluation, interdisciplinary collaboration, and patient education in addressing this anatomical variation. As research in this area continues to evolve, a deeper understanding of PP will contribute to enhanced patient care and a broader appreciation of the complexity of cervical spine anatomy in orthodontics.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Sharma, V., D. Chaudhary and R. Mitra. "Prevalence of ponticulus posticus in Indian orthodontic patients." Dentomaxillofac Radiol 39 (2010): 277-283.

Google Scholar, Crossref, Indexed at

2. Shahidi, S., M. Hasani and M. Khozaei. "Evaluating the relation between the elongated styloid process and the ponticulus posticus using cone-beam computed tomography." Folia Morphol 81 (2022): 196-202.

Google Scholar, Crossref, Indexed at

3. Baccetti, Tiziano, Lorenzo Franchi and James A. McNamara Jr. "An improved version of the Cervical Vertebral Maturation (CVM) method for the assessment of mandibular growth." Angle Orthodont 72 (2002): 316-323.

Google Scholar, Crossref, Indexed at

4. Bayrakdar, İbrahim Şevki, Özkan Miloğlu, Selin Yeşiltepe and Ahmet Berhan Yılmaz. "Ponticulus posticus in a cohort of orthodontic children and adolescent patients with different sagittal skeletal anomalies: A comparative cone beam computed tomography investigation." Folia Morphologica 77 (2018): 65-71.

Google Scholar, Crossref, Indexed at 

5. Corsalini, Massimo, Saverio Capodiferro, Fabio dell’Olio and Giovanni Albanese, et al. "Cranio-mandibular disorders after whiplash injury: A mono-institutional clinical study on 31 patients." Int J Environ Res Pub Health 19 (2022): 901.

Google Scholar, Crossref, Indexed at