Palatal bone thickness for mini-implant insertion in different vertical growth patterns: a systematic review.

Introduction: The purpose of this systematic review was to identify, evaluate, and provide information about palatal bone thickness in different vertical growth patterns for the placement of orthodontic anchorage devices. Methods: We performed a systematic review of the published data in Medline via PubMed, Web of Science, Cochrane Library, and Scopus from January 2000 to August 2022 using eligibility criteria. Data collection analysis and data extraction were performed independently by three reviewers. Sensitivity analyses were performed with the Cochrane risk of bias tool and the ROBINS-I tool was used for non-randomized studies. Results: A total of 343 articles were identified. The inclusion criteria included palatal bone thickness and vertical facial growth. However, both variables were found in 4 studies and only 2 had a control group. The different studies evaluated palatal bone thickness according to sex (male 14.1 mm; female 9.68 mm) and vertical malocclusion (normal 2.2 -12.6 mm; open bite 1.9 -13.2mm) with heterogeneous results. Likewise, the vertical growth pattern with a low angle (9.39 mm) was greater than the normal (8.55 mm) and high angle (7.53 mm). Conclusions: Palatal bone thickness varies according tp different vertical growth patterns, with the greatest thickness being found near the incisive foramen in hypodivergent individuals.

Introducción: El propósito de esta revisión sistemática fue identificar, evaluar y brindar información sobre el espesor óseo palatino en diferentes patrones de crecimiento vertical para la colocación de dispositivos de anclaje ortodónticos. Materiales y métodos: Realizamos una revisión sistemática de los datos publicados de Medline, a través de PubMed, Web of Science, Cochrane Library y Scopus. Se realizaron búsquedas sistemáticas con criterios de elegibilidad desde enero de 2000 hasta agosto de 2022. Tres revisores realizaron de forma independiente el análisis de recopilación de datos y la extracción de datos. Los análisis de sensibilidad se realizaron con la herramienta Cochrane de riesgo de sesgo y para estudios no aleatorios seleccionados de intervenciones se utilizó la herramienta ROBINS-I. Resultados: Se identificaron un total de 343 artículos. La elegibilidad de los estudios incluyó el grosor del hueso palatino y el crecimiento facial vertical. Sin embargo, ambas variables se encontraron en 4 estudios y solo 2 tenían grupo control. El espesor óseo palatino presentó resultados heterogéneos, los estudios evaluaron el espesor óseo palatino en cuanto al sexo (masculino: 14,1 mm; femenino: 9,68 mm), y maloclusión vertical (normal: 2,2-12,6 mm; mordida abierta: 1,9-13,2 mm). Asimismo, el patrón de crecimiento vertical con ángulo bajo (9,39 mm) fue mayor que el ángulo normal (8,55 mm) y ángulo alto (7,53 mm). Conclusiones: El grosor del hueso palatino muestra diferencia en los patrones de crecimiento vertical, el mayor grosor se encontró cerca del foramen incisivo en individuos hipodivergentes.

Radiological evaluation of the bone and soft tissue thicknesses of the palate for using a miniscrew-supported maxillary skeletal expander.

PURPOSE: The purpose of this study was to determine the palatal bone and soft tissue thicknesses using a miniscrew-supported maxillary skeletal expander (MSE) in Class III malocclusion. METHODS: The thicknesses of the palatal bone and soft tissue were measured in cone-beam computed tomography images obtained from 58 patients. All 20 points were crossing points between five levels, which were defined at 3 mm intervals relative to the line connecting the central fossae of the first molar (Level 0), and 2 mm and 4 mm lateral to the anteroposterior reference line (AP line). RESULTS: The palatal bone was significantly thicker in males than females in the anterior palate up to Level 0, while there was no significant sex-related difference in the posterior palate. There was a tendency for the thickness to decrease in the posterior direction, except in females at 2 mm lateral to the AP line. The palatal soft tissue was significantly thicker in males than females in all positions. At 2 mm lateral to the AP line, the palatal soft tissue thickness decreased in the posterior direction. A 4 mm lateral to the AP line, it initially decreased in the posterior direction, and then increasing again at Level - 6 (6 mm posterior of Level 0). As the lateral distance from the AP line increased, the palatal bone thickness decreased while the palatal soft tissue thickness increased. CONCLUSIONS: These findings provide quantitative data on the palatal bone and soft tissue thicknesses for the miniscrew-supported MSE in the posterior palate.

Qualitative and Quantitative Assessments of Alveolar Bone Dimension and Its Correlation with Tooth Angulation in the Anterior Maxilla for Immediate Implant Placement.

AIM AND OBJECTIVE: The aim of this paper is to ascertain the quantitative measurements of alveolar bone thickness at all maxillary anterior teeth and qualitatively demonstrate the relationship between tooth angulation (TA) and alveolar bone thickness. MATERIALS AND METHODS: Cone-beam computed tomography (CBCT) images of 189 maxillary anterior teeth were collected. Sagittal view was selected to perform the measurement on alveolar bone wall at crestal, midlevel, and palatal. TA was measured along to the tooth long axis (TLA) related to the alveolar bone housing. Spearman's correlation coefficients were conducted to test the correlation between the variables. RESULTS: The facial alveolar bone (FAB) is predominantly thin (<1 mm) at the crestal and midroot region. A significant difference was recorded in the median thickness of FAB at the midroot and apical area (p = 0.001, p = 0.021). The FAB thickness was not gradual with midroot being thinner than crestal. For the palatal alveolar bone (PAB), the thickness was increased continuously toward the apex. At all apical levels of inspected teeth, a significant negative correlation existed between TA and FAB. A positive correlation of TA was only significant at the facial crest of lateral incisor (r = 0.308). However, the canines did not correlate with the FAB, but correlated with the PAB at the apical level (r = 0.478). CONCLUSION: The FAB wall crest of maxillary anterior teeth was generally thin and not gradual with the lateral incisor being the thinnest. A significant correlation of TA existed based on different types of maxillary anterior teeth and alveolar bone level. The maxillary anterior teeth with increased buccolingual angulation were correlated with thicker bone at the apical level. CLINICAL SIGNIFICANCE: The quantitative assessment of FAB and TA in degree may serve as an anatomical index for ideal implant position.

Clinical assessment of the palatal alveolar bone thickness and its correlation with the buccolingual angulation of maxillary incisors for immediate implant placement.

BACKGROUND: Clinicians needed to be aware of the thinness of the palatal bone plate when identifying severe protrusion of maxillary incisors, as this could result in perforation of the palatal bone plate during surgical procedures associated with immediate maxillary implant placement. PURPOSE: This study evaluated the thickness of the palatal bone plate, the buccolingual angulation of maxillary incisors, and the correlation between these two parameters in relation to immediate implant placement. MATERIALS AND METHODS: Cone-beam computed tomography images of 37 Asian patients (20-60 years old) with no evidence of dental treatment in the maxillary incisor area were collected and classified into groups based on sex and incisor locations. Sagittal slices were used to measure the palatal bone plate thickness at the cervical, middle, and apical levels, and the buccolingual angulation of each tooth was also measured. The intraclass correlation, Shapiro-Wilk test, descriptive analysis, Student's t-test, and Pearson correlation were used for statistical and correlation analyses, with P < .05 applied as the criterion for statistical significance. RESULTS: At the apical level of all inspected teeth and the middle level of lateral incisors, the palatal bone was significantly thicker in males than in females. The inclination of the maxillary lateral incisor showed a moderate negative linear correlation with the palatal bone thickness at the apical level (R = -0.517 and R = -0.579 for males and females, respectively). CONCLUSIONS: In an Asian population, an increased buccolingual angulation of the maxillary lateral incisors was correlated with a thinner palatal bone plate at the apical level.

Utility of CBCT for the measurement of palatal bone thickness.

INTRODUCTION: The palate is an alternative anchoring site for orthodontic implants. Adequate bone at mini-implant placement site can influence the success or failure of anchorage. Hence, it is imperative to measure the thickness of the palatal bone. MATERIALS AND METHODS: CBCT scans of 30 subjects in the age range of 12 to 28 years were retrospectively analyzed with the objective of measuring the palatal bone thickness. Thirty sites were identified on each CBCT scan with incisive foramen as a landmark and measurements were obtained anteroposteriorly as well as mediolaterally, using Carestream 3D imaging software. The data collected was analyzed using one-way ANOVA. RESULTS: Statistical analysis revealed higher palatal bone thickness at the median and paramedian regions of anterior palate, 4mm and 8mm distal to incisive foramen. CONCLUSION: CBCT is an ideal modality for measuring palatal bone thickness and can be utilized for locating the ideal site for placement of orthodontic mini-implants.