Is palatal cavity volume affected by maxillary sinus pathologies? A CBCT study.

AIM: This study uses cone beam computed tomography (CBCT) to determine whether pathology in the maxillary sinus (MS) affects the volume of the palatal cavity. METHODS: 188 individuals, 95 women and 93 men, aged between 17 and 63, were included in the study. MS pathology in the patients and the open-closed status of the maxillary sinus ostium (MSO) were recorded. Palatal volume measurements were performed using open-access ITK-SNAP via CBCT images. Statistical analysis of the study was conducted using SPSS v.21 software (IBM. Chicago. IL. USA), and p<0.05 was considered statistically significant. RESULTS: The average palatal volume was 1375.29±313.38 mm3 in male patients and 1235.33±250.40 mm3 in females, and it was found to be statistically significant between genders (p=0.001). MS pathology was detected in 114 (60.6%) of the patients. It was determined that the most frequently observed pathology in both the right (n = 58, 30.9%) and left (n = 65, 34.6%) side MS of individuals was mucosal hypertrophy. It was determined that the mean palatal volume was higher when the MSO was closed (p = 0.000). As a result of the correlation analysis, it was shown that the presence of MS pathology had a positive effect in explaining palate volume by 38.6% (R2 = 0.386). CONCLUSION: Palatal cavity volume was affected by maxillary sinus pathologies. Palatal cavity volume increases in the presence of MS pathologies and when MSOs are closed.

Sex and Population Variations in Nasopalatine Canal Dimensions: A CBCT-Based Systematic Review.

The nasopalatine canal (NPC), an interosseous conduit in the anterior maxilla, plays a crucial role in various dental procedures, such as implant placement, orthodontics, and surgical interventions. Accurate anatomical characterization of the NPC is essential to avoid complications, as its morphometric variations can impact the nasopalatine nerve and vascular structures within the canal. Traditional radiography techniques are limited in displaying the canal's detailed anatomy due to issues like magnification and distortion. Cone beam computed tomography (CBCT), with its superior imaging quality and reduced radiation exposure, has become the preferred method for NPC evaluation. This systematic review aimed to evaluate the published literature on the variations in anatomy and dimensions of the NPC using CBCT. A complete literature search was conducted in Web of Science, PubMed/Medline, EMBASE, Scopus, Cochrane Library, Google Scholar, and ProQuest electronic databases. The following keywords were used alone or combined: CBCT, measurements [(nasopalatine canal length), (incisive foramen), (foramina of Stenson), (buccal bone plate), gender, plane as (oblique measurements), or (sagittal or axial). Papers were manually searched utilizing their reference titles. Research selection was restricted to the time of publication but not to the type of tested publication from different countries or sex and NPC parameter measurements. Fourteen full-length papers were included. Parameters like NPC length and diameters of incisive foramen (IF) and foramina of Stenson (FS) were generally higher in males than females, with significant differences noted across most studies. NPC dimensions are influenced by sex, with males typically exhibiting larger measurements. Additionally, NPC dimensions vary among different populations.

Comparison of the Effects of Different Palatal Morphology on Maxillary Expansion via RME and MSE: A Finite Element Analysis.

OBJECTIVES: This study aims to compare and analyze the biomechanical effect and the displacement trend of RME and MSE on the maxillofacial complex under different palatal shapes by using finite element analysis. METHODS: The three-dimensional model of maxillofacial complex was obtained from a computed tomography image of a person with a normal palate. Then, we modified the shape of the palate to obtain the model with a high palate. Additionally, two expander devices were considered. MSE and RME were created and four models were made: Model 1: Normal-palate craniomaxillofacial complex with RME expander; Model 2: Normal-palate craniomaxillofacial complex with MSE expander; Model 3: High-palate craniomaxillofacial complex with RME expander; Model 4: High-palate craniomaxillofacial complex with MSE expander. Then, lateral forced displacement was applied and the analysis results were obtained. RESULTS: The lateral displacement of the palatal suture of Model 3 is greater than that of Model 1, and the maxilla has more rotation. The crown/root ratio of Model 1 is significantly greater than that of the other three groups. Compared with Model 1, Model 3 has greater stress concentration in the superstructure of the craniomaxillofacial complex. Both of them have greater stress in the anchorage area than Model 2 and Model 4. CONCLUSION: Different shapes of the palate interfere with the effects of RME and MSE, and its influence on the stress distribution and displacement of the craniomaxillary complex when using RME is greater than MSE. The lateral displacement of the palatal suture of MSE is significantly larger than that of RME. It is more prone to tipping movement of the anchor teeth using RME under normal palate, and MSE may manage the vertical control better due to the smaller crown/root ratio than RME and intrusive movement of molars.

Morphological CBCT parameters for an accurate differentiation between nasopalatine duct cyst and the normal nasopalatine canal.

BACKGROUND: The incisive foramen width was a traditional imaging criterion for diagnosing nasopalatine duct (NPD) cysts. Recent CBCT studies demonstrated significant dimensional variations of the nasopalatine canal, which raised questions about the accuracy of this criterion. This study investigated whether nasopalatine canal diameters assessed on CBCT images can accurately differentiate NPD cysts from normal nasopalatine canals. METHODS: The study included 19 patients with NPD cysts (12 (63.2%) males, 7 (36.8%) females, mean age 44.7 ± 13.3), and a control group of 164 patients (72 (43.9%) males, 92 (56.1%) females, mean age 47.25 ± 17.74). CBCT images were retrospectively evaluated. The following nasopalatine canal diameters were measured on reference sagittal, coronal, and axial reformation images: nasal opening anteroposterior (AP) and mediolateral (ML) diameter, oral opening AP (APOO) and ML (MLOO) diameter, nasopalatine canal length, minimum ML (minML) diameter, anterior wall expansion (AWE), nasopalatine canal angle, and the mid-level AP diameter (midAP). All parameters were compared between groups. Discriminant functional analysis (DFA) was applied to detect CBCT parameters that best differentiate the NPD cyst from the normal canal. RESULTS: Patients with NPD cyst had significantly greater values of APOO (7.06 ± 2.09 vs. 5.61 ± 1.70), MLOO (6.89 ± 2.95 vs. 3.48 ± 1.24), minML (2.88 ± 1.53 vs. 2.25 ± 1.09), AWE (2.15 ± 0.65 vs. 0.41 ± 0.67), and midAP (4.58 ± 1.61 vs. 2.48 ± 0.96). DFA showed MLOO, AWE, and midAP as the most accurate in distinguishing NPD cyst from the normal canal. When combined in the discriminant function equation X = 0.390·MLOO + 1.010·AWE + 0.288·midAP (cut score 1.669), the differentiation can be performed with a sensitivity and specificity of 98.8% and 76.9%, respectively. CONCLUSION: NPD cysts can be accurately distinguished from the normal nasopalatine canal by measuring MLOO, AWE, and midAP diameter on CBCT images.

A comparative study of the application of three digital imaging techniques to assess the thickness of the palatal mucosa of the maxillary anterior teeth.

BACKGROUND: This study highlights the need for precise and efficient methods to measure palatal mucosal thickness in the maxillary anterior teeth, particularly for soft tissue augmentation in the aesthetic zone. The research evaluates three digital imaging techniques, suggesting that Cone Beam Computed Tomography (CBCT) combined with intraoral scanners (IOS) is a promising approach for reliable clinical assessment. METHODS: Ten volunteers with healthy periodontium were selected, and three methods were employed: CBCT-based indirect gingival imaging, modified soft tissue CBCT (ST-CBCT), and CBCT combined with IOS. Measurements of palatal mucosal thickness were taken at multiple points along the palatal gingival margin. Statistical analysis included Bland-Altman plots for method agreement and intraclass Correlation Coefficient (ICC) analysis for reliability. All measurements were standardized, repeated for consistency, and accurate to 0.01 mm to ensure reliability. RESULTS: The Bland-Altman plots showed that less than 5% of the points for palatal mucosal thickness differences measured by the gingival indirect radiographic method, modified ST-CBCT, and CBCT combined with IOS were located outside the 95% limits of agreement (LoA). The mean value of the differences was within 0.2 mm, indicating good clinical agreement among the three methods. The inter- and intra-study ICC values for palatal mucosal thickness measurements of the maxillary anterior teeth using the three CBCT methods were greater than 0.75 (P < 0.001), demonstrating reproducibility. CONCLUSIONS: Based on the evaluation of three digital imaging techniques, this study indicates that the combination of CBCT with IOS is a feasible method for measuring palatal mucosal thickness in the maxillary anterior teeth and demonstrates good reproducibility.

Morphometric analysis of the skull base and palatal regions for gender identification using CBCT: a retrospective study.

Objectives: The objectives of this study were to evaluate the accuracy of morphometry of skull base and palate in gender discrimination using cone beam computed tomography (CBCT) scanning and to assess the accuracy of the results among a sample of the Arab population. Materials & Methods: Using CBCT scans, a cross-sectional analysis was conducted on 142 consented patients who underwent various dental procedures at the University Dental Hospital, Sharjah (UDHS). Of these patients, 70 were females and 72 were males, with respective means of 38.5 and 36.2 years. Eleven parameters related to skull base and palatal region were measured on the CBCT scans by two expert radiologists followed by statistical analysis. Results: There was significant gender-based difference in the mean palatal width (PW) (p = 0.001), mean palatal height (PH) (p = 0.005). Among other skull base region parameters that were significant in term of gender-based difference like; the clivus length (CL) (p < 0.001), occipital condyle height (OCH) (p < 0.001), basal angle (BA) (p = 0.006) and transverse diameter of foramen magnum (p = 0.003). Only palate variables showed a significant age difference. Discriminant analysis related to gender showed that occipital condyle height was the most accurate and best discriminator among the skull base region parameters. Conclusion: The use of discriminant analysis in CBCT based on skull base and palatal region variables provides an efficient method for determining gender, which is particularly valuable in forensic science and anthropological research. Significance of study: Accurate gender identification is crucial in forensic investigations, and the skull base region, being a stable and sexually dimorphic anatomical feature, can serve as a reliable marker for this purpose.

Evaluating palatal mucosal thickness in orthodontic miniscrew sites using cone-beam computed tomography.

PURPOSE: To comprehensively analyze the palatal thickness of soft tissues and determine optimal regions for the placement of palatal orthodontic miniscrews. METHODS: Cone-beam computed tomography (CBCT) images on the coronal plane were obtained from 60 patients (30 female, 30 male; age range 19-45; mean age 32 ± 11), with 3-mm intervals in the regions of the canine (Ca), first premolar (Pr1), second premolar (Pr2), midpoint between the first and second molars (M1-M2), first molar (M1), second molar (M2) and midpalate. RESULTS: The mucosal thickness measurements between the teeth showed significantly greater thickness in the Ca region at the 3 mm point, in the Pr1 region at the 6 mm point, and in the Pr2 region at the 9 and 12 mm points. At the 9 mm point, the Pr1 region demonstrated greater thickness than the M1-M2 whereas the Pr2 region was thicker than the M1 and M1-M2 regions. At the 12 and 15 mm points, the thickness increased from anterior to posterior: the Pr1 region was thinner than the Pr2, M1, and M2 regions and the Pr2 region was thinner than the M2 region. A schematization was devised for the optimal areas recommended for miniscrews in the palatal region. CONCLUSION: The mucosal thickness in the palatal region increases from anterior to posterior except the midpalatal region. Based on the results, in terms of soft tissue, the most suitable place for miniscrew placement is 6 mm from the gingival margin of the teeth and in the median portion of the palate. The findings may guide clinicians in choosing the optimal sites for palatal mini-implants.

Evaluation of palate morphology in patients treated with leaf expander and hyrax expander: A geometric morphometric analysis.

OBJECTIVE: The aim of this study was to evaluate changes in shape of the palatal vault after maxillary expansion with hyrax expander (HE) and leaf expander (LE), using 3D Geometric Morphometric Analysis. SETTING AND SAMPLE POPULATION: Overall, 250 patients (110 M, 140 F) with maxillary transverse deficiency were selected for this study. In this study, 127 subjects were treated with HE, 123 with LE. MATERIALS AND METHODS: Digital dental models were obtained pre-treatment (T0) and after 12 months from the cementation of the device (T1) and processed by means of a digital scanner. Linear and morphometric analyses were conducted to determine the effects of each appliance on dental measurements and palatal shape, and a multiple linear regression was performed to analyse the influence of anchorage and appliance type on final shape. RESULTS: Morphometric analysis showed that there was a lowering of the palatal vault in the HE group, while in the LE group it remained unchanged: the difference in palatal shape at time T0 and T1 was statistically significant in both treatments (HE vs. LE). In the HE group, the change in shape also included the upper part of the palatal vault in the vertical dimension, while in the LE group the change in shape interested mainly palatal shelves and the lower portion of the palate. CONCLUSIONS: Both LE and HE produce clinically significant changes in the morphology of the palatal vault.

An effective ultrasound fetal palate screening software based on the "sequential sector scan through the oral fissure" and three-dimensional ultrasound.

BACKGROUND: Orofacial clefts are one of the most common congenital malformations of the fetal face and ultrasound is mainly responsible for its diagnosis. It is difficult to view the fetal palate, so there is currently no unified standard for fetal palate screening, and the diagnosis of cleft palate is not included in the relevant prenatal ultrasound screening guidelines. Many prenatal diagnoses for cleft palate are missed due to the lack of effective screening methods. Therefore, it is imperative to increase the display rate of the fetal palate, which would improve the detection rate and diagnostic accuracy for cleft palate. We aim to introduce a fetal palate screening software based on the "sequential sector scan though the oral fissure", an effective method for fetal palate screening which was verified by our follow up results and three-dimensional ultrasound and to evaluate its feasibility and clinical practicability. METHODS: A software was designed and programmed based on "sequential sector scan through the oral fissure" and three-dimensional ultrasound. The three-dimensional ultrasound volume data of the fetal face were imported into the software. Then, the median sagittal plane was taken as the reference interface, the anterior upper margin of the mandibular alveolar bone was selected as the fulcrum, the interval angles, and the number of layers of the sector scan were set, after which the automatic scan was performed. Thus, the sector scan sequential planes of the mandibular alveolar bone, pharynx, soft palate, hard palate, and maxillary alveolar bone were obtained in sequence to display and evaluate the palate. In addition, the feasibility and accuracy of the software in fetal palate displaying and screening was evaluated by actual clinical cases. RESULTS: Full views of the normal fetal palates and the defective parts of the cleft palates were displayed, and relatively clear sequential tomographic images and continuous dynamic videos were formed after the three-dimensional volume data of 10 normal fetal palates and 10 cleft palates were imported into the software. CONCLUSIONS: The software can display fetal palates more directly which might allow for a new method of fetal palate screening and cleft palate diagnosis.

Prediction of midpalatal suture maturation stage based on transfer learning and enhanced vision transformer.

BACKGROUND: Maxillary expansion is an important treatment method for maxillary transverse hypoplasia. Different methods of maxillary expansion should be carried out depending on the midpalatal suture maturation levels, and the diagnosis was validated by palatal plane cone beam computed tomography (CBCT) images by orthodontists, while such a method suffered from low efficiency and strong subjectivity. This study develops and evaluates an enhanced vision transformer (ViT) to automatically classify CBCT images of midpalatal sutures with different maturation stages. METHODS: In recent years, the use of convolutional neural network (CNN) to classify images of midpalatal suture with different maturation stages has brought positive significance to the decision of the clinical maxillary expansion method. However, CNN cannot adequately learn the long-distance dependencies between images and features, which are also required for global recognition of midpalatal suture CBCT images. The Self-Attention of ViT has the function of capturing the relationship between long-distance pixels of the image. However, it lacks the inductive bias of CNN and needs more data training. To solve this problem, a CNN-enhanced ViT model based on transfer learning is proposed to classify midpalatal suture CBCT images. In this study, 2518 CBCT images of the palate plane are collected, and the images are divided into 1259 images as the training set, 506 images as the verification set, and 753 images as the test set. After the training set image preprocessing, the CNN-enhanced ViT model is trained and adjusted, and the generalization ability of the model is tested on the test set. RESULTS: The classification accuracy of our proposed ViT model is 95.75%, and its Macro-averaging Area under the receiver operating characteristic Curve (AUC) and Micro-averaging AUC are 97.89% and 98.36% respectively on our data test set. The classification accuracy of the best performing CNN model EfficientnetV2_S was 93.76% on our data test set. The classification accuracy of the clinician is 89.10% on our data test set. CONCLUSIONS: The experimental results show that this method can effectively complete CBCT images classification of midpalatal suture maturation stages, and the performance is better than a clinician. Therefore, the model can provide a valuable reference for orthodontists and assist them in making correct a diagnosis.

Three-dimensional analysis of palatal morphology and PAS in patients with cleft lip and palate prior to orthodontic treatment.

BACKGROUND: Since many different conclusions of craniofacial anomalies and their relation to the posterior airway space coexist, this comparative clinical study investigated the palatal morphology concerning volumetric size, posterior airway space dimension and the adenoids of patients with and without a cleft before orthodontic treatment. METHODS: Three-dimensional intraoral scans and cephalometric radiographs of n = 38 patients were used for data acquisition. The patients were divided into three groups: unilateral cleft lip and palate (n = 15, 4 female, 11 male; mean age 8.57 ± 1.79 years), bilateral cleft lip and palate (n = 8, 0 female, 8 male; mean age 8.46 ± 1.37 years) and non-cleft control (n = 15, 7 female, 8 male; mean age 9.03 ± 1.02 years). The evaluation included established procedures for measurements of the palatal morphology and posterior airway space. Statistics included Shapiro-Wilk-Test and simple ANOVA (Bonferroni) for the three-dimensional intraoral scans and cephalometric radiographs. The level of significance was set at p < 0.05. RESULTS: The palatal volume and cephalometric analysis showed differences between the three groups. The palatal volume, the superior posterior face height and the depth of the bony nasopharynx of patients with cleft lip and palate were significantly smaller than for non-cleft control patients. The superior posterior face height of bilateral cleft lip and palate patients was significantly smaller than in unilateral cleft lip and palate patients (BCLP: 35.50 ± 2.08 mm; UCLP: 36.04 ± 2.95 mm; p < 0.001). The percentage of the adenoids in relation to the entire nasopharynx and the angle NL/SN were significantly bigger in patients with cleft lip and palate than in the non-cleft control. In particular, the palatal volume was 32.43% smaller in patients with unilateral cleft lip and palate and 48.69% smaller in patients with bilateral cleft lip and palate compared to the non-cleft control. CONCLUSIONS: Skeletal anomalies relate to the dimension of the posterior airway space. There were differences among the subjects with cleft lip and palate and these without a cleft. This study showed that the morphology of the palate and especially transverse deficiency of the maxilla resulting in smaller palatal volume relates to the posterior airway space. Even the adenoids seem to be affected, especially for cleft lip and palate patients.

Evaluating the long-term stability of a predefined palatal region for tooth movement analysis.

OBJECTIVES: We conducted a three-dimensional (3D) analysis of orthodontic tooth movement (TM) using digital dental models (DMs), focusing on the palatal region of interest (PROI), aiming to evaluate the long-term stability of the PROI, validate the 3D TM analysis with PROI registration, and compare it with conventional lateral cephalometric analyses. METHODS: Twenty adult patients treated with a multibracket appliance were evaluated at their first visit (T0) and at least 5 years later (T1) using DMs and lateral cephalograms (LCs). The long-term stability of PROI was assessed by calculating the point cloud distances between DM-T0 and DM-T1. TM analysis using DM with PROI registration for the maxillary central incisors was assessed through linear and angular measurements in the sagittal view and subsequently compared with the LCs. RESULTS: The average point cloud distance of the PROI between DM-T0 and DM-T1 was 0.21 mm (standard deviation, 0.13 mm). TM analysis using DMs demonstrated excellent reproducibility for both linear and angular measurements (intra-rater correlation coefficient, > 0.99). The 95 % limits of agreement between the DM and LC measurements were < 5.14° for angular change, 3.53 mm for horizontal displacement, and 0.98 mm for vertical displacement. No significant differences were observed in the angular and linear measurements when the TM was compared using the DMs and LCs. CONCLUSIONS: The PROI remained stable for over 5 years, supporting the reproducibility and accuracy of TM assessment using PROI registration in orthodontic clinical practice. CLINICAL SIGNIFICANCE: DM analysis lacks the risks associated with X-ray exposure and can be easily performed in daily clinical practice, indicating its potential for future clinical applications. These findings further support the use of DM with PROI registration for TM analysis in orthodontic clinical practice, emphasizing its long-term stability and reproducibility.

Efficacy of clear aligners vs rapid palatal expanders on palatal volume and surface area in mixed dentition patients: A randomized controlled trial.

INTRODUCTION: This study aimed to evaluate the efficacy of Invisalign First Phase I treatment compared with tooth-borne rapid maxillary expansion (RME) in mixed dentition patients by examining changes in palatal volume, palatal surface area, and maxillary interdental transverse measurements. METHODS: In this open-label, 2-arm, parallel, randomized controlled trial, patients with a posterior transverse discrepancy ≤6 mm were allocated into the clear aligner therapy (CAT) group (Invisalign First Phase I treatment) and RME group (tooth-borne RME) according to a computer-generated randomization list immediately before the start of treatment. Digital models were obtained before the beginning of the treatment (T0) and at the end of the retention period/treatment (T1) using an intraoral scanner. Palatal volume was measured as the primary outcome, and palatal surface area and intermolar and intercanine transverse widths at the cusps and gingival level were measured as secondary outcomes. Patients and interventionists were not blinded because of the nature of the intervention. RESULTS: Out of 50 patients, 41 (19 males and 22 females; mean age, 8.12 ± 1.53 years) were enrolled and divided into 2 groups: 20 in the CAT group and 21 in the RME group. Two participants did not receive the allocated intervention for different reasons (1 patient discontinued the intervention in the CAT group, and another patient was lost to follow-up in the RME group). Thus, 19 patients (5 males and 14 females; mean age, 8.48 ± 1.42 years) were analyzed from the CAT group, and 20 patients (12 males and 8 females; mean age, 7.83 ± 1.19 years) from the RME group. Regarding intragroup comparisons, all outcome measures significantly increased from T0 to T1 in both groups. In terms of intergroup comparisons, there were no significant differences in the variation (Δ) of outcome measures between the 2 groups from T0 to T1, except for the intermolar width at the gingival level (P <0.005). The change in palatal volume was 532.01 ±540.52 mm³ for the RME group and 243.95 ± 473.24 mm³ for the CAT group (P = 0.084), with a moderate effect size (d = 0.57). CONCLUSIONS: RME showed trends favoring better outcomes compared with Invisalign First Phase I treatment across all assessed measures. The only parameter that showed statistically significant differences between the 2 groups was variation in intermolar width at the gingival level, suggesting the occurrence of buccal tipping in patients undergoing Invisalign First Phase I treatment. TRIAL REGISTRATION: The trial was registered at ClinicalTrial.gov (no. NCT04760535).

Does krill oil enhancing the new bone formation in orthopedically expanded median palatal suture in rat model? A micro-CT and immunohistochemical analysis.

BACKGROUND: The purpose of this study was to assess the effects of systemically given krill oil (KO) on the development of new bone formation in the sutura palatina media following rapid maxillary expansion (RME). METHODS: 28 4-5 week-old male Wistar albino rats were randomly divided into 4 groups: Control (C), Only Expansion (OE) (no supplement but undergoing expansion and retention), KE (supplemented during both the expansion and retention phases), Krill Oil Nursery Group (KN) (supplemented during the 40-day nursery phase as well as during the expansion and retention phases). A 5-day RME was followed by a 12-day retention period. All rats were euthanized simultaneously. Micro-computerized tomography (Micro-CT), hemotoxylen-eosin (H&E) staining, and immunohistochemical analysis were conducted. Kruskal-Wallis and Dunn tests with Bonferonni corrrection were applied (p < 0.05). RESULTS: Expansion and KO supplementation did not cause a statistically significant change in bone mineral density (BMD), bone volume fraction (BV/TV), spesific bone surface (BS/BV) and trabecular thickness (Tb.Th). While the expansion prosedure increased the trabecular seperation (Tb.Sp), KO supplemantation mitigated this effect. The KE group exhibited a statistically significantly increase in trabecular number (Tb.N) compared to the OE group. Although receptor activator of nuclear factor-kappa-Β ligand (RANKL)/osteoprotegerin (OPG) ratios did not show significant differences between groups, the KE and OE groups demonstrated the lowest and highest value, respectively. KE showed a reduced amount of tartrate-resistant acid phosphatase (TRAP) compared to the OE. CONCLUSION: KO positively affected the architecture of the new bone formed in the mid-palatal suture. In this rat model of RME, results support the idea that administering of KO during the expansion period or beginning before the RME procedure may reduce relapse and enhance bone formation within the mid-palatal suture.

Computer-assisted open exposure of palatally impacted canines for orthodontic eruption: A randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to assess the feasibility of computer-assisted open exposure of palatally impacted canines. MATERIALS AND METHODS: Patients aged 11-30 years who required orthodontic eruption for the full palatal impaction of their canines were included in this study. Exclusion criteria were psychosocial and dental contraindications of orthodontic treatment, congenital craniofacial disorders, and trauma in the patient's history in the vicinity of the surgical site. Virtual planning software was used to register the intraoral scans and cone-beam computed tomography data and to design a surgical template. In the test group, exposure of the canines was guided by a surgical template, whereas in the control group, the surgeon relied on the surgical plan to localize the impacted canine. The success of the intervention, duration of surgery, and complications, including excessive hemorrhage, damage to the canine or neighboring anatomical landmarks, and postoperative inflammation of the surgical site were assessed. Postoperative pain was reported by the patients using the visual analog pain scale (VAS). RESULTS: Surgery was deemed successful in all patients in both groups. During healing, no complications were observed. The duration of surgery decreased significantly in the test group (4 min 45.1 s ± 1 min 8.4 s) compared to that in the control group (7 min 22.3 s ± 56.02 s). No statistically significant differences were observed between the VAS scores of the two study groups. CONCLUSIONS: The application of virtual planning and static navigation is a viable approach for the open exposure of palatally impacted canines. CLINICAL TRIAL REGISTRATION NUMBER: NCT05909254. CLINICAL SIGNIFICANCE: Computer-assisted surgery is a feasible method for open exposure of palatally impacted canines, which decreases the duration of surgery compared to the freehand method.

Morphological and Dimensional Analysis of the Nasopalatine Canal: Insights from Cone-Beam Computed Tomography Imaging in a Large Cohort.

BACKGROUND The nasopalatine canal (NPC), or incisive canal, is located in the midline of the palate, posterior to the maxillary central incisors. Its anatomy is important in prosthetic dentistry procedures. This study aimed to assess the anatomical morphology of the NPC according to age, sex, and dental status using cone-beam computed tomography (CBCT) in 335 patients. MATERIAL AND METHODS In this retrospective cross-sectional study, a total of 335 patients were recruited and categorized according to sex, age, and dental status. Individual CBCT images were analyzed in the sagittal, coronal, and axial planes. Also, we recorded the dimensions and morphological shape of the NPC and adjacent buccal bone plate (BBP) under standardized conditions. The associations between sex, age group, NPC shapes and types, and presence of central incisors were assessed. A significance level was set at P<0.05. RESULTS Mean labio-palatal and mediolateral measurements of the incisive foramen were 5.13±1.45 mm and 3.21±0.96 mm, whereas the mean diameter of Stenson foramen was 2.57±1.25 mm, and the total length of the NPC was 11.79±2.50 mm. Funnel, Y, and round-shaped canals were the most prevalent shapes of the NPC in sagittal, coronal, and axial planes. BBP was greater in men, with P=0.011, P=0.000, and P=0.001 at BBP1, BBP2, and BBP3, respectively. CONCLUSIONS NPC and BBP parameter values were slightly higher among male patients. NPC parameters increased with older age. The crest width of BBP decreased with older age and after missing maxillary central incisor teeth.

Morphological Variations of the Nasopalatine Canal in the North Cyprus Population: A Cone Beam Computed Tomography Study.

BACKGROUND This study aimed to evaluate the morphological characteristics of the anterior maxillary nasopalatine canal and the width of the buccal bone using cone-beam computed tomography (CBCT) in 150 adults in Northern Cyprus. MATERIAL AND METHODS The study included 150 participants, and their anterior maxillary morphometric measurements (eg, length of the nasopalatine canal and anteroposterior diameter of the nasal foramen) were taken using CBCT with the scanning parameters of 90 kvP, 24 s, 4 mA, voxel size 0.3 mm, and field of view 10×6 cm. The shapes of the nasopalatine canal (NPC) were categorized into 4 types: cylindrical, hourglass, funnel-shaped, and banana (54%, 20.6%, 18.6%, and 4%, respectively). RESULTS The findings showed a clear link between the shape of the NPC and the horizontal dimensions of the anterior maxilla's morphometric properties. In general, decreased horizontal bone dimensions were found in the premaxilla at the banana- and funnel-shaped type for the nasopalatine canal. Also, the anteroposterior diameter of a nasal foramen in the hourglass shape was significantly larger in diameter than all other shapes. Additionally, the morphology of the nasopalatine canal is influenced by its shape. The sagittal cross-section has shown significant correlations with the sizes of the incisive foramen, nasal foramen, and the length of the nasopalatine canal. CONCLUSIONS The study found a correlation between the shape of the NPC and the horizontal dimensions of the anterior maxilla's anatomy. The measurements of NPC in a North Cyprus population slightly differ from the established standards found in the existing literature. Conducting more extensive studies with a larger number of CBCT images will offer additional insights.

Florid follicular lymphoid hyperplasia of the palate: review of the literature and report of an illustrative case.

OBJECTIVE: The aim of this report was to review oral follicular lymphoid hyperplasia, with emphasis on palatal lesions. METHOD AND MATERIALS: A comprehensive search was performed on PubMed for case reports and case series of palatal follicular lymphoid hyperplasia published in the English language literature. Relevant data from collated articles was sought, including patient demographics, clinical manifestations, imaging modalities and findings, comorbidities, etiopathogenesis, lesional management, and lesional outcome. A new palatal case has also been provided to illustrate several features of this lesion. RESULTS: In total, 32 cases were assembled to establish clinicopathologic correlations, representing the largest aggregation of published cases. Most of the affected patients were at least 60 years old and with a decisive female predilection. The majority of lesions were ≤ 3 cm, appearing as normal color, purple-red or red, and varied from soft to firm. Notably, 32% of palatal follicular lymphoid hyperplasias were associated with denture wear, and lesional recurrence was recorded in 16% of cases. To date, none of the reported cases of palatal follicular lymphoid hyperplasia has undergone malignant transformation. CONCLUSIONS: Palatal follicular lymphoid hyperplasias often arise as a reactive process. Critical histopathologic and histochemical assessments are necessary to establish benignity. Postoperatively, clinicians should follow patients for at least 5 years for recurrence and remain vigilant for neoplastic change as several published accounts of non-oral follicular lymphoid hyperplasias have undergone malignant transformation, usually to lymphoma.

How palatal vault morphology and screw length influence the accuracy of dynamic computer-guided orthodontic miniscrew insertion. A prospective clinical study.

OBJECTIVES: The aim of this study was to evaluate the influence of palatal vault morphology and screw length on the accuracy of miniscrew insertion in dynamic computer-assisted surgery (d-CAS). METHODS: Twenty-four subjects were allocated into three groups, according to their palatal vault morphology (Group A: medium; Group B: steep/high; Group C: low/flat) and the length of miniscrew used. For each subject, two miniscrews were inserted using a dynamic navigation system. To assess the accuracy of insertion, a postoperative CBCT was performed, and the pre- and post-operative scans were superimposed. Five variables were evaluated: Entry-3D, Entry-2D, Apex-3D, Apex-vertical and angular deviation. Descriptive statistics, Shapiro-wilk, Kruskal-Wallis and Dunn's tests were used for the statistical analysis. The level of significance was P ≤ 0.05. RESULTS: The mean angular deviation values revealed strong discrepancies amongst the groups (Group A:7.11°±5.70°; Group B:13.30°±7.76°; Group C:4.92°±3.15°) and significant differences were found regarding the Apex-3D (P = 0.036) and angular deviations (P = 0.008). A Dunn's test revealed differences in angular deviation between the medium and high/steep palate group (P = 0.004), and between low/flat and high/steep palate group (P = 0.01) but did not confirm any significant difference in the Apex-3D parameter (Group A-B P = 0.10; Group B-C, P = 0.053; Group A-C, P = 1.00). No significant differences were found regarding the length of the miniscrews. CONCLUSIONS: Palatal vault morphology is a factor that influences the accuracy of miniscrew insertion in d-CAS. In subjects with steep and high palatal vaults, insertion accuracy is lower when considering the angular deviation value. Miniscrew length does not influence accuracy. CLINICAL SIGNIFICANCE: Although computer-guided surgery assists the clinician in preventing damage to nearby anatomical structures, individual anatomical variability is a crucial variable. In subjects with a high/steep palate, greater attention should be paid during the planning phase in order to allow for a wide margin from adjacent anatomical structures to achieve better outcomes.

Morphological evaluation of the nasopalatine canal using cone beam computed tomography and its clinical implications for orthodontic miniscrew insertion.

BACKGROUND: The morphology of the nasopalatine canal is crucial in the planning of prosthetic restorations in the anterior region of the maxilla, as well as in the placement of orthodontic mini-implants. OBJECTIVES: The aim of this study was to assess the morphology of the nasopalatine canal using cone beam computed tomography (CBCT) scans of patients from the University Dental Clinic in Krakow, Poland, to define the position of the canal in relation to common sites of palatal median microimplant placement, and to investigate potential correlations between the anatomy of the canal and age and gender of the patients. MATERIAL AND METHODS: A total of 120 CBCT images were used to assess the anatomy of the nasopalatine canal in 3 planes of space. The bone thickness anterior to the nasopalatine canal and the distance between the distal margin of Stenson's foramen and the predicted midpalatal microimplant position were also measured. RESULTS: The most frequently observed canal type in the coronal plane was the Y-shaped canal, which was present in 60.8% of patients. The nasopalatine canal was classified as cone-shaped in 31.7% of the scans, cylindrical in 28.3%, hourglass-shaped in 27.5%, and banana-shaped in 12.5%. The mean length of the nasopalatine canal was 11.58 mm. The mean width of the canal was 2.89 mm at the nasal fossa level, 1.94 mm in the middle, and 5.09 mm at the palatal level. The mean bone thickness anterior to the nasopalatine canal was 9.07 mm at the level of the nasal opening, 6.84 mm at the level of the oral opening, and 7.32 mm in the middle. The mean distance between the distal margin of Stenson's foramen and the predicted midpalatal microimplant position varied from 0 to 11.94 mm, with a mean of 2.49 mm. CONCLUSIONS: Given the variety of nasopalatine canal forms and dimensions, detailed analysis of CBCT scans is essential prior to the placement of implants and microimplants.