Quantitative analysis of maxillary palatal masticatory mucosa thickness and anatomical morphology of palatal vault in Zhejiang province.

OBJECTIVE: To quantitatively analyze the maxillary palatal masticatory mucosa thickness and anatomical morphology of palatal vault in Zhejiang province. METHODS: Cone beam computed tomography (CBCT) images of 146 adult patients were collected from outpatients in Department of Stomatology, the First Affiliated Hospital, Zhejiang University School of Medicine. The images were reconstructed by adjusting the reference line and analyzed on the sagittal plane of the measured teeth. The thickness of masticatory mucosa from maxillary canine to second molar area was measured at the level of 3, 6, 9, 12 mm from the gingival margin. At the same time, the height and width of the palatal vault were measured, the position of the greater palatal foramen relative to the second molar, and the distance from the greater palatal foramen to the mid-palatal suture and the alveolar crest were determined. Spearman correlation analysis and multiple regression analysis were used to explore the influencing factors of the maxillary masticatory mucosa thickness. One-way analysis of variance and LSD multiple comparisons were used to analyze the difference in palatal mucosal thickness of each tooth position in different age groups. The sample t-test was used to analyze the differences in the mucosal thickness of each tooth position and the distance from the greater palatal foramen to the mid-palatal suture and the alveolar crest in different anatomical forms of the palatal vault. RESULTS: The mean palatal masticatory mucosa thickness from maxillary canines, first premolars, second premolars, first molar and second molar areas were (2.94±0.48), (3.28±0.49), (3.43±0.53), (3.01±0.55), (3.49±0.70) mm, respectively. The mucosa thickness of canines, first premolars and second premolars areas showed increasing at first and then decreasing trend. The mucosal thickness of the canines area was greatest at 6 mm from the gingival margin, and the thickness of the first and second premolars areas was greatest at 9 mm from the gingival margin. Premolars are thickest at 9 mm from the gingival margin. The thickness of the mucosa of the first molars area increased with the increase of the distance from the gingival margin, and the thickness of the mucosa of the second molars area was the thinnest at 6 mm, and then increased with the increase of the distance from the gingival margin. The main influencing factors of the mucosal thickness of canines, first premolars and first molars areas were age and palatal vault aspect ratio, the main influencing factor of the mucosal thickness of second premolars area was age, and the main influencing factor of the mucosal thickness of second molars area was palatal vault aspect ratio. There was no significant colinearity among the variables ( VIF<10). The results of the further stratified analysis showed that the mucosal thickness of the maxillary canine to the first molar area was positively correlated with age, and mucosal thickening is more pronounced in people aged 45 years old and above. The thickness of the canine mucosa in the high palate vault group was greater than that in the low palate vault group ( P<0.05), and the thickness of the second molar mucosa was smaller than that in the low palate vault group ( P<0.05). The greater palatal foramen was mostly located in the distal region of the second molar crown. The distance from the greater palatal foramen to the alveolar crest in the high palatal vault group was greater than that in the low palatal vault group ( P<0.05), while there was no significant difference between the two groups in the distance from the foramen magnum to the mid-palatal suture ( P>0.05). CONCLUSION: The most suitable donor site for autologous soft tissue graft may be 3-9 mm from the gingival margin of the first and second premolars area.

Correlación del diagnóstico clínico e histopatológico de lesiones de la mucosa oral entre 2008-2015 en la Universidad de Costa Rica / Correlation of Clinical and Histopathological Diagnosis of Oral Mucosa Lesions at the University of Costa Rica Between 2008 and 2015

RESUMEN: El objetivo de este estudio es determinar la concordancia existente entre el diagnóstico clínico e histopatológico de las lesiones en la mucosa oral en la Facultad de Odontología de la Universidad de Costa Rica (UCR). Es un estudio retrospectivo de 261 informes de lesiones orales recuperados del archivo de biopsias de la Facultad de Odontología de la UCR de 2008 a 2015, fueron analizados 165 reportes que cumplian con los criterios de inclusión. La concordancia entre el diagnóstico clínico e histopatológico fue verificada mediante el test Kappa. Del total de los informes, 96 (36.8%) no contaban con alguna hipótesis diagnóstica. La concordancia con la primera hipótesis diagnóstica se presentó en 114 (69.1%) casos, el valor de kappa fue de 0.663 (concordancia sustancial). Las lesiones premalignas presentaron una concordancia excelente (kappa=0.902). La concordancia del grupo de lesiones proliferativas no neoplásicas fue moderada (kappa=0.504) y las condiciones dermatológicas y autoinmunes con una concordancia insignificante (0.157). La concordancia se produjo en la mayoría de los pacientes investigados con un valor correspondiente a un acuerdo sustancial, sin embargo, se debe mejorar el porcentaje de informes que no contaban con hipótesis clínica.

ABSTRACT: The objective of this study is to determine the existing concordance between the clinical and histopathological diagnosis of lesions in the oral mucosa at the Faculty of Dentistry of the University of Costa Rica (UCR). A retrospective study of 261 reports of oral lesions recovered from the biopsy archive of the UCR Faculty of Dentistry from 2008 to 2015. Of the total reports 165 were included in the analysis, 96 (36.8%) did not have any diagnostic hypotheses. The concordance between the clinical and histopathological diagnosis was verified by the Kappa test. Concordance with the first diagnostic hypothesis was presented in 114 (69.1%) cases, the value of kappa was 0.663 (substantial agreement) and 36.8% without clinical diagnosis only a description of the lesion. The premalignant lesions presented an excellent concordance (kappa=0.902). The concordance of the group of non-neoplastic proliferative lesions was moderate (kappa=0.504) and the dermatological and autoimmune conditions with negligible concordance (0.157). Concordance occurred in the majority of the patients investigated with a value corresponding to a substantial agreement, however, the percentage of reports that did not have a clinical hypothesis should be improved.

Regulatory mechanism of oral mucosal rete peg formation.

Rete pegs are finger-like structures that are formed during the development and wound healing process of the skin and oral mucosa, and they provide better mechanical resistance and nutritional supply between the epithelium and dermis. An increasing number of studies have shown that rete pegs have physiological functions, such as resisting bacterial invasion, body fluid loss, and other harmful changes, which indicate that rete pegs are important structures in natural skin and oral mucosa. Although a great deal of progress has been made in scaffold materials and construction methods for tissue-engineered skin and oral mucosa in recent years, construction of the oral mucosa with functional rete pegs remains a major challenge. In this review, we summarized current research on the progress on formation of rete pegs in human oral mucosa as well as its molecular basis and regulatory mechanism, which might provide new ideas for functional construction of tissue-engineered skin and oral mucosa.

Labial and buccal minor salivary glands of the dog - location, three-dimensional arrangement and histology.

OBJECTIVE: Transplantation of minor salivary glands (MSGs) to the conjunctiva is a treatment option for patients suffering from dry eye disease. As there is not enough information about labial and buccal MSGs in dogs, the aim of this study was to provide evidence of the presence of these glands and to investigate their spatial arrangement and excretory ducts. METHODS: The oral mucosa of the lower lip of 4 dogs and the whole lower jaw of 1 dog were used for histological and microCT analysis. Presence, number, volumes and the tissue depth of MSGs were assessed. RESULTS: Histological analysis showed that compact tubulo-acinar glands were located in the submucosal connective tissue. MicroCT images revealed that 9 to 21 MSGs were arranged in a single row at the level of the dental alveolae. The volume of the MSGs increased from rostral to caudal and the total volume of glandular tissue per animal ranged from 35.01 mm3 to 549.43 mm3 . The mean tissue depth of MSGs ranged from 0.57 mm to 1.37 mm (upper surface of glands) and between 1.43 mm and 3.09 mm (lower surface of the glands). Excretory ducts left the dorsal part of the glands and ran in dorso-rostral direction. CONCLUSIONS: The location, number and volume of the labial and buccal MSGs in the dog could be detected and described using microCT scans and histology. The present results can provide valuable information for future transplantation of labial MSGs as therapeutic measure against keratoconjunctivitis sicca.

Genetic variants in bone morphogenetic proteins signaling pathway might be involved in palatal rugae phenotype in humans.

This study investigated, if genetic variants in BMP2, BMP4 and SMAD6 are associated with variations in the palatal rugae pattern in humans. Dental casts and genomic DNA from 75 patients were evaluated. Each patient was classified as follows: total amount of rugae; bilateral symmetry in the amount, length and shape of the palatal rugae; presence of secondary or fragmentary palatal rugae; presence of unifications; predominant shape; and predominant direction of the palatal rugae. The genetic variants in BMP2 (rs1005464 and rs235768), BMP4 (rs17563) and SMAD6 (rs2119261 and rs3934908) were genotyped. Genotype distribution was compared between palatal rugae patterns using the chi-square test (alpha = 0.05). The allele A was associated with the presence of secondary or fragmentary rugae for rs1005464 (OR = 2.5, 95%CI 1.1-6.3; p = 0.014). Secondary or fragmentary rugae were associated with the G allele in rs17563 (OR = 2.1, 95%CI 1.1-3.9; p = 0.017). rs17563 was also associated with rugae unification (p = 0.017 in the additive model). The predominant shape (wavy) was associated with rs2119261 (p = 0.023 in the additive model). The left-right symmetry of the length of primary rugae was associated with rs3934908 in the recessive model (OR = 3.6, 95%CI 1.2-11.7; p = 0.025). In conclusion, genetic variants in the BMP pathway impacted on palatal rugae pattern.

Clase metodológica instructiva de la asignatura Sistema Masticatorio, orientada a la relación básico-clínica / Instructive methodological class of the Masticatory System subject, oriented towards the basic-clinical relationship

RESUMEN La preparación del personal docente en las universidades exige un alto nivel científico y de maestría pedagógica. Todo esto requiere un esmerado trabajo metodológico que garantice una planificación organización, regulación y control del proceso docente educativo. Para esto se diseñó una clase metodológica instructiva sobre mucosa oral, de la asignatura Sistema Masticatorio, en la disciplina Histología, con el objetivo de instruir al profesor en la utilización de la vinculación básico-clínica. Se indicó a los profesores cómo relacionar el contenido de la clase con la clínica, desde el punto de vista de las lesiones precancerosas y sus factores de riesgo. Se logró la instrucción de los docentes en la utilización del contenido de las asignaturas y disciplinas de las Ciencias Básicas con la relación básico-clínica, y así se contribuyó a ampliar el espectro científico metodológico de los docentes en la Universidad de Ciencias Médicas de Matanzas (AU).

ABSTRACT Training the teaching staff in the universities demands a high scientific level and pedagogical expertise. All of these requires a careful methodological work guaranteeing the teaching-learning process planning, organization, regulation and control. For that the authors designed an instructive methodological lesson aimed to train the teaching staff in the use of the basic-clinical link during a lesson of the subject Masticatory System about Oral Mucosa, in the subject Histology. They indicate to professors how to relate the lesson content to clinic from the point of view of pre-cancer lesions and its risk factors. Training the teaching staff in the use of subjects and disciplines of the Basic Sciences with the basic-clinical relation, the authors contribute to widening the scientific methodological spectrum of the teaching staff of the Matanzas University of Medical Sciences (AU).

A new technique for ureteral reconstruction using lingual mucosa grafts in a beagle model.

PURPOSE: To investigate the feasibility of ureteral reconstruction using lingual mucosa graft (LMG) and evaluate the histological changes of the engrafted LMG in beagles. METHODS: Twelve male beagle dogs were randomly divided into groups A, B and C (n = 4). A ventral ureteral defect was created by excising half of the ureteral wall. The length of the defect was 3 cm, 6 cm, and 10 cm in groups A, B, and C, respectively. The LMGs were harvested and employed to repair the ureteral defects in onlay fashion. Two dogs per group were sacrificed after 6 months, with additional two dogs per group sacrificed after 12 months. Intravenous urography (IVU) and macroscopic examination were performed to evaluate renal function and ureteral patency. Histological changes in the engrafted LMGs during the tissue incorporation process were assessed by histological analysis. RESULTS: There were no postoperative complications. Only one dog in group C developed a mild stricture near the proximal anastomosis. In the remaining 11 animals, IVU showed normal renal function and a wide ureteral caliber without stricture or fistula. The diameter of the LMG-reconstructed ureter was greater than that of the proximal and distal ureter (each p value < 0.01). The LMGs survived in situ with newly formed capillaries. The epithelium of the lingual mucosa resembled the urothelium in postoperative 12 months. CONCLUSION: This new technique for ureteral reconstruction using LMGs is feasible. This approach is a promising alternative clinical treatment for curing long ureteral strictures.

How Thick Is the Oral Mucosa around Implants after Augmentation with Different Materials: A Systematic Review of the Effectiveness of Substitute Matrices in Comparison to Connective Tissue Grafts.

This systematic review aimed to assess the effectiveness of xenogeneic collagen matrices (XCMs) and acellular dermal matrices (ADMs) in comparison to connective tissue grafts (CTGs) for the augmentation of oral mucosa around dental implants. MEDLINE and the Web of Science were searched for clinical studies that compared substitute materials for the augmentation of oral mucosa to the subepithelial connective tissue graft around dental implants during or after implantation. The review was conducted according to the recommendations of the PRISMA statement. From an initial search result set of 1050 references, seven articles were included in the review. The study designs were heterogeneous, so no meta-analysis could be performed. Both the CTG and either type of substitute material resulted in increased mucosal thickness. Four studies showed no significant difference, while three demonstrated a significant difference, favoring the CTGs over alternative materials. Soft tissue augmentation around dental implants is a safe procedure and leads to thicker mucosal tissue. The subepithelial connective tissue graft can still be regarded as the gold standard, but substitute materials may be an acceptable alternative in some situations, such as for pain-sensitive patients, among inexperienced surgeons, and for sites with an already thick biotype.

Anatomic factors influencing dimensions of soft tissue graft from the hard palate. A clinical study.

OBJECTIVES: The aim of the present study was to measure the thickness of the palatal mucosa in a Jordanian (Middle Eastern) population as well as identify possible factors that may influence the thickness of palatal mucosa. MATERIAL AND METHODS: Sixty period on tally healthy subjects (29 males and 31 females) were selected. Fifteen measurement points were defined on the palate. The mucosal thickness in the hard palate was determined by "bone sounding" with a Hu-Friedy® round periodontal probe. RESULTS: The overall mean thickness of the palatal masticatory mucosa was 3.23 ± 0.47 mm.The mean thickness increased from the gingival margin to a more apical position irrespective of the tooth measured or side of the mouth in the following sequence: canine, second molar, first premolar, second premolar and lastly, the first molar. No significant difference between gender, smoking status, gingival phenotype andsides of the mouth with the thickness of palatal masticatory mucosa was determined. A significant difference between palatal shape and palatal gingival thickness was found. CONCLUSIONS: The most appropriate site for graft harvesting is the canine-premolar area 8-13 mm from the mid-palatal aspect of each respective tooth in a Jordanian population. Except for the palatal shape, the side of the mouth, smoking, gender or gingival phenotype does not affect the graft harvest. CLINICAL RELEVANCE: SCIENTIFIC RATIONALE FOR STUDY: Knowledge on the thickness of the masticatory mucosa is crucialin making decisions for surgical treatment modality and may affect surgical outcome. We measured the thickness of the palatal mucosa in a Jordanian population and identified possible influencing factors. PRINCIPAL FINDINGS: The thickness varied according to the teeth and the canine to premolar region was found to be the appropriate donor site. PRACTICAL IMPLICATIONS: This information on safe zone for graft harvest can guide the periodontist to make appropriate incisions and choose the appropriate location to obtain a graft of adequate thickness and dimensions.

Profound approach to check legitimacy of an old technique used to gauge palatal rugae.

AIMS: The present study aimed at assessing two fixed points of reference from where the mesial and distal point of all rugae can be measured so that the exact movement of particular rugae in any direction can be evaluated and assessing the changes in the palatal rugae after orthodontic treatment. METHODS: A longitudinal study conducted among a sample of 20 (8 male and 12 female) adult patients. Pre- and post-orthodontic treatment casts of patients were obtained from the Department of Orthodontics College of Dentistry Jazan University. Antero-posterior linear distances (Technique I) between medial and lateral points of primary, secondary and tertiary rugae were measured. Also, the transverse linear distance (Technique II) between medial and lateral points of right and left rugae were measured. Technique III involved marking two fixed points and using these two points a third point is located on the medial or lateral end of rugae of right and left side in pre and post-treatment orthodontic casts. The independent sample t-test was employed to compare gender. Difference between the pre- and post-treatment mean values were checked by the paired t-test. RESULTS: Technique III successfully showed the statistically significant difference (P ≤ 0.05, 95% CI) in the overall pre and post-treatment values on the patients' cast (N = 20) which was not observed with a technique I and technique II. CONCLUSION: The triangle created by the three reference points in the technique III was able to identify the changes in the palatine rugae more precisely than the technique I and Technique II.

The oral mucosa: Epithelial professional phagocytes, lymphatics, telocytes, and false telocytes.

BACKGROUND: The oral mucosa protects the underlying tissue from mechanical damage as well as from the entry of exogenous particles and microorganisms. Telocytes (TCs) are disputed stromal cells featuring peculiarly long and thin processes with uneven calibre known as telopodes, which play a number of roles within the interstitia. The present study aimed to test the key markers recommended for discriminating between TCs and false TCs in samples of normal oral mucosa. METHODS: Archived paraffin-embedded oral mucosa samples were tested by means of immunohistochemistry with the following markers: CD34, D2-40, CD31 and CD68. RESULTS: The epithelial expression of CD68, D2-40 and CD34 was detected. Two subsets of CD34-expressing stromal cells were identified, large cells with telopodial processes, presumably of the hematopoietic lineage, and spindle-shaped TC-like cells. Macrophages and TC-like cells within the lamina propria expressed CD68. The lymphatic endothelia were found to express CD31 and D2-40, but not CD34. Sprouting lymphangiogenesis was demonstrated by the lymphatic endothelial tip cells, which were projecting thin processes within the connective stroma. CONCLUSIONS: The epithelial expression of CD68 suggests the professional phagocytic potential of the oral epithelium. Regarding the TCs and TC-like cells in the oral mucosa they could not be accurately distinguished from other possible cell types, neither on morphological basis (evidence of telopodes) nor by use of panels of markers which include CD34.

Bioimpedance spectroscopy and spectral camera techniques in detection of oral mucosal diseases: a narrative review of the state-of-the-art.

Oral mucosal diseases are common health problems that reduce overall wellbeing and increase the risk for several systemic diseases. Due to the limitations of present diagnostics, new non-invasive methods are needed for reliable, affordable, real-time screening and follow-up of oral mucosal lesions. Bioimpedance spectroscopy, spectral camera imaging and other optical methods are promising novel techniques to detect abnormal changes in oral mucosa. In this review, the current status of bioimpedance spectroscopy and autofluorescence utilising spectral camera techniques in the assessment of oral mucosal health is critically evaluated. Scientific publications related to bioimpedance spectroscopy were surveyed using PubMed and Scopus databases. Search was done using a combination of terms "oral mucosa", "oral cancer", "squamous cell cancer", "tissue", "electrical impedance measurement" and "bioimpedance spectroscopy". Publications related to spectral cameras were searched from PubMed with a focus on autofluorescence utilising spectral camera techniques. Search was done using terms "autofluorescence", "oral disease" and "VELscope" publication date restricted from 2008 to date. In this review, we also discuss the future trends and strategies such as combining different methods, e.g. spectral cameras and bioimpedance spectroscopy that could represent a unique multimodality in vivo tool for providing complementary information on the health status of the oral mucosa.

Elucidation of Differential Nano-Textural Attributes for Normal Oral Mucosa and Pre-Cancer.

Computational analysis on altered micro-nano-textural attributes of the oral mucosa may provide precise diagnostic information about oral potentially malignant disorders (OPMDs) instead of an existing handful of qualitative reports. This study evaluated micro-nano-textural features of oral epithelium from scanning electron microscopic (SEM) images and the sub-epithelial connective tissue from light microscopic (LM) and atomic force microscopic (AFM) images for normal and OPMD (namely oral sub-mucous fibrosis, i.e., OSF). Objective textural descriptors, namely discrete wavelet transform, gray-level co-occurrence matrix (GLCM), and local binary pattern (LBP), were extracted and fed to standard classifiers. Best classification accuracy of 87.28 and 93.21%; sensitivity of 93 and 96%; specificity of 80 and 91% were achieved, respectively, for SEM and AFM. In the study groups, SEM analysis showed a significant (p < 0.01) variation for all the considered textural descriptors, while for AFM, a remarkable alteration (p < 0.01) was only found in GLCM and LBP. Interestingly, sub-epithelial collagen nanoscale and microscale textural information from AFM and LM images, respectively, were complementary, namely microlevel contrast was more in normal (0.251) than OSF (0.193), while nanolevel contrast was more in OSF (0.283) than normal (0.204). This work, thus, illustrated differential micro-nano-textural attributes for oral epithelium and sub-epithelium to distinguish OPMD precisely and may be contributory in early cancer diagnostics.

Non-dendritic Langerhans cells: A new entity in normal and malignant buccal mucosa

Langerhans cells (LCs) are the most effective antigen presenting cells against foreign bodies and carcinogens. Since the oral cavity is a portal of entry for these antigens, the aim of this study was to morphologically classify CD1a+ LCs, quantify them in the normal and malignant buccal mucosa, and evaluate their relation to the age of patients. Healthy buccal mucosal samples collected from 16 patients undergoing reconstructive operation, and malignant samples obtained from 15 patients undergoing radical oncological resection. were processed for immunohistochemistry four- to fivemicron thick sections were stained with CD1a antibody (CD1a). At 40X magnification, CD1a+ LCs were morphologically classified and quantified manually for a 25mm length of basement membrane using Cellsens image analysing software and the data was analysed. Two categories of CD1a+ LCs were identified in the normal and malignant buccal mucosa a) typical dendritic LCs and b) non-dendritic LCs (a new entity). Non-dendritic LCs were of significantly higher number compared to the typical dendritic LCs in the normal tissues (p -0.001). In the malignant group, the non-dendritic CD1a+ LCs were significantly fewer in number (p0.004), when compared to the normal group. Nondendritic LCs were also significantly fewer (p0.026) in patients over 60 years of age. This is the first report of non-dendritic Langerhans cells in normal buccal mucosa and malignant buccal mucosa using the CD1a marker. The significantly higher number of these cells in normal tissues and younger individuals supports their role as accessory antigen presenting cells

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The Association between Morphological Characteristics of Palatal Rugae and Sagittal Skeletal Patterns.

INTRODUCTION: To find the association between the morphological characteristics of palatal rugae and sagittal skeletal patterns. METHODS: The retrospective charts review was conducted at the Aga Khan University Hospital from April to June 2016, and comprised data obtained from the pretreatment dental cast of orthodontic patients visiting the dental clinics over 5 years from 2011 to 2015. The sample was divided equally in three malocclusion groups based on sagittal skeletal relationship Class I, Class II and Class III. The number of palatal rugae was recorded for both right and left sides. Morphological features of the three anterior most primary rugae were recorded for the length, pattern and orientation bilaterally. SPSS 20 was used to compare the number and lengths as well as the pattern and orientation of palatal rugae among the groups. RESULTS: Of the 165 subjects, there were 55(33.3%) in each of the three groups. Significant differences were recorded in rugae lengths among the groups at ruga 1 on both sides and rugae 2 and 3 on the left side (p<0.05 each). There were significant differences in the palatal rugae patterns among the groups (p<0.05) except at rugae 2 and 3 on the left side (p>0.05). Orientation showed significant differences at ruga 2 on the right side (p=0.02). CONCLUSIONS: No specific pattern was associated with any skeletal pattern. Further studies are required to evaluate three-dimensional characteristics of rugae to assess the association between palatal rugae and sagittal skeletal patterns.

The association between palatal rugae pattern and dental malocclusion.

INTRODUCTION: Palatal rugae complete its development during early intrauterine life, whereas dental malocclusions in permanent dentition establishes several years into the post-natal life. OBJECTIVE: The objective of present study was to determine if there is an association between the palatal rugae pattern and Angle's classes of malocclusion. METHODS: A cross-sectional study was conducted on pretreatment dental casts of 184 patients. The sample was divided into the following groups: Class I, Class II div. 1, Class II div. 2, and Class III. The number of palatal rugae was recorded, bilaterally. The length, pattern and orientation of three anterior-most primary rugae on both sides were recorded. RESULTS: The mean age of the study sample was 17.8 ± 5.4 years. The mean number of the palatal rugae was 11.18 ± 2.5, with significant differences among different malocclusion groups. The length of the first rugae on left side and third rugae on both sides varied significantly among the groups (p< 0.05). Similarly, the pattern of palatal rugae was also found to be significantly different among the malocclusion groups. The right sided rugae did not have any significant difference in the orientation in different malocclusion groups; however, the left sided rugae showed significant differences among the four malocclusion groups (p< 0.001). CONCLUSIONS: The current study showed subtle differences in the palatal rugae pattern among the Angle's classes of malocclusion. Similarly, the length and orientation of some rugae were also found to be significantly different between malocclusion groups.

Buccal Mucosa Assessed by Ultrasonography in Healthy Adults: Methodology and Determination of Normal Appearance.

The aim of the work described here was to compare intra-oral and transcutaneous ultrasonography (US) scanning and to determine the normal values of buccal mucosa thickness and echogenicity. A total of 190 volunteers underwent US examination of the buccal mucosa. The thickness of the buccal epithelial layer was recorded in 19 subjects via both intra-oral and transcutaneous methods. Overall, 171 healthy adults were examined through intra-oral US. Buccal epithelial layer measurement was unreliable via the transcutaneous method (p = 0.001). The mean time required for visualizing the buccal mucosa was 75 and 171s with intra-oral and transcutaneous US, respectively (p < 0.001). The thickness of the buccal epithelial layers significantly differed with age and sex (p < 0.001), and was positively correlated with height, weight and body surface area. Intra-oral US was proposed as a conventional method for examination of the buccal mucosa. Normal buccal epithelial thickness in adults is associated with age, sex, height, weight and body surface area.

What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum.

Surgical release of the lingual frenulum (frenotomy) has become an increasingly common procedure, performed from birth through to adulthood. Surprisingly, detailed anatomy of the in-situ lingual frenulum has never been described, and no anatomical basis has been proposed for the individual variability in frenulum morphology. The lingual frenulum is frequently referred to as a "cord" or "submucosal band" of connective tissue, yet there is no evidence to support this anatomical construct. This paper aims to describe the anatomy of the in-situ lingual frenulum and its relationship to floor of mouth structures. Fresh tissue microdissection of the lingual frenulum and floor of mouth was performed on nine adult cadavers with photo-documentation and description of findings. The lingual frenulum is a dynamic structure, formed by a midline fold in a layer of fascia that inserts around the inner arc of the mandible, forming a diaphragm-like structure across the floor of mouth. This fascia is located immediately beneath the oral mucosa, fusing centrally with the connective tissue on the tongue's ventral surface. The sublingual glands and submandibular ducts are enveloped by the fascial layer and anterior genioglossus fibers are suspended beneath it. Lingual nerve branches are located superficially on the ventral surface of the tongue, immediately deep to the fascia. The lingual frenulum is not a discrete midline structure. It is formed by dynamic elevation of a midline fold in the floor of mouth fascia. With this study, the clinical concept of ankyloglossia and its surgical management warrant revision. Clin. Anat. 32:749-761, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

The association between palatal rugae pattern and dental malocclusion

ABSTRACT Introduction: Palatal rugae complete its development during early intrauterine life, whereas dental malocclusions in permanent dentition establishes several years into the post-natal life. Objective: The objective of present study was to determine if there is an association between the palatal rugae pattern and Angle's classes of malocclusion. Methods: A cross-sectional study was conducted on pretreatment dental casts of 184 patients. The sample was divided into the following groups: Class I, Class II div. 1, Class II div. 2, and Class III. The number of palatal rugae was recorded, bilaterally. The length, pattern and orientation of three anterior-most primary rugae on both sides were recorded. Results: The mean age of the study sample was 17.8 ± 5.4 years. The mean number of the palatal rugae was 11.18 ± 2.5, with significant differences among different malocclusion groups. The length of the first rugae on left side and third rugae on both sides varied significantly among the groups (p< 0.05). Similarly, the pattern of palatal rugae was also found to be significantly different among the malocclusion groups. The right sided rugae did not have any significant difference in the orientation in different malocclusion groups; however, the left sided rugae showed significant differences among the four malocclusion groups (p< 0.001). Conclusions: The current study showed subtle differences in the palatal rugae pattern among the Angle's classes of malocclusion. Similarly, the length and orientation of some rugae were also found to be significantly different between malocclusion groups.

RESUMO Introdução: as rugas palatinas completam seu desenvolvimento ainda no início da vida intrauterina, enquanto as más oclusões dentárias na dentição permanente se estabelecem após vários anos de vida pós-natal. Objetivos: o presente estudo foi planejado para determinar se há associação entre o padrão das rugas palatinas e as más oclusões, segundo a classificação Angle. Métodos: um estudo transversal foi conduzido a partir dos modelos dentários pré-tratamento de 184 pacientes. A amostra foi dividida em quatro grupos: Classe I; Classe II, divisão 1; Classe II, divisão 2 e Classe III. O número de rugas palatinas foi registrado bilateralmente. O comprimento, padrão e a orientação das três rugas primárias mais anteriores de ambos os lados foram registrados. Resultados: a idade média da amostra desse estudo foi de 17,8 ± 5,4 anos. O número médio de rugas palatinas foi de 11,18 ± 2,5, com diferenças significativas entre os grupos de más oclusões. O comprimento da primeira ruga do lado esquerdo e da terceira ruga em ambos os lados variou significativamente entre os grupos (p< 0,05). De forma semelhante, o padrão das rugas palatinas também mostrou diferença significativa entre os grupos com diferentes má oclusões. As rugas do lado direito não apresentaram nenhuma diferença significativa de orientação nos diferentes grupos; no entanto, as rugas do lado esquerdo apresentaram diferenças significativas nos grupos estudados (p< 0,001). Conclusões: o presente estudo demonstrou diferenças sutis quanto ao padrão das rugas palatinas entre as classes de má oclusão definidas por Angle. Do mesmo modo, o comprimento e a orientação de algumas rugas também se apresentaram consideravelmente diferentes entre os grupos com diferentes má oclusões.

The repeatability and reproducibility of gingival thickness measurement with an ultrasonic device.

BACKGROUND: Successful periodontal and implant surgery as well as orthodontic treatment often depends on gingival and mucosal thickness. So far there has been no generally accepted protocol of measuring the thickness of gingiva by non-invasive methods. OBJECTIVES: The aim of the study was to evaluate the repeatability and reproducibility (%R&R) of the 20 MHz A-Scan ultrasonic device in measuring gingival thickness (GT) in the mucogingival complex. MATERIAL AND METHODS: A 2-stage study utilizing non-invasive ultrasonic methods was conducted. In the 1st stage, 3 operators got calibrated by measuring previously established GT in porcine cadaver jaws. In the 2nd stage, 1 periodontally healthy subject was recruited in the study. Three operators performed the measurements of GT in maxillary left central and lateral incisors and canines, using the 20 MHz A-Scan ultrasonic device with a probe of 1.7 mm in diameter. The thickness was measured in 4 standardized points located in the free gingiva (FGT), supracrestal gingiva (SGT), crestal gingiva (CGT) and the mucosa (MGT). RESULTS: The analysis of variance (ANOVA) method was used to quantify %R&R. The repeatability and reproducibility of the measurements was 8.4%. Interobserver reproducibility varied from 0.8% to 13.4%. The average intraobserver coefficient of variation (CV) was 6.6% (1.9-13.6%). The median of the reproducibility of all measurements was 8.1 %. Nevertheless, the median of CV was variable to the observer, i.e. 5.4%, 6.5%, 6.4%. CONCLUSIONS: The obtained results in %R&R prove the good recognition of methodology as well as the usefulness of the device. Non-invasive ultrasonic biometer GT measurements are crucial in periodontology as well as in other fields of dentistry.