Sutural Morphology in the Craniofacial Skeleton: A Descriptive Microcomputed Tomography Study in a Swine Model

Three-dimensional morphometric analysis of cranial sutures - A novel approach to quantitative analysis

Objective

Differences in complexity of cranial suture forms on the endocranial (i.e., deep) and ectocranial (i.e., superficial) skull surfaces have been noted in the literature, indicating through thickness three-dimensional (3D) suture variability depending on the chosen section and necessity for considering the complete 3D structure in many cases. This study aims to evaluate the variability of suture morphology through the skull thickness using a rat model, and to provide more robust metrics and methodologies to analyze suture morphology.

Design

X-ray micro-computed tomographic (μCT) imaging methods were utilized in order to provide internal structure information. Methods were developed to isolate and analyze sutures widths and linear interdigitation index (LII) values on each adjacent offset transverse plane of the μCT datasets. LII was defined as the curved path length of the suture divided by the linear length between the ends of the region of interest. Scans were obtained on 15 female rats at ages of 16, 20, and 24 weeks (n = 5/age). Samples were imaged at 18 μm resolutions with 90 kV source voltage, 278 μA source amperage, and 0.7° increments. Suture widths and LII values were compared using a Kruskal-Wallis test.

Results

3D variability in local suture widths within individuals, as well as through thickness variabilities in planar widths and LII was observed. Kruskal-Wallis tests for bulk through thickness averaged suture widths and LII were found to be statistically insignificant, despite clear geometric differences through suture thicknesses.

Conclusion

Although the bulk morphometric variability between age groups was found to be statistically insignificant, the 3D variability within individuals point to the importance of analyzing suture form using 3D metrics when studying suture development, response to functional activity, or morphometry in general.

Age-related transversal changes in craniofacial sutures of the anterior viscerocranium in growing rats

Objective: To evaluate the dimensional changes that occur in the internasal and nasopremaxillary sutures, and related transverse craniofacial dimensions, of rats from 4 to 38-weeks of age. Methods: Four groups of twelve male Wistar rats were sacrificed at different ages [4-weeks (immature), 16-weeks (adolescent), 26-weeks (young adult), 38-weeks (adult)]. The rats were scanned with a high-resolution micro-computed tomography imaging device with 90 µm voxel size and 45 mm × 45 mm field of view (FOV) to obtain images of the viscreocranium, and with 10 µm voxel size and 5 mm × 5 mm FOV to obtain images of the internasal and left nasopremaxillary sutures. The nasal bone width, transverse width between the nasopremaxillary sutures and interzygomatic width were measured as craniofacial measurements. The endocranial, ectocranial and mean suture widths (cross-sectional area between endocranial and ectocranial borders/suture height), and suture height were measured at 5 frontal planes with 1.2 mm intervals. Outcomes were compared at different ages, and correlation coefficients were used to assess the relationship between craniofacial and suture changes. Results: All transverse craniofacial dimensions increased significantly from 4-16 weeks of age (p < 0.001). After 16-weeks of age, the only significant increase was observed in interzygomatic width (p = 0.02), between 26 and 38 weeks. In both the internasal and nasopremaxillary sutures, the endocranial suture mean widths decreased from 4-16 weeks (p < 0.001 and p = 0.002, respectively), but did not show any significant change after 16-weeks of age. The ectocranial internasal suture width decreased from 4-16 weeks (p < 0.001), increased until 26-weeks (p = 0.035), and subsequently decreased (p < 0.001). The nasopremaxillary suture widths decreased from 4-38 weeks to varying degrees in different frontal planes. Except for the internasal ectocranial suture width, all suture measurements were found highly and negatively correlated with the transverse craniofacial dimensions. The height of the sutures increased with time, with the most significant changes occurring between 4 and 16 weeks of age (p < 0.001). Conclusion: Although the internasal and nasopremaxillary endocranial suture widths nearly reach their final widths during adolescence, the changes in the ectocranial and mean suture widths continue into early adulthood. These results may serve as a reference for future studies aiming to evaluate the effects of functional demands on suture development and dimensional changes of the viscerocranium.

Cranial suture morphometry and mechanical response to loading: 2D vs. 3D assumptions and characterization

Cranial sutures are complex soft tissue structures whose mechanics are often studied due to their link with bone growth in the skull. Researchers will often use a cross-sectional two-dimensional slice to define suture geometry when studying morphometry and/or mechanical response to loading. However, using a single cross section neglects the full suture complexity and may introduce significant errors when defining their form. This study aims to determine trends in suture path variability through skull thickness in a swine model and the implications of using a 'representative' cross section on mechanical modeling. To explore these questions, a mixture of quantitative analysis of computed tomography images and finite element models was used. The linear interdigitation and width of coronal and sagittal sutures were analyzed on offset transverse planes through the skull thickness. It was found that sagittal suture width and interdigitation were largely consistent through the skull thickness, whereas the coronal suture showed significant variation in both. The finite element study found that average values of displacement and strain were similar between the two-dimensionally variable and three-dimensionally variable models. Larger ranges and more complex distributions of strain were found in the three-dimensionally variable model. Outcomes of this study indicate that the appropriateness of using a representative cross section to describe suture morphometry and predict mechanical response should depend on specific research questions and goals. Two-dimensional approximations can be sufficient for less-interdigitated sutures and when bulk site mechanics are of interest, while taking the true three-dimensional geometry into account is necessary when considering spatial variability and local mechanical response.

Facial Asymmetry Detected with 3D Methods in Orthodontics: A Systematic Review

Background:

Historically, the development of two-dimensional (2D) imaging techniquesforerun that of three-dimensional (3D) ones. Some 2D methods are still considered valid and effective to diagnose facial asymmetry but 3D techniques may provide more precise and accurate measurements.

Objective:

The aim of this work is to analyze the accuracy and reliability of the imaging techniques available for the diagnosis of facial asymmetry in orthodontics and find the most reliable.

Methods:

A search strategy was implemented using PubMed (National Library of Medicine, NCBI).

Results:

A total of 3201 papers were identified in electronic searches. 90 articles, available in full text, were included in the qualitative synthesis consisting of 8 reviews on the diagnosis of facial asymmetry, 22 in vivo and in vitro studies on 2D methods and 60 in vivo and in vitro studies on 3D methods to quantify the asymmetry.

Conclusion:

2D techniques include X-ray techniques such as posterior-anterior cephalogram, which still represents the first level exam in the diagnosis of facial asymmetry. 3D techniques represent the second level exam in the diagnosis of facial asymmetry. The most current used techniques are CBCT, stereophotogrammetry, laser scanning, 3D optical sensors and contact digitization. The comparison between bilateral parameters (linear distances, angles, areas, volumes and contours) and the calculation of an asymmetry index represent the best choices for clinicians who use CBCT. The creation of a color-coded distance map seems to represent the most accurate, reliable and validated methods for clinicians who use stereophotogrammetry, laser scanning and 3D optical sensors.

Midpalatal suture maturation staging using cone beam computed tomography in patients aged between 9 to 21 years

Midpalatal suture was analysed with cone beam computed tomography to identify its maturation with respect to age and maxillary-complex growth in 72 patients 9- to 21-year-old. Maxillary-complex was divided in premaxillary, maxillary, and palatine segment. Interdigitation and ossification of midpalatal suture, its density relative to hard tissues and soft tissues, and midpalatal suture density ratio were measured for each segment. Correlation of each parameter with age and maxillary-complex length was analysed, and classification trees were developed for staging parameters. Midpalatal suture maturation stages (MPSMS, from A to E) were applied to assess relationship with age and maxillary-complex length. Regarding age, ossification increased in maxillary segment of males (r_S = 0.39, p = 0.032), while suture density relative to soft tissues increased in maxillary (r_S = 0.37, p = 0.042) and palatine segments (r_S = 0.41, p = 0.027) of males and in palatine segment of females (r_S = 0.32, p = 0.041). In males, suture density relative to soft tissues discriminated two age-stages (p = 0.024), and the same parameter (p = 0.023) paired with ossification (p = 0.027) discriminated two length-stages. MPSMS identified length-differences between stage A and B in females (p = 0.001). Midpalatal-suture ossification and its density relative to soft tissues showed some relationship with age and maxillary-complex length, especially in males. However, challenging staging and limitations in the imaging method may limit clinical applications.

Appropriateness of standard cephalometric norms for the assessment of dentofacial characteristics in patients with cleidocranial dysplasia

OBJECTIVES

Cleidocranial dysplasia (CCD) is a rare skeletal syndrome affecting craniofacial and dental development. As a consequence, conventional cephalometric landmarks may not be valid for CCD patients, and the appropriateness of norms used for the general population should be critically discussed.

METHODS

Five patients 9- to 22-year-old (three females, two males) with CCD were included. Lateral-cephalograms, orthopantomographies, and intra-oral photos were retrospectively analysed. Lateral-cephalograms of 50 normal controls (ten for each CCD patient) matched for age and sex were selected from an online database. Cephalometric measurements of each CCD patients were compared with average values of matched controls using Wilcoxon signed-rank test for paired values (α = 0.05).

RESULTS

In CCD patients, a shortening of the cranial base was present (ΔSN = -17.1 mm, p = 0.043). Thus, the mandible (ΔSNPg = +9.5°, p = 0.043) and the maxilla (ΔSNA = +11.2°, p = 0.043) showed protrusion compared to the cranial base, despite a reduced maxillary (ΔCo-A = -15.1 mm, p = 0.043) and mandibular (ΔCo-Gn = -15.2 mm, p = 0.080) length. The mandibular divergence was reduced (ΔSN/GoGn = -6.4°, p = 0.043), a reduced overbite was present (ΔOverbite = -2.9 mm, p = 0.043), and the interincisal angle was increased (ΔInterincisalAngle = +13.7°, p = 0.043), mainly due to retro-inclination of lower incisors.

CONCLUSIONS

Standard cephalometric norms for the assessment of horizontal jaw position may not be applicable to CCD patients because of a reduced anterior cranial base length compared to normal subjects. Vertical relationships may not be affected, and mandibular hypodivergency was confirmed.

Treatment of ankylosed deciduous molars with or without permanent successors in children and adolescents: a systematic review

INTRODUCTION

The aim of this systematic review was to provide guidelines for decision-making during orthodontic treatment planning of infra-occluded deciduous molars with or without their successors in children and adolescents.

EVIDENCE ACQUISITION

Computerized search was conducted on Medline via PubMed, and Cochrane Library. Articles published until 2020 in English language were analyzed following the Preferred Reporting Items for Systematic Reviews (PRISMA) Checklist. Observational and interventional longitudinal studies reporting the treatment of ankylosed deciduous molars with or without successor tooth in 3 to 15-year-old patients were included.

EVIDENCE SYNTHESIS

In case of ankylosis with presence of successor, exfoliation took place in 77% of teeth, while extraction involved 23%. Infra-occlusion happened in 53% of teeth (worsening in 52%), alveolar bone loss in 37%, mesial tipping of first permanent molar in 5%, and over-eruption of antagonist in no cases (after exfoliation and eruption of successor). In case of ankylosis without successor, exfoliation took place in 1% of teeth, progression of infra-occlusion in 42%, progression of root resorption in 58%, development of mesial tipping of first permanent molars in 25%, while no case of antagonist over-eruption was reported.

CONCLUSIONS

When the permanent tooth is present and the ankylosed tooth is slightly or moderately infra-occluded, observation is appropriate. In case of severe infra-occlusion or absence of successor, tooth extraction may be considered together with orthodontic space closure, transplantation, or prosthetic replacement. Alternatively, nonextraction and a prosthetic build-up may be considered.

The Human Bone Collection of the Faculty of Dentistry at the University of Hong Kong: History and description of cranial and postcranial skeletal remains

OBJECTIVES

The present work describes the status and contents of The Human Bone Collection of the Faculty of Dentistry at the University of Hong Kong.

MATERIALS AND METHODS

The Collection originates from the 1980s and became officially established in 2017 for teaching and research purposes. Most of the Collection consists of unclaimed human remains of southern Chinese individuals exhumed from local cemeteries and donated to the Faculty in the last few decades. The demographic information was provided largely from burial records and forensic estimations. Since 2016, the Collection has undergone a process of reorganization into cranial and postcranial remains, followed by preservation procedures that included cleaning and classification.

RESULTS

The Collection currently consists of remains belonging to about 368 individuals (243 males, 54 females, 71 unknown), with ages ranging from 0.8 to 90 years (mean 57.4 years). It comprises cranial remains belonging to 260 individuals (169 males, 39 females, 52 unknown), and postcranial remains belonging to 248 individuals (180 males, 42 females, 26 unknown). The preservation status ranges from poor to good, with the cranial remains better preserved than the postcranial elements. For a large number of individuals, ear ossicles, soil samples, and other materials are also available.

DISCUSSION

The Collection is accessible to local and international institutions for teaching and research.

Anteroposterior length of the maxillary complex and its relationship with the anterior cranial base

OBJECTIVES

To use both absolute anteroposterior maxillary complex length (APMCL) and relative APMCL to investigate the relationship between the maxillary complex, its individual bony segments, and their association to the anterior cranial base. In addition, the relationship between length and position of the maxillary complex was analyzed.

MATERIALS AND METHODS

Sixty human skulls were analyzed using cone beam computed tomography. The maxillary complex length was measured between anterior and posterior nasal spine (ans-pns), and the average was used as the cut-off to identify a high- and a low-length group based on absolute APMCL. The length ratio between the maxillary complex and the anterior cranial base (ans-pns/SN) was used to identify the two groups based on relative APMCL. The anterior cranial base length and the lengths of the maxillary complex bones were compared between the high- and low-length groups.

RESULTS

Based on absolute APMCL, individuals with shorter maxillary complex had shorter anterior cranial base (P = .003), representing normal proportions. Based on relative APMCL, individuals with shorter maxillary complex had longer anterior cranial base and vice versa (P = .014), indicating disproportions. Individuals with shorter maxillary complex exhibited shorter maxilla (Δ = -1.5 mm, P = .014).

CONCLUSIONS

When skeletal deformity of the midface is suspected, individual disproportions in the anteroposterior length of the maxillary complex in relation to the anterior cranial base (relative measurements) should be assessed through radiological imaging. A shorter maxillary complex may be associated with a shorter maxilla, and not with a shorter premaxilla or palatine bone.