Effect of hyaluronic acid on palatal wound healing: A systematic review.

OBJECTIVES: To evaluate the efficacy of topically applied hyaluronic acid on wound healing (patient-reported outcomes and clinical healing) after a palatal autogenous gingival graft is harvested. MATERIALS AND METHODS: A systematic search was performed in April 2024 in eleven electronic databases. Two investigators independently screened the references for inclusion. Outcomes of interest included postoperative pain, analgesic consumption, complete epithelialization, and color match, which were synthesized using narrative synthesis. RESULTS: A total of 535 results were identified and eight articles were included in the systematic review. Hyaluronic acid use on the palatal donor site had a better response to healing and wound size compared to the control sites with no agent applied. Hyaluronic acid demonstrated a positive effect in the form of complete epithelialization, and color match, with improved patient-reported outcomes such as post-operative pain. CONCLUSION: Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions. CLINICAL RELEVANCE: Within the limitations of this systematic review, it can be concluded that hyaluronic acid shows a strong potential to improve patient-reported outcomes and clinical wound healing at the graft donor site on the palate. Future studies are required to clarify the optimal concentration, frequency of application, and synergistic effect when HA is combined with other interventions.

Reasonable Risk Ratio of Palate Surgery: A New Critical Analysis.

OBJECTIVE.: A new critical complication risk analysis, the reasonable risk ratio (RRR or R3) for palate surgeries in obstructive sleep apnea patients. METHODS.: Analysis from published meta-analyses, systematic reviews on success rates, and complications encountered for 3 palate surgeries, expansion sphincter pharyngoplasty (ESP), barbed repositioning pharyngoplasty (BRP) and modified uvulopalatopharyngoplasty (mUPPP), over 20 years. The RRR is derived from a ratio of the percentage of each respective complication over the success rate of that particular surgical procedure. The benchmark RRR of tonsillectomy is set at 0.035 to 0.078. An RRR below this benchmark value is more favorable as tonsillectomy is a widely accepted ENT procedure with risks to benefit well accepted. RESULTS.: The RRR for foreign body (FB) sensation (BRP) ranged from 0.03 to 0.23 (mean RRR of 0.14), FB sensation (ESP) 0.01, FB sensation (mUPPP) ranged from 0.33 to 0.55 (mean RRR of 0.44). The RRR for swallowing difficulties (BRP) ranged from 0.04 to 0.23 (mean RRR of 0.11), mUPPP, was 0.37; no reported swallowing difficulties with the ESP. The RRR for velopharyngeal insufficiency (VPI) (BRP) ranged from 0.009 to 0.18 (mean RRR of 0.07), and RRR VPI (mUPPP) was 0.14. The RRR (BRP) for dry throat was 0.06 and the mUPPP was 0.35, with no reported VPI or dry throat for ESP. The overall RRR for the BRP was 0.09, ESP was 0.01 and mUPPP was 0.29. CONCLUSION.: RRR provides a summarized data-driven, statistical guide to aid decision-making, and helps in patient counseling. BRP and ESP have been shown to have less complications compared to mUPPP.Level of evidence: IV.

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.

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.

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.

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.

Gross and scanning electron microscopic features of the oral cavity (palate, tongue, and sublingual floor) of the Egyptian long-eared hedgehog (Hemiechinus auratus aegyptius).

The study was focused on the anatomical characteristics of the Egyptian long-eared hedgehog's oral cavity by using gross and scanning electron microscopic examinations. The upper lip had an elongated T-shaped snout-like structure. The hard palate had a triangular rostral part (which had a semicircular area and a caudal ridged area with the first 3 or 4 ridges) and a caudal part (which contained seven or eight slightly oblique ridges with raphae). The diamond-incisive papilla is flanked on both sides by a groove and a fissure. The hard palate surface had glandular openings and a microplicae system. The uneven, soft palate's surface had multiple grooves and folds with 12-16 Gemmal papillae. The Gemmal papillary surface had three to four taste pores with microplicae and glandular openings. The dorsal lingual surface had six filiform subtypes: pointed (on the tip, rostral border, and median apical region), triangular (on the lateral apical and circumvallate regions), bifurcated (on the median tip only), leaf-like (on the median body region), branched (on the lateral root region), and small pointed papillae (on the median root). There were two fungiform subtypes: ovals (on the rostral border and lateral region) and rounds (on the median apical region and body). The caudal root part had a triangular arrangement of three circumvallate papillae. In conclusion, the finding confirmed its oral cavity adaptation with its insectivorous feeding habits and Egyptian environment.

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.

Cocaine-induced destruction of the palate: a diagnostic and management challenge.

Cocaine usage is increasing at a rate faster than population growth worldwide. The habitual and chronic insufflation of pulverised cocaine is associated with the progressive destruction of the osseocartilaginous structures of the midface, termed cocaine-induced midline destructive lesions (CIMDLs). These entities present a challenging diagnostic picture, mimicking other infectious, malignant and inflammatory conditions associated with midface destruction. CIMDLs can present along a wide spectrum of disease, with minimal palatal perforation to extensive sinonasal destruction. With the increasing usage of cocaine, there is likely to be a concurrent increase in patients presenting to emergency departments with these destructive entities. Therefore, there is a need to create awareness of this uncommon entity and to document a systematic approach that must be adopted to reach a definitive diagnosis which will subsequently inform management. We report four clinical cases of CIMDLs at varying stages of the disease process which presented to the Dublin Dental University Hospital between January 2023 and June 2024 and document their multidisciplinary management from initial presentation to eventual treatment.

Palatal groove associated with periodontal lesions: a systematic review illustrated by a decisional tree for management.

BACKGROUND: Palatal groove represents a relatively uncommon developmental root anomaly, usually found on the palatal aspect of maxillary incisors. While its origin is controversial, its presence predisposes to severe periodontal defects. AIM: This study aimed to provide a systematic review of the literature focusing on the varied diagnostic techniques and treatment modalities for periodontal lesions arising from the presence of palatal groove. Based on the existing evidence and knowledge, the study also provides a comprehensive decisional tree, guiding clinicians in the challenging decision-making process face to a palatal groove. METHODS: The literature search was conducted on Medline and Cochrane databases by two independent reviewers, who also performed the screening and selection process, looking for English written articles reporting on diagnosis and management (all treatment approaches) of periodontal lesion(s) associated with a palatal groove. Based on this literature, a comprehensive decisional tree, including a standardized palatal groove evaluation and tailored treatment approaches, is proposed. Moreover, a clinical case is described to demonstrate the practical application of the developed decisional tree. RESULTS: Over a total of 451 articles initially identified, 34 were selected, describing 40 patients with 40 periodontal lesions associated with palatal grooves. The case report illustrates a deep, large, circumferential intra-bony defect on the palatal side of the tooth #22 associated with a shallow, moderately long palatal groove in an 18-year-old male patient. Following reevaluation, a single flap surgery was deemed necessary, combined with a regenerative procedure. At 2 years post-treatment, the tooth #22 is healthy, in a functional and esthetic position. The decision-making process, based on local and systemic patient's conditions, should allow an early and precise diagnosis to prevent further complications and undertake an adequate treatment. CONCLUSION: Palatal grooves are relatively rare; however, they are frequently associated with severe periodontal defects. The identification, diagnosis, prompt, and tailored management of the associated lesion is essential to mitigate potential periodontal and endodontic complications related to the presence of palatal groove. SYSTEMATIC REVIEW REGISTRATION: [ https://www.crd.york.ac.uk/prospero/ ], identifier [C CRD42022363194].

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.

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.

[Analysis of the difference of therapeutic effect and predictive factors between postural and non-postural OSA after modified uvulopalatopharyngoplasty].

Objective:To analyze the factors influencing the outcome of uvulopalatopharyngoplasty in positional obstructive sleep apnea（POSA） and non-positional OSA（NPOSA） patients, and to explore the differences between the two groups. Methods:The data of 101 patients with obstructive sleep apnea who received treatment from November 2020 to November 2023 were retrospectively analyzed. Among them, 45 positional patients（POSA group） and 56 non-positional patients（NPOSA group）, who underwent overnight polysomnography were included. The upper airway（UA） anatomy was evaluated by three-dimensional computer tomography（3D-CT）. All patients received revised uvulopalatopharyngoplasty with uvula preservation and were followed using polysomnography for at least three months postoperatively. Results:The overall effective rate was 55.45%. The surgical success rate in POSA undergoing UPPP was higher than NPOSA（POSA 30/45, 66.7% versus NPOSA 26/56, 46.4%, P=0.042）. The H-UPPP effect of POSA was negatively correlated with the minimum lateral airway of the Velopharyngeal airway（r=-0.505, P<0.001）, the minimum lateral airway of the glossopharyngeal airway（r=-0.474, P=0.001） and the minimum cross-sectional area（r=-0.394, P=0.007）. Logistic analysis showed that minimal lateral airway of the glossopharynxgeum（mLAT）（OR 0.873; 95%CI 0.798-0.955, P=0.003） was a significant predictor for surgical outcomes among POSA patients. In NPOSA, age（OR 0.936; 95%CI 0.879-0.998, P=0.042） was a significant predictor for surgical outcomes. Conclusion:The effect of H-UPPP was higher in POSA than in NPOSA. The width of glossopharyngeal mLAT was an important predictor of POSA efficacy. Age was a predictor of NPOSA efficacy.

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.

Mechanically induced M2 macrophages are involved in bone remodeling of the midpalatal suture during palatal expansion.

BACKGROUND: Palatal expansion is a common way of treating maxillary transverse deficiency. Under mechanical force, the midpalatal suture is expanded, causing local immune responses. This study aimed to determine whether macrophages participate in bone remodeling of the midpalatal suture during palatal expansion and the effects on bone remodeling. METHODS: Palatal expansion model and macrophage depletion model were established. Micro-CT, histological staining, and immunohistochemical staining were used to investigate the changes in the number and phenotype of macrophages during palatal expansion as well as the effects on bone remodeling of the midpalatal suture. Additionally, the effect of mechanically induced M2 macrophages on palatal osteoblasts was also elucidated in vitro. RESULTS: The number of macrophages increased significantly and polarized toward M2 phenotype with the increase of the expansion time, which was consistent with the trend of bone remodeling. After macrophage depletion, the function of osteoblasts and bone formation at the midpalatal suture were impaired during palatal expansion. In vitro, conditioned medium derived from M2 macrophages facilitated osteogenic differentiation of osteoblasts and decreased the RANKL/OPG ratio. CONCLUSIONS: Macrophages through polarizing toward M2 phenotype participated in midpalatal suture bone remodeling during palatal expansion, which may provide a new idea for promoting bone remodeling from the perspective of regulating macrophage polarization.

Homemade CAD-CAM surgical guide for palatal mini-screw insertion for maxillary molar distalization providing anchorage. A two times original protocol / Pose de mini-vis palatines par chirurgie guidée à l'aide d'un guide CFAO in-office. Description d'un protocole original en deux temps.

Introduction: Temporary Anchorage Devices have revolutionized our approach to anchorage management. However, their placement may carry risks, such as root perforation, damage to the periodontal ligament, buccal-nasal communication, etc. The aim of this article is to describe an original protocol in two times for the placement of a palatal mini-screw through guided surgery using a guide created by Computer-Aided Design and Manufacturing (CAD/CAM) followed by the transfer of placement information to the laboratory for the fabrication of a Custom Medical Device (CMD) for distalization. Materials and Methods: A two-stage protocol is described and illustrated step by step. Phase 1 comprises 7 steps (including superimposition of maxillary cast and profile teleradiography, surgical tray design), followed by phase 2, which involves 3 final steps (including production of impression for laboratory, production of laboratory model with transfer of mini-screw position). Results: Although the position of the mini screws remains precise, a discrepancy between the planning and the intraoral situation exists. The addition of a second step therefore enables the distalization appliance to be fitted precisely and without pitfalls. Finally, this protocol ensures safe placement, making work easier for the practitioner and, ultimately, for the patient. Conclusion: In a two-stage process, the placement of palatal mini screws through guided surgery using a guide created by CAD/CAM followed by the transfer of this information to the laboratory for the fabrication of a CMD for distalization proves to be a relevant approach.

Introduction: Les dispositifs d'ancrage temporaires ont révolutionné notre vision de la gestion de l'ancrage. En revanche, leur mise en place peut comporter certains risques (perforation radiculaire, communication bucco-nasale, lésions vasculaires…). Cet article vise à décrire un protocole original, en deux temps, de pose de mini-vis palatine par chirurgie guidée à l'aide d'un guide réalisé par conception et fabrication assistée par ordinateur (CFAO) in-office suivie du transfert des informations de pose au laboratoire pour la confection d'un appareil de distalisation. Matériel et méthodes: Un protocole en deux temps est décrit pas à pas. Le temps 1 comprend sept étapes (dont le placement virtuel des mini-vis et la création de la gouttière chirurgicale), suivi du temps 2 qui implique trois étapes (dont la réalisation de l'empreinte pour le laboratoire et l'élaboration du modèle de laboratoire avec transfert de la position des mini-vis). Résultats: Bien que la pose puisse être considérée comme précise, une différence existe entre la planification et la situation clinique. L'apport d'un second temps améliore l'adaptation de l'appareil de distalisation. Enfin, ce protocole offre une pose sécurisée et apporte ainsi un confort de travail pour le praticien et, in fine, pour le patient. Conclusion: Réalisée en deux temps, la pose de mini-vis palatine par chirurgie guidée à l'aide d'un guide réalisé par CFAO in-office suivie du transfert de cette information au laboratoire pour la confection d'un appareil de distalisation s'avère être une approche pertinente.

Genetic and environmental impact on variation in the palatal dimensions in permanent dentition: a twin study.

The objective of this study was to assess the relative contributions of genetic and environmental factors to variation in palatal parameters in twins with completed maxillary growth. The subjects of this study comprised digital dental casts of 50 monozygotic and 35 dizygotic twin pairs. The subjects' average age was 17.95 ± 2.83 years. Zygosity determination was carried out using 15 specific DNA markers and an amel fragment of the amelogenin gene. The interdental distances were measured between selected dental landmarks at the occlusal and gingival planes. The palatal height, surface area and volume were measured between the gingival plane and the midpalate suture. High heritability estimates were observed for all transverse intra-arch measurements. The palate height (a2 = 0.8), dental arch width in the molar area (a2 = 0.86), palatal surface area (a2 = 0.61) and palate volume (a2 = 0.69) were under strong additive genetic control. Moderate genetic dominance was observed for dental arch widths at the gingival line in the canine (d2 = 0.5) and premolar regions (d2 = 0.78-0.81). Sexual dimorphism was shown, with males exhibiting a greater arch width, palate surface area and volume than females (p < 0.01). The majority of palate parameters variation in twins was controlled by genetic effects, and most were highly heritable.

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).

Protective effect of Sasa veitchii extract against all-trans-retinoic acid-induced inhibition of proliferation of cultured human palate cells.

Cleft palate is the most common facial birth defect worldwide. It is caused by environmental factors or genetic mutations. Environmental factors such as pharmaceutical exposure in women are known to induce cleft palate. The aim of the present study was to investigate the protective effect of Sasa veitchii extract against medicine-induced inhibition of proliferation of human embryonic palatal mesenchymal cells. We demonstrated that all-trans-retinoic acid inhibited human embryonic palatal mesenchymal cell proliferation in a dose-dependent manner, whereas dexamethasone treatment had no effect on cell proliferation. Cotreatment with Sasa veitchii extract repressed all-trans-retinoic acid-induced toxicity in human embryonic palatal mesenchymal cells. We found that cotreatment with Sasa veitchii extract protected all-trans-retinoic acid-induced cyclin D1 downregulation in human embryonic palatal mesenchymal cells. Furthermore, Sasa veitchii extract suppressed all-trans-retinoic acid-induced miR-4680-3p expression. Additionally, the expression levels of the genes that function downstream of the target genes ( ERBB2 and JADE1 ) of miR-4680-3p in signaling pathways were enhanced by cotreatment with Sasa veitchii extract and all-trans-retinoic acid compared to all-trans-retinoic acid treatment. These results suggest that Sasa veitchii extract suppresses all-trans-retinoic acid-induced inhibition of cell proliferation via modulation of miR-4680-3p expression.

Giant stem tetrapod was apex predator in Gondwanan late Palaeozoic ice age.

Current hypotheses of early tetrapod evolution posit close ecological and biogeographic ties to the extensive coal-producing wetlands of the Carboniferous palaeoequator with rapid replacement of archaic tetrapod groups by relatives of modern amniotes and lissamphibians in the late Carboniferous (about 307 million years ago). These hypotheses draw on a tetrapod fossil record that is almost entirely restricted to palaeoequatorial Pangea (Laurussia)1,2. Here we describe a new giant stem tetrapod, Gaiasia jennyae, from high-palaeolatitude (about 55° S) early Permian-aged (about 280 million years ago) deposits in Namibia that challenges this scenario. Gaiasia is represented by several large, semi-articulated skeletons characterized by a weakly ossified skull with a loosely articulated palate dominated by a broad diamond-shaped parasphenoid, a posteriorly projecting occiput, and enlarged, interlocking dentary and coronoid fangs. Phylogenetic analysis resolves Gaiasia within the tetrapod stem group as the sister taxon of the Carboniferous Colosteidae from Euramerica. Gaiasia is larger than all previously described digited stem tetrapods and provides evidence that continental tetrapods were well established in the cold-temperate latitudes of Gondwana during the final phases of the Carboniferous-Permian deglaciation. This points to a more global distribution of continental tetrapods during the Carboniferous-Permian transition and indicates that previous hypotheses of global tetrapod faunal turnover and dispersal at this time2,3 must be reconsidered.