An exploration of the enigmatic ponticulus posticus: a cone beam computed tomographic study

During embryonic development, the activity of neural crest cells has the potential to induce the ossification of the posterior atlantooccipital ligament, resulting in the formation of an abnormal bony bridge known as "Ponticulus Posticus" (PP). The presence of PP increases the likelihood of vertebral artery obstruction, and patients with this condition frequently exhibit symptoms of vertebrobasilar insufficiency. Furthermore, connections have been depicted between PP and dental agenesis, malocclusions, and cleft lip and palate. This study assessed the prevalence, morphology, and superior articular facet (SAF) dimensions in PP using Cone Beam Computed Tomography (CBCT). In this retrospective study, SPSS 22.0 was used to analyse 202 cervical CBCT images devoid of pathologies. PP, age, and sex relationship were examined using the t-test and chi2 analysis. Pearson correlation examined the relationship between PP and non-PP SAF dimensional differences. P values <0.05 were significant. The prevalence of PP was 8.4%, with 64.7% constituting complete type and 35.2% partial type. The unilateral partial group's anteroposterior (D1) and transverse (D2) dimensions showed a strong positive association and significant difference. Understanding this anomaly and the changes it can cause in depth is essential for a clinician to diagnose orofacial pain. Taking into account the benefits of using CBCT enables a detailed evaluation of the vertebral column in three different planes, allowing us to measure the metrical dimensions of SAF precisely in the present study. It can be considered a gold standard in evaluating PP as a diagnostic tool.