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Maino GB, Maino G, Cremonini F, Lombardo L. Class III treatment with mini-implants anchorage in young adult patients: short and long-term results. Dental Press J Orthod 2023; 28:e23spe2. [PMID: 37283427 DOI: 10.1590/2177-6709.28.2.e23spe2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/04/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. OBJECTIVE To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. CONCLUSION The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.
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Affiliation(s)
| | - Giovanna Maino
- University of Ferrara, Postgraduate School of Orthodontics (Ferrara, Italy)
| | | | - Luca Lombardo
- University of Ferrara, Postgraduate School of Orthodontics (Ferrara, Italy)
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Mang de la Rosa MR, Safaltin A, Jost-Brinkmann PG, Aigner A, Koch PJ. Accuracy of palatal orthodontic mini-implants placed by conventionally or CAD/CAM-based surgical guides: a comparative in vitro study. Angle Orthod 2023; 93:79-87. [PMID: 36048244 PMCID: PMC9797149 DOI: 10.2319/011722-55.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/01/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate and compare the transfer accuracy of five different surgical guides (SGs) for the insertion of orthodontic mini-implants (OMIs) in the anterior palate. MATERIALS AND METHODS Stereolithographic files of 10 maxillary patient models and their corresponding lateral cephalograms were virtually matched and used for planning the position of two parallel OMIs in the paramedian region of the anterior palate. For each patient model, three 3-dimensional (3D)-printed and two conventional SGs were manufactured from different materials, and a total of 96 OMIs were transferred to the anterior palates of the respective 50 molded resin models. The planned (T0) and the actual (T1) OMI positions were analyzed and compared after superimposition of the digitized models. The deviations between the OMI positions in T0 and T1 were described as the distance between the head and the tip, respectively, of each OMI in millimeters and the deviating angle between the OMI axes for each patient and SG. RESULTS The conventionally manufactured SGs of Pattern Resin LS (GC Europe N.V., Leuven, Belgium) showed the highest linear and angular transfer accuracy for the insertion of OMIs. The highest deviations were found with the SGs made of IMPRIMO LC Splint (3D-printed; Scheu-Dental, Iserlohn, Germany) and Memosil 2 (conventional SG; Kulzer, Hanau, Germany). CONCLUSIONS The 3D-printed SGs did not reach the accuracy of the conventional SGs made of Pattern Resin but may provide sufficient accuracy for palatal OMI placement.
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Nienkemper M, Ludwig B. Risk of root damage after using lateral cephalogram and intraoral scan for guided insertion of palatal miniscrews. Head Face Med 2022; 18:30. [PMID: 36057719 PMCID: PMC9440511 DOI: 10.1186/s13005-022-00335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Guided insertion of palatal miniscrews using a lateral cephalogram instead of cone beam computed tomography (CBCT) significantly reduces the radiation level for the patient. Till now no data are available on the risk of hitting the incisors in this regard, which is one of the worst clinical complications when inserting a paramedian miniscrew. Hence, this study aims to investigate the distance between the mini-implant and the roots of the central and lateral incisors. Methods Lateral cephalogram, an intraoral scan, and CBCT of 20 patients were superimposed. After a miniscrew (1.7 × 8 mm) placement based on intraoral scan and lateral cephalogram, the CBCT was used as control for the distance between the miniscrews and the roots of the incisors. Results The mean value of the shortest distance between the miniscrew and roots of the incisors in the lateral cephalogram was 4.74 ± 1.67 mm. The distance between both miniscrews and the central incisors measured in the CBCT was 5.03 ± 2.22 mm and 5.26 ± 2.21 mm and between the two miniscrews and the lateral incisors was 4.93 ± 1.91 mm and 5.21 ± 2.64 mm. No significant differences between the distances in the CBCT and the lateral cephalogram could be observed. In one case, the CBCT control revealed the penetration of two palatally displaced canines after insertion based on intraoral scan and lateral cephalogram. Conclusions The use of an intraoral scan and a lateral cephalogram for guided paramedian insertion of palatal miniscrews can prevent incisor root damage. This may reduce the radiation since no CBCT seems necessary. The current investigation focuses on the anterior paramedian area of the palate. Outside that region and in complex cases with displaced teeth in the palatal area, a CBCT might be indicated.
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Iodice G, Nanda R, Drago S, Repetto L, Tonoli G, Silvestrini-Biavati A, Migliorati M. Accuracy of direct insertion of TADs in the anterior palate with respect to a 3D-assisted digital insertion virtual planning. Orthod Craniofac Res 2021; 25:192-198. [PMID: 34344059 DOI: 10.1111/ocr.12525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Direct and 3D-assisted methods are an available alternative when inserting temporary anchorage devices (TADs) in the anterior palate for orthodontic anchorage. This study aimed to evaluate the differences between a planned insertion versus a direct method on digital models. SETTINGS AND SAMPLE POPULATION Seventy TADs were inserted by the direct insertion method in 35 patients who needed palatal TADs for orthodontic anchorage. For each patient, placement was independently planned by the superimposition of lateral cephalograms and corresponding plaster models. After mini-implant placement, impressions were taken with scanbodies. For the measurement of both linear and angle deviations, virtual planning models and postoperative oral scans were compared using 3D software for automatic surface registration and calculations. RESULTS Comparing TADs positioned by the direct method and the digitally planned method, a mean linear distance was found of 2.54 ± 1.51 mm in the occlusal view and 2.41 ± 1.33 mm in the sagittal view. No significant difference has been found between TADs positioned in the right and left palatal sides. A mean distance of 7.65 ± 2.16 mm was found between the tip of the digitally planned TAD and the central incisors root apex. CONCLUSIONS Both direct and 3D-assisted TAD insertion methods are safe and accurate in the anterior palate. However, the use of insertion guides facilitates TAD insertion, allowing less-experienced clinicians to use palatal implants.
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Affiliation(s)
- Giorgio Iodice
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Division of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Ravindra Nanda
- Department of Craniofacial Sciences, Division of Orthodontics, School of Dental Medicine, University of Connecticut, Farmington, CT, USA.,Division of Orthodontics, University of Connecticut Health Center, Farmington, CT, USA
| | - Sara Drago
- Orthodontic Department, Dental School, Genova University, Genova, Italy
| | - Laura Repetto
- Orthodontic Department, Dental School, Genova University, Genova, Italy
| | - Giorgio Tonoli
- Orthodontic Department, Dental School, Genova University, Genova, Italy
| | | | - Marco Migliorati
- Orthodontic Department, Dental School, Genova University, Genova, Italy
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Lombardo L, Palone M, Maino G, Paoletto E, Carlucci A, Siciliani G. Class II subdivision with skeletal transverse maxillary deficit treated by single-sitting bone-borne appliance. Angle Orthod 2021; 91:129-137. [PMID: 33289804 DOI: 10.2319/050520-394.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/01/2020] [Indexed: 11/23/2022] Open
Abstract
This case report describes orthodontic treatment including both skeletal maxillary expansion and unilateral distalization by means of a single bone-borne appliance followed by clear aligner therapy in a young adult patient. A surgical guide was digitally designed and three-dimensionally printed to facilitate the placement of four miniscrews in the palatal vault. The miniscrews were fitted and the bone-borne appliance was delivered in a single clinical appointment. The postexpansion photographic records and models demonstrate the opening of the palatal median suture, the pure skeletal expansion, and the resolution of the left crossbite after 40 activations. Specifically, left molar Class I was obtained in about 5 months without any loss of anterior anchorage, and the subsequent aligner phase achieved all of the objectives established in the treatment plan. This case report shows clearly how careful digital planning of miniscrew insertion and the delivery of a pure bone-borne appliance in a single sitting enabled good clinical outcomes to be achieved in an acceptable timeframe, without side effects, even in a young adult patient.
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Yu SK, Cho Y, Seo YS, Kim JS, Kim DK, Kim HJ. Radiological evaluation of the bone and soft tissue thicknesses of the palate for using a miniscrew-supported maxillary skeletal expander. Surg Radiol Anat 2021; 43:1001-1008. [PMID: 33386930 DOI: 10.1007/s00276-020-02634-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to determine the palatal bone and soft tissue thicknesses using a miniscrew-supported maxillary skeletal expander (MSE) in Class III malocclusion. METHODS The thicknesses of the palatal bone and soft tissue were measured in cone-beam computed tomography images obtained from 58 patients. All 20 points were crossing points between five levels, which were defined at 3 mm intervals relative to the line connecting the central fossae of the first molar (Level 0), and 2 mm and 4 mm lateral to the anteroposterior reference line (AP line). RESULTS The palatal bone was significantly thicker in males than females in the anterior palate up to Level 0, while there was no significant sex-related difference in the posterior palate. There was a tendency for the thickness to decrease in the posterior direction, except in females at 2 mm lateral to the AP line. The palatal soft tissue was significantly thicker in males than females in all positions. At 2 mm lateral to the AP line, the palatal soft tissue thickness decreased in the posterior direction. A 4 mm lateral to the AP line, it initially decreased in the posterior direction, and then increasing again at Level - 6 (6 mm posterior of Level 0). As the lateral distance from the AP line increased, the palatal bone thickness decreased while the palatal soft tissue thickness increased. CONCLUSIONS These findings provide quantitative data on the palatal bone and soft tissue thicknesses for the miniscrew-supported MSE in the posterior palate.
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Affiliation(s)
- Sun-Kyoung Yu
- Department of Anatomy and Orofacial Development, College of Dentistry, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea
| | - Yonghwa Cho
- Department of Anatomy and Orofacial Development, College of Dentistry, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea
| | - Yo-Seob Seo
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Chosun University, Gwangju, Korea
| | - Jae-Sung Kim
- The Institute of Dental Science, College of Dentistry, Chosun University, Gwangju, Korea
| | - Do Kyung Kim
- The Institute of Dental Science, College of Dentistry, Chosun University, Gwangju, Korea
| | - Heung-Joong Kim
- Department of Anatomy and Orofacial Development, College of Dentistry, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea.
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Kim MS, Lim SH, Jeong SR, Park JH. Maxillary molar intrusion and transverse decompensation to enable mandibular single-jaw surgery with rotational setback and transverse shift for a patient with mandibular prognathism and asymmetry. Am J Orthod Dentofacial Orthop 2020; 157:818-831. [PMID: 32487312 DOI: 10.1016/j.ajodo.2019.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 10/24/2022]
Abstract
When performing single-jaw surgery for mandibular setback, the distal segment of the mandible is brought distally along the occlusal plane, leaving the relationship of the B-point and pogonion unchanged. Double-jaw surgery for rotation of the maxillomandibular complex can be considered for solving this problem. However, maxillary surgery for rotational setback of the mandible can be replaced with orthodontic intrusion of the maxillary molars. Correcting the mandibular asymmetry that frequently accompanies mandibular prognathism often requires corrections of roll, yaw, and transverse shift of the mandible. Performing these corrections in mandibular single-jaw setback surgery requires transverse decompensation and orthodontic correction of maxillary occlusal-plane canting. This case report describes the simultaneous achievement of maxillary molar intrusion, transverse decompensation, and canting correction using a palatal lever supported by 2 midpalatal mini-implants. After creating a lateral open bite, mandibular setback surgery was performed with a 13.5° clockwise rotation, 2.9° roll correction, 3.5° yaw correction, and 3.5-mm transverse shift. The application of rotational setback significantly improved the facial esthetics. This case report demonstrates that orthodontic intrusion of the maxillary molars and transverse decompensation can replace maxillary surgery in the treatment of mandibular prognathism with asymmetry.
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Affiliation(s)
- Min-Su Kim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea
| | - Sung-Hoon Lim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea.
| | - Seo-Rin Jeong
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul and Seoul, Korea
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Wei D, Zhang L, Li W, Jia Y. Quantitative Comparison of Cephalogram and Cone-Beam Computed Tomography in the Evaluation of Alveolar Bone Thickness of Maxillary Incisors. Turk J Orthod 2020; 33:85-91. [PMID: 32637188 DOI: 10.5152/turkjorthod.2020.19097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/05/2020] [Indexed: 11/22/2022]
Abstract
Objective This study aims to quantitatively compare cephalogram and cone-beam computed tomography (CBCT) when evaluating maxillary central incisor alveolar bone thickness. Methods We used 30 sets of lateral cephalograms and CBCT images that were recorded at the same time. Labial, buccal, and overall alveolar bone thicknesses were measured on three measurement lines of the forward-most incisor in lateral cephalograms and four maxillary incisors in CBCT images. Paired t-test, interclass correlation coefficient analysis, one-way analysis of variance (ANOVA), and Bland-Altman analysis were used to assess cephalometrically measured alveolar bone thickness of maxillary incisors and compare these measurements with those made using CBCT images. Results Significant differences were observed between cephalometric and CBCT-based measurements of maxillary incisor alveolar bone thickness; most values showed mild or moderate correlation between the two methods. In most cases, cephalometric measurements were greater than CBCT-based measurements. Bland-Altman plots and ANOVA revealed that measurement bias increased when measurement lines moved apically. Alveolar bone thickness was always overestimated on cephalograms. Conclusion Maxillary incisor alveolar bone thickness is always overestimated on cephalograms compared with CBCT-based measurements, with the overestimations ranging from 0.3 to 1.3 mm. Cephalometric measurement bias increases when measurement lines move apically. Thus, CBCT should be recommended when the accurate evaluation of alveolar bone thickness is warranted.
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Affiliation(s)
- Diyang Wei
- Department of Orthodontics, Peking University School of Stomatology, Peking, China
| | - Lingyun Zhang
- Department of Orthodontics, Peking University School of Stomatology, Peking, China
| | - Weiran Li
- Department of Orthodontics, Peking University School of Stomatology, Peking, China
| | - Yilin Jia
- Department of Orthodontics, Peking University School of Stomatology, Peking, China
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Möhlhenrich SC, Kniha K, Peters F, Chhatwani S, Prescher A, Hölzle F, Modabber A, Danesh G. Anatomical assessment by cone beam computed tomography with the use of lateral cephalograms to analyse the vertical bone height of the anterior palate for orthodontic mini-implants. Orthod Craniofac Res 2020; 24:78-86. [PMID: 32608152 DOI: 10.1111/ocr.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Lateral cephalograms (LC) should be usable to evaluate the vertical bone height of the anterior maxilla for planning the placement of orthodontic mini-implants (OMI). The purpose of this study is to determine the usability of LC for examining the real vertical dimension of the anterior palate. SETTING AND SAMPLE POPULATION Lateral cephalograms and corresponding cone beam computed tomography (CBCT) scans were employed for examining 30 fresh cadaver heads. MATERIALS & METHODS The minimum (distance A) and maximum (distance B) vertical palatal bone heights on LCs at the level of first premolars were measured, whereas the corresponding measurements were taken via CBCTs on the median, and 2-, 4- and 6-mm paramedian planes. Additionally, the overall minimum vertical palatal height on CBCT was recorded. RESULTS Distance A and B on LC were about 8.3 ± 2.5 mm and 9.9 ± 2.5 mm, respectively. The median palatal height on CBCT was significantly higher than both measurements on LC (P < .01). Furthermore, the bone supply on the paramedian planes was similar or higher on CBCT compared to Distance A and similar or less compared to Distance B. The strongest correlation at the level of the premolars was found in the comparison of the maximum vertical palatal height via LC with the vertical palatal height on the median plane via CBCT (r = .84, 95% CI: 0.69-0.92, P < .001). CONCLUSIONS In order to make the best possible use of the vertical bone supply of the anterior palate and to avoid injuries to the nasal floor, Distance A should be taken into account for planning paramedian OMI placements and distance B for median OMI insertion.
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Affiliation(s)
- Stephan Christian Möhlhenrich
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany.,Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - Sachin Chhatwani
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany
| | - Andreas Prescher
- Medical Faculty of RWTH-Aachen, Institute of Molecular and Cellular Anatomy, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - Golamreza Danesh
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany
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Nienkemper M, Willmann JH, Becker K, Drescher D. RFA measurements of survival midpalatal orthodontic mini-implants in comparison to initial healing period. Prog Orthod 2020; 21:5. [PMID: 32064547 PMCID: PMC7024683 DOI: 10.1186/s40510-020-0305-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background In dental implantology, the development of stability over time is a well-investigated topic. In case of orthodontic mini-implants, quantitative data for long-term stability is not available yet. This study aims to clinically investigate the long-term stability of mini-implants inserted in the midsagittal suture of the anterior palate. Moreover, the influence of the length of implants was elucidated. The stability of 2 × 9 and 2 × 11 mm mini-implants after orthodontic treatment (9 mm, 2.84 years ± 1.25 years; 11 mm, 3.17 years ± 0.96 years) was assessed by resonance frequency analysis (RFA). The obtained long-term pieces of data were compared with each other (9 mm vs 11 mm), as well as with the data from the matched early stability groups, to assess the initial and early secondary stability after the insertion from previous clinical trials. Results For both lengths, the long-term stability (2 × 9 mm, 25.12 ± 7.11, n = 21; 2 × 11 mm, 24.39 ± 5.82, n = 18) was significantly lower than primary stability (2 × 9 mm, 36.14 ± 6.08, n = 19; 2 × 11 mm, 33.35 ± 3.53, n = 20). The differences within the groups disappeared over the initial healing period: after 4 weeks for the 2 × 9 mm implants and after 2 weeks for the 2 × 11 mm implants. Also, the 2 × 9 mm and 2 × 11 mm implants showed comparable long-term stability values. Conclusion The stability of midpalatal mini-implants does not change in the long term after the initial healing period. Moreover, 2 × 9 mm mini-implants seem to be appropriate for orthodontic anchorage, as the stability of 2 × 11 mm implants is not higher. Therefore, owing to lower invasiveness, 2 × 9 mm implants should be preferred.
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Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany.,Private Practice, Düsseldorf, Germany
| | - Jan H Willmann
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany.
| | - Kathrin Becker
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, Heinrich-Heine-University of Düsseldorf, Moorenstr.5, Building 18.21, 40225, Düsseldorf, Germany
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Kang Q, Cha C, Huang D, Zuo S, Yan X. Evaluation of palatal support tissues for placement of orthodontic mini-implants in mouth breathers with high-narrow palates versus nose breathers with normal palates: a retrospective study. Clin Oral Investig 2019; 24:1259-1267. [PMID: 31302770 DOI: 10.1007/s00784-019-03004-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to compare the palatal total support tissues (TSTs) and bone support tissues (BSTs) at 5-mm paramedian section to the midsagittal suture between mouth breathers with high-narrow palates and nose breathers with normal palates and confirm the practicability and limitation on superimposition of lateral cephalograms and plaster models for orthodontic mini-implant (OMI) implantation in these patients. MATERIAL AND METHODS The sample consisted of 27 mouth breathers with high-narrow palates (study group (SG)) and 27 nose breathers with normal palates (control group (CG)). Upper digital dental models were superimposed with corresponding cone beam computed tomography (CBCT) images; then, TSTs and BSTs vertical to the curvature of the palatal mucosa were measured on the 5-mm paramedian section to the midsagittal suture. The measuring sites were the third ruga (R) and the sites anterior and posterior to R at 2-mm interval (A2, A4, A6, and A8; P2, P4, P6, and P8) along the palatal mucosa outline. TSTs and BSTs were also measured on the superimposition of lateral cephalograms and plaster models, and the site with the largest TST value in each patient was recorded. Descriptive statistics, independent-samples t test, and hierarchical clustering heat map were used for statistical analysis. RESULTS The greatest average values of TSTs and BSTs in SG were 12.24 ± 2.63 mm and 9.59 ± 2.36 mm at P2 site, and those in CG were 12.96 ± 2.39 mm and 10.56 ± 2.38 mm at R site, respectively. The average values of both TSTs and BSTs in SG were less than those in CG at all insertion sites. Significant differences (P < 0.05) were found at A4, A6, and R for TSTs and at R and P4 for BSTs. P2 and R were clustered together for both TSTs and BSTs by the cluster analysis on heat map in both SG and CG. In both groups, only one patient from SG was found to have the insertion site with the largest TST value on 2D superimposition located in the blue area on the heat map, where the measurement values of TSTs were less than 8.5 mm and those of BSTs were less than 5 mm. CONCLUSIONS Mouth breathers with high-narrow palates may have less palatal support tissues than nose breathers with normal palates at 5-mm paramedian section to the midsagittal suture of palate. The site a little posterior to R is more suitable for OMI implantation in mouth breathers. Two-dimensional superimposition of lateral cephalograms and plaster models can provide relatively effective assessment for the site choice of OMI implantation in both mouth breathers with high-narrow palates and nose breathers with normal palates. CLINICAL RELEVANCE Three-dimensional superimposition of CBCT data and digital dental model can provide accurate information for palatal OMI implantation. Meanwhile, 2D superimposition of lateral cephalograms and plaster models can be used for assessing the implantation sites at 5-mm paramedian section to the midsagittal suture of palates in mouth breathers under most conditions even those who have less palatal support tissues.
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Affiliation(s)
- Qichao Kang
- Department of Orthodontics, School of Stomatology, China Medical University, NO.117, Nanjing North Street, Heping District, Shenyang, 110002, Liaoning, China
| | - Chang Cha
- Department of Orthodontics, School of Stomatology, China Medical University, NO.117, Nanjing North Street, Heping District, Shenyang, 110002, Liaoning, China
| | - Desheng Huang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Sihui Zuo
- Department of Orthodontics, School of Stomatology, China Medical University, NO.117, Nanjing North Street, Heping District, Shenyang, 110002, Liaoning, China
| | - Xiulin Yan
- Department of Orthodontics, School of Stomatology, China Medical University, NO.117, Nanjing North Street, Heping District, Shenyang, 110002, Liaoning, China.
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Moscarino S, Scholz J, Bastian A, Knaup I, Wolf M. Bone and soft tissue palatal morphology and potential anchorage sides in cleft palate patients. Ann Anat 2019; 224:41-46. [PMID: 30953811 DOI: 10.1016/j.aanat.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/22/2019] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to evaluate palatal vertical bone thickness and density in relation to soft tissue on the hard palate for better selection of adequate bone regions for the insertion of orthodontic mini-implants (MIs) in cleft palate patients. MATERIALS AND METHODS Cone beam computed tomography scans (CBCT) were obtained from 60 patients (mean age range 9-12). The study population included patients with isolate right side cleft palate formation (n = 20; 6 females; 14 males), left side cleft palate formation (n = 20; 9 females; 11 males) and without cleft formation as control group (n = 20; 15 females; 5 males). Bone and soft tissue measurements were performed vertical at a 90° angle to the bone surface, on previously defined measurement points (n = 88) on the hard palate. Bone density was measured on ten vertical layers in caudo-cranial direction. RESULTS In non-cleft patient the highest bone thickness was in the anterior palate and decreased significantly in posterior direction. In patients with right and left cleft palate, the highest vertical bone level could be observed at the palatal premaxillary border opposite to the cleft side. Patients in the control group showed a significantly lower vertical soft tissue thickness than patients with palatal cleft formation. The evaluation of bone density showed no significant differences in all three groups. CONCLUSION The results suggest that the favorable region for orthodontic MI placement is in the similar anatomical region compared to non-cleft patients, but differs from one side in each group. In unilateral cleft palate patients, the highest bone level was found on the anterior palate side opposite to the cleft side, indicating the most effective region for MIs placement.
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Affiliation(s)
- Samantha Moscarino
- Department of Orthodontics, Dental Clinic, University of Aachen, Germany.
| | - Johannes Scholz
- Department of Orthodontics, Dental Clinic, University of Aachen, Germany; Department of Maxillofacial Surgery, Dental Clinic, University of Essen, Germany
| | - Asisa Bastian
- Department of Orthodontics, Dental Clinic, University of Aachen, Germany
| | - Isabel Knaup
- Department of Orthodontics, Dental Clinic, University of Aachen, Germany
| | - Michael Wolf
- Department of Orthodontics, Dental Clinic, University of Aachen, Germany
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Maino G, Turci Y, Arreghini A, Paoletto E, Siciliani G, Lombardo L. Skeletal and dentoalveolar effects of hybrid rapid palatal expansion and facemask treatment in growing skeletal Class III patients. Am J Orthod Dentofacial Orthop 2018; 153:262-268. [DOI: 10.1016/j.ajodo.2017.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 10/18/2022]
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Hourfar J, Bister D, Lux CJ, Al-Tamimi B, Ludwig B. Anatomic landmarks and availability of bone for placement of orthodontic mini-implants for normal and short maxillary body lengths. Am J Orthod Dentofacial Orthop 2017; 151:878-886. [PMID: 28457265 DOI: 10.1016/j.ajodo.2016.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Increasing numbers of orthodontic mini-implants are placed in the anterior maxilla. To our knowledge, bone levels and root proximity of patients with cephalometrically short maxillae have not been investigated before. The first, second, and third rugae were used as clinical reference lines, and the aim of this study was to measure bone availability in that area by comparing patients with short and normal maxillary body lengths. METHODS The sample consisted of 21 patients in each group: short maxillary body length and normal maxillary body length. The patients' study models were bisected, and the outline of the palatal contour was marked on the surface. The models were scanned, and the palatal contours were superimposed on the palatal structures of their respective initial cephalometric headfilms, and the vertical and oblique bone levels of the sagittal plane were compared using the Student t test. The level of significance was set at P <0.05. RESULTS Compared with maxillae of normal maxillary body length, less bone was available in maxillae of short maxillary body length. However, the differences did not reach clinical or statistical significance (P >0.05) at the third rugae. CONCLUSIONS Almost equivalent average bone depth at the third rugae in patients with normal and short maxillary body lengths suggests that this site can be used for 8-mm long obliquely inserted orthodontic mini-implants.
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Affiliation(s)
- Jan Hourfar
- Private Practice, Reinheim, Germany; Department of Orthodontics, University of Saarland, Homburg, Germany
| | - Dirk Bister
- Department of Orthodontics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher J Lux
- Department of Orthodontics, University of Heidelberg, Heidelberg, Germany
| | - Bouthayna Al-Tamimi
- Dental and Maxillofacial Surgery Department, Great Ormond Street Hospital, NHS Foundation Trust, London, United Kingdom
| | - Björn Ludwig
- Private Practice, Traben-Trarbach, Germany; Department of Orthodontics, University of Saarland, Homburg, Germany.
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Sumer A, Caliskan A, Uzun C, Karoz T, Sumer M, Cankaya S. The evaluation of palatal bone thickness for implant insertion with cone beam computed tomography. Int J Oral Maxillofac Surg 2016; 45:216-20. [DOI: 10.1016/j.ijom.2015.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/14/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022]
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