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Hoang TH, Nguyen KCT, Kaipatur NR, Alexiou M, La TG, Lagravère Vich MO, Major PW, Punithakumar K, Lou EH, Le LH. Ultrasonic mapping of midpalatal suture - An ex-vivo study. J Dent 2024; 145:105024. [PMID: 38670332 DOI: 10.1016/j.jdent.2024.105024] [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: 08/10/2023] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Rapid maxillary expansion is a common orthodontic procedure to correct maxillary constriction. Assessing the midpalatal suture (MPS) expansion plays a crucial role in treatment planning to determine its effectiveness. The objectives of this preliminary investigation are to demonstrate a proof of concept that the palatal bone underlying the rugae can be clearly imaged by ultrasound (US) and the reconstructed axial view of the US image accurately maps the MPS patency. METHODS An ex-vivo US scanning was conducted on the upper jawbones of two piglet's carcasses before and after the creation of bone defects, which simulated the suture opening. The planar images were processed to enhance bone intensity distribution before being orderly stacked to fuse into a volume. Graph-cut segmentation was applied to delineate the palatal bone to generate a bone volume. The accuracy of the reconstructed bone volume and the suture opening was validated by the micro-computed tomography (µCT) data used as the ground truth and compared with cone beam computed tomography (CBCT) data as the clinical standard. Also included in the comparison is the rugae thickness. Correlation and Bland-Altman plots were used to test the agreement between the two methods: US versus µCT/CBCT. RESULTS The reconstruction of the US palatal bone volumes was accurate based on surface topography comparison with a mean error of 0.19 mm for pre-defect and 0.15 mm and 0.09 mm for post-defect models of the two samples, respectively when compared with µCT volumes. A strong correlation (R2 ≥ 0.99) in measuring MPS expansion was found between US and µCT/CBCT with MADs of less than 0.05 mm, 0.11 mm and 0.23 mm for US, µCT and CBCT, respectively. CONCLUSIONS It was possible to axially image the MPS opening and rugae thickness accurately using high-frequency ultrasound. CLINICAL SIGNIFICANCE This study introduces an ionizing radiation-free, low-cost, and portable technique to accurately image a difficult part of oral cavity anatomy. The advantages of conceivable visualization could promise a successful clinical examination of MPS to support the predictable treatment outcome of maxillary transverse deficiency.
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Affiliation(s)
- Trang H Hoang
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Kim-Cuong T Nguyen
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | | | - Maria Alexiou
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Thanh-Giang La
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | | | - Paul W Major
- School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Edmond H Lou
- Department of Electrical and Computing Engineering, University of Alberta, Edmonton, AB, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; School of Dentistry, University of Alberta, Edmonton, AB, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada; Department of Physics, University of Alberta, Edmonton, AB, Canada.
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Willershausen I, Kopp M, Scholz M, Ströbel A, Seidel CL, Paulsen F, Uder M, Gölz L, May MS. Feasibility of 3 Tesla MRI for the assessment of mid-palatal suture maturation: a retrospective pilot study. Odontology 2024:10.1007/s10266-024-00950-0. [PMID: 38758257 DOI: 10.1007/s10266-024-00950-0] [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: 03/08/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024]
Abstract
The maxilla occupies a key position in dentofacial orthopaedics, since its transversal development can be directly influenced by orthodontic therapy. The maturation stages of the mid-palatal suture, which are obtained from cone-beam computed tomography images (CBCT), present an addition to clinical decision-making in transversal discrepancies of the upper jaw. In an endeavour to reduce ionizing radiation in adolescents and young adults, who are particularly susceptible to long term stochastic irradiation effects, we investigated the feasibility of 3 Tesla (3T) MRI in detecting the maturation stages of the mid-palatal suture. A collective of 30 patients aged 24-93 years with routine neck MRI at 3T, underwent an additional three-dimensional isotropic T1 weighted study sequence of the midface. Image evaluation was performed on axial, multi-planar formatted reconstructions of the dataset aligned to the midline axis of the palate, and curved reconstructions aligned to the concavity of the palate. Inverted images helped to achieve an image impression similar to the well-known CBCT appearance. All datasets were reviewed by three readers and mid-palatal maturation was scored twice according to Angelieri et al. Intra- and inter-rater agreement were evaluated to measure the robustness of the images for clinical evaluation. 3T MRI deemed reliable for the assessment of mid-palatal suture maturation and hence for the appraisal of the hard palate and its adjacent sutures. The data of this pilot study display the feasibility of non-ionizing cross-sectional MRI for the determination of sutural maturation stages. These findings underline the potential of MRI for orthodontic treatment planning, further contributing to the avoidance of unnecessary radiation doses.
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Affiliation(s)
- Ines Willershausen
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
| | - Markus Kopp
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Scholz
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Ströbel
- Center for Clinical Studies (CCS), Medical Faculty, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Corinna Lesley Seidel
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Lina Gölz
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Stefan May
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Villarroel T, Yagnam S, Vicuña D, Concha G, Oyonarte R. Midpalatal suture maturation in 15- to 35-year-olds: morphological assessment in the coronal plane using CBCT-an exploratory study. Odontology 2024; 112:647-656. [PMID: 37851186 DOI: 10.1007/s10266-023-00861-6] [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: 09/27/2022] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
Rapid maxillary expansion (RME) is used in patients presenting transverse maxillary deficiency. However, RME may be unpredictable after late adolescence if the midpalatal sutural maturation stage (MPMS) is in late stage. Since MPMS evaluation is influenced by the expertise of the operator and image quality, this classification method could be complemented. Therefore, this study aimed to analyze the morphology of the midpalatal suture (MPS) and its surrounding bone in the coronal plane using cone beam computed tomography (CBCT) images of adolescents and young adults and to correlate the findings with their respective MPMS status. CBCT scans of 200 patients aged 15-35 years of both sexes were evaluated. MPS and surrounding bone tissue characteristics in the coronal and axial sections were analyzed, and MPMS was evaluated (A to E). Six categories were identified for the coronal evaluation, analyzing it in 2 standardized locations. Sutural morphology: I, hypodense sutural line limited by 2 hyper-dense para-sutural lines; II, hypodense sutural line; and III, suture not visible. The presence of para-sutural cancellous bone: CB0, compact bone; CB1, dense cancellous tissue; CB2, spaced cancellous bone. Midpalatal bone thickness (MBTh) was also measured. ANOVA-Bonferroni, chi-square, logistic regression and t-tests were used. MPMS increased with age. Sutural morphology I and CB0 bone were the most prevalent. Here we show that sutural morphology, para-sutural bone characteristics, and MPSM were significantly associated. The coronal evaluation of the MPS can complement the information from the MPSM assessment, allowing the identification of patent MPS even in the presence of late MPSM.
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Affiliation(s)
- Tannia Villarroel
- Graduate Orthodontic Program, Faculty of Odontology, Universidad de los Andes, Mons. Álvaro del Portillo 12.455. Las Condes, Santiago, Chile
- Private Practice, Curicó, Chile
| | - Sharime Yagnam
- Graduate Orthodontic Program, Faculty of Odontology, Universidad de los Andes, Mons. Álvaro del Portillo 12.455. Las Condes, Santiago, Chile
| | - Daniela Vicuña
- Graduate Program in Oral and Maxillofacial Radiology, Faculty of Odontology, Universidad de los Andes, Santiago, Chile
| | - Guillermo Concha
- Graduate Program in Oral and Maxillofacial Radiology, Faculty of Odontology, Universidad de los Andes, Santiago, Chile
| | - Rodrigo Oyonarte
- Graduate Orthodontic Program, Faculty of Odontology, Universidad de los Andes, Mons. Álvaro del Portillo 12.455. Las Condes, Santiago, Chile.
- Health Sciences Doctoral Program, Universidad Internacional de Cataluña, Barcelona, Spain.
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Liu H, Feng L, Wang L. Diagnostic value of cervical vertebral maturation stages for midpalatal suture maturation assessment: a study in the Chinese population. BMC Oral Health 2023; 23:504. [PMID: 37474915 PMCID: PMC10360312 DOI: 10.1186/s12903-023-03220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To evaluate the correlation between cervical vertebral maturation stages (CVMS) and midpalatal suture maturation stages (MPSMS), and to analyze the diagnostic value of CVMS for the assessment of MPSMS. METHODS Cone beam computed tomography (CBCT) images of 233 subjects (8-20 years) were selected. The CVMS was determined using the McNamara and Franchi method, while the MPSMS was evaluated using the Angelieri method. Spearman rank correlation was used to analyze the results, and positive likelihood ratios were calculated to evaluate the diagnostic value of CVMS in identifying MPSMS. RESULTS Spearman rank correlation results showed a strong positive correlation (r = 0.867, P < 0.001) between CVMS and MPSMS. The positive likelihood ratios of CS12, CS4, and CS56 for the identification of stages AB, C, and DE were 12.17, 7.64, and 7.79, respectively. The values of the positive likelihood ratios of the other groups were less than five. CONCLUSION CS12 of the CVMS can be used as a reliable indicator for the assessment of MPSMS stage AB. From CVMS stage 4 forward, midpalatal suture maturation should be evaluated using CBCT.
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Affiliation(s)
- Henglang Liu
- Department of Stomatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd., Chengdu, Sichuan Province, 610072, China
| | - Linjing Feng
- Chengdu Stomatological Hospital, No.17 Chunxi Road South, Chengdu, Sichuan Province, 610000, China
| | - Lili Wang
- Department of Stomatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd., Chengdu, Sichuan Province, 610072, China.
- School of Medicine, University of electronic science and technology of china, No.4, Section 2, North Jianshe Road, Chengdu, 610054, China.
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Govaerts D, Da Costa O, Garip M, Combes F, Jacobs R, Politis C. Can surgically assisted rapid palatal expansion (SARPE) be recommended over orthodontic rapid palatal expansion (ORPE) for girls above the age of 14? : A cone-beam CT study on midpalatal suture maturation. J Orofac Orthop 2023:10.1007/s00056-023-00487-x. [PMID: 37407791 DOI: 10.1007/s00056-023-00487-x] [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: 05/12/2022] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND For patients with a maxillary transversal deficiency (MTD), various treatment options are available, partly based on the practitioner's experience. This study aimed to determine a cut-off age for decision making between surgically assisted rapid palatal expansion (SARPE) over orthodontic rapid palatal expansion (ORPE) based on skeletal maturation in a female population. METHODS A total of 100 cone beam computed tomography (CBCT) images of young females were analyzed on maturation of the pterygomaxillary (PMS), zygomaticomaxillary (ZMS), transpalatal (TPS), and midpalatal (MPS) sutures. Based on the maturation of these four junctions, four independent observers had to determine whether they would prefer ORPE or SARPE to widen the maxilla. RESULTS For the PMS, the results show a closure of 83-100% from 13 to 17 years. As for the TPS, a closure of 78-85% was observed from 15 years of age. For the 15- to 17-year-old females, a closed ZMS was present in 32-47%. Regarding MPS, closed sutures presented in 61% (stages D and E) of the 15-year-old females. The cut-off age at which SARPE was recommended was 15.1 years for the orthodontist observers and 14.8 years for the maxillofacial surgeon observers. CONCLUSIONS Significant maturation of MPS was reached at the age of 15 in a female population. The PMS, TPS, MPS, and ZMS closed sequentially. A comprehensive diagnostic approach is necessary for choosing the appropriate treatment. When in doubt, age could assist decision making in a female population, with a cut-off age of 15 years in favor of SARPE based on this study.
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Affiliation(s)
- Dries Govaerts
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Oliver Da Costa
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Melisa Garip
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - François Combes
- Department of Oral and Maxillofacial Surgery, AZ Delta Hospital, Roeselare, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Darawsheh AF, Kolarovszki B, Hong DH, Farkas N, Taheri S, Frank D. Applicability of Fractal Analysis for Quantitative Evaluation of Midpalatal Suture Maturation. J Clin Med 2023; 12:4189. [PMID: 37445223 DOI: 10.3390/jcm12134189] [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: 04/19/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The treatment of transversal maxillary deficiency usually aims at skeletal expansion. The treatment option highly depends on the maturation stage of the midpalatal suture (MPS), which may vary between individuals at the same chronological age. Therefore, the individual determination of the MPS maturation is crucial. AIMS Our aim was to investigate the applicability of fractal analysis for the quantitative evaluation of MPS maturation. METHODS Nine experienced orthodontists were asked to evaluate the MPS maturation on 51 cone beam computed tomography (CBCT) scans according to the Angelieri classification method. Intra- and inter-examiner reliability was measured using Cohen's Kappa coefficient. The stages were agreed upon according to the results of the examiners with the highest strength of agreement. Fractal analysis was then performed on the CBCTs and the correlation between the fractal dimension values and maturation stages was then evaluated. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. RESULTS The cut-off point was found at 1.073, at which the use of fractal dimension for predicting MPS maturation showed 100% sensitivity, 93.7% specificity, 9.5% false positive, 0% false negative rate. CONCLUSION Our results provided further evidence that fractal analysis is a reliable tool to determine MPS maturation stage.
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Affiliation(s)
- Ali Farid Darawsheh
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Béla Kolarovszki
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Da Hye Hong
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Soroush Taheri
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Dorottya Frank
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, 7624 Pécs, Hungary
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Shayani A, Merino-Gerlach MA, Garay-Carrasco IA, Navarro-Cáceres PE, Sandoval-Vidal HP. Midpalatal Suture Maturation Stage in 10- to 25-Year-Olds Using Cone-Beam Computed Tomography-A Cross-Sectional Study. Diagnostics (Basel) 2023; 13:diagnostics13081449. [PMID: 37189552 DOI: 10.3390/diagnostics13081449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 05/17/2023] Open
Abstract
In this study, we aimed to evaluate the frequency of midpalatal maturational stages in a Chilean urban sample of adolescents, post-adolescents and young adults, associated with chronological age and sex, by assessing CBCT scan images. Tomographic images in axial sections of the midpalatal sutures from 116 adolescents and young adults (61 females and 55 males, 10-25 years old) were classified according to their morphologic characteristics in five maturational stages (A, B, C, D and E), as proposed by Angelieri et al. The sample was divided into three groups: adolescents, post-adolescents and young adults. Three previously calibrated examiners (radiologist, orthodontist and general dentist) analyzed and classified the images. Stages A, B and C were considered to be an open midpalatal suture, and D and E were considered to be a partially or totally closed midpalatal suture. The most frequent stage of maturation was D (37.9%), followed by C (24%) and E (19.6%). The possibility of finding closed midpalatal sutures in individuals of 10 to 15 years was 58.4%, and in subjects aged 16 to 20 and 21 to 25 years, it was 51.7% and 61.7%, respectively. In males, Stages D and E were present in 45.4%; for females, this prevalence was 68.8%. Individual assessment of the midpalatal suture in each patient is of crucial importance before making the clinical decision of which is the best maxillary expansion method. Due to the extensive calibration and training required, it is advisable to always request a report from a radiologist. Individual evaluation with 3D imaging is recommended because of the great variability observed in the ossification of midpalatal sutures in adolescents, post-adolescents and young adults.
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Affiliation(s)
- Anis Shayani
- Master Program in Dental Science, Faculty of Dentistry, Universidad de La Frontera, Temuco 4780000, Chile
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Valdivia 5090000, Chile
| | | | | | - Pablo Eliseo Navarro-Cáceres
- Centro de Investigación en Ciencias Odontológicas (CICO), Departamento de Odontología Integral de Adultos, Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
- Universidad Autónoma de Chile, Temuco 4780000, Chile
| | - Héctor Paulo Sandoval-Vidal
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4780000, Chile
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Balakrishnan R, Sengottuvel N, Altaf SK, Bhandari PK, Kumaragurubaran P, Antony M. Three-Dimensional Finite Element Analysis of Maxillary Protraction Using Diverse Modes of Rapid Palatal Expansion. Cureus 2023; 15:e36328. [PMID: 37077604 PMCID: PMC10108977 DOI: 10.7759/cureus.36328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Three-dimensional finite elemental analysis (FEA) is a contemporary research instrument for the numeric simulation of a real physical system's mechanical process. FEA can be used as a very effective tool to analyze and compare various aspects of rapid palatal expanders and to determine the stress distribution in maxillofacial bones and displacement and the biomechanical effects it has on the circummaxillary sutures. This study evaluates the effects of different modes of rapid palatal expansion on maxillary protraction as a treatment modality in skeletal Class III malocclusion by determining the stress and displacement along the circummaxillary sutures using the FEA. MATERIALS AND METHODS Initially, a three-dimensional finite element simulation of the maxillofacial skeleton and sutures was obtained by Mimics software (Leuven, Belgium) from the cone-beam computed tomography (Dentsply Sirona, USA) images of a 30-year-old adult with normal occlusion. A geometrical preparation of the three expansion appliances, (A) hybrid MARPE (miniscrew-assisted rapid palatal expander) appliance (Fav anchor, India), (B) tooth-borne HYRAX (hygenic rapid expander) appliance (Welcare orthodontics, Kerela), and (C) bone-borne modified MARPE appliance (Biomaterials, Korea), was transferred to ANSYS WORKBENCH, 2020 R1 software (ANSYS, Inc., USA), and three finite element models with each appliance were prepared. A protraction force of 500g was applied to the occlusal plane that is directed 20 degrees inferiorly. The tensile stress, compressive stress, and the amount of displacement on the circummaxillary sutures were assessed and compared in all the three appliances. Young's modulus (kg/mm2) and Poisson's ratio (V) were used to calculate the stress and displacement in sutures adjacent to the maxilla in different aspects. RESULTS On analyzing the stress distribution, the tensile stress was found to be maximum in the medial aspect of the frontomaxillary suture of the bone-borne modified MARPE appliance (C), and the minimum tensile stress was found in the lateral aspect of the sphenozygomatic suture in hybrid MARPE (A). Again, the compressive stress distribution was found to be maximum in the medial aspect of the frontomaxillary suture in all three simulations and the minimum compressive stress in the superior aspect of the internasal suture in hybrid MARPE (A) along with the frontonasal suture at its medial aspect for tooth-borne HYRAX (B) and bone-borne modified MARPE (C). Displacement of the maxilla in all the planes was observed to be the largest for the bone-borne modified MARPE (C) appliance. On the contrary, the minimum displacement was found in the tooth-borne HYRAX (B) appliance. Conclusion: The findings reveal that all three modes of rapid palatal expanders produced stress and displacement along the circummaxillary sutures on the application of protraction force with bone-borne modified MARPE being more effective in treating posterior crossbites thereby correcting the skeletal Class III malocclusions successfully.
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Lee JM, Choi SH, Choi YJ, Lee KJ, Yu HS. Evaluation of miniscrew-assisted rapid palatal expansion success by comparing width of circummaxillary sutures before expansion in adult male patients. Angle Orthod 2022; 93:489524. [PMID: 36548811 PMCID: PMC9933570 DOI: 10.2319/062722-456.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate the relationship between circummaxillary sutures and miniscrew-assisted rapid palatal expansion (MARPE) success in adult male patients and to evaluate the correlation between the width of the sutures and the maxilla expansion ratio. MATERIALS AND METHODS This retrospective study comprised 40 adult male patients treated with MARPE divided into a separation group (N = 20, mean age, 21.9 years) consisting of subjects with midpalatal suture opening and a nonseparation group (N = 20, mean age, 21.7 years) consisting of subjects with no midpalatal suture opening. Cone-beam computed tomography images were obtained before MARPE expansion for both groups and after expansion for the separation group. Vertical and horizontal skeletal relationships, palate length, and widths of 10 circummaxillary sutures before expansion were compared. The correlation between maxilla expansion ratio (jackscrew expansion to maxillary expansion ratio) and circummaxillary suture widths was also analyzed in the separation group. RESULTS There were no significant differences in age, vertical and horizontal skeletal relationships, and palate length between the two groups. Zygomaticomaxillary, pterygomaxillary, midpalatal, and transverse palatine sutures showed significantly greater width in the separation group (P < .05). The zygomaticomaxillary suture showed the greatest difference (Δ = 0.36 mm) between the groups. The zygomaticomaxillary and pterygomaxillary sutures showed significant positive correlation with the maxilla expansion ratio (P < .01). CONCLUSIONS In adult male patients, greater circummaxillary suture widths before MARPE expansion, especially zygomaticomaxillary and pterygomaxillary sutures, resulted in a better chance of successful suture separation and more maxillary expansion.
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Yi F, Liu OS, Lei L, Liu SL, Wang Y, Chu YH, Zhang LL, Li CR, Chen JJ, Lu YQ. Factors related to microimplant-assisted rapid palatal expansion in teenagers and young adults: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2022; 163:475-482. [PMID: 36564316 DOI: 10.1016/j.ajodo.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION For patients with maxillary transverse deficiency, selecting an appropriate therapeutic method is important for the treatment effect and prognosis. Our study aimed to explore factors related to microimplant-assisted rapid palatal expansion (MARPE) in teenagers and young adults using cone-beam computed tomography. METHODS Twenty-five patients who underwent MARPE were included in this retrospective study from February 2014 to June 2019. Midpalatal suture density (MPSD) ratio, midpalatal suture maturation (MPSM), bone effect, dentoalveolar effect, and dental effect in maxillary first molar were evaluated using cone-beam computed tomography. Spearman correlation analysis was used to analyze the correlation between the MPSD ratio, MPSM, age, and the expansion amount generated by MARPE. RESULTS Twenty-five patients (mean age, 19.84 ± 3.96 years; range, 15-29 years) with maxillary transverse deficiency were analyzed. Age was negatively correlated with bone expansion, alveolar expansion, and alveolar change (all P <0.05). There was a negative correlation between MPSM and nasal cavity variation, bone expansion, and alveolar change (all P <0.05). The bone expansion was negatively correlated with MPSD ratio 3 (r = -0.417; P <0.05) and MPSD ratio 4 (all P <0.05). CONCLUSIONS Age, MPSM, and MPSD ratio were significantly related to the MARPE effect. Age, MPSM, and MPSD ratio should be considered when choosing MARPE.
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Affiliation(s)
- Fang Yi
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Ou-Sheng Liu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Lei Lei
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Si-Ling Liu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yue Wang
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yan-Hao Chu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Ling-Ling Zhang
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Cheng-Ri Li
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Jun-Jie Chen
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yan-Qin Lu
- Hunan Key Laboratory of Oral Health Research and Hunan 3D Printing Engineering Research Center of Oral Care and Hunan Clinical Research Center of Oral Major Diseases and Oral Health and Xiangya Stomatological Hospital, and Xiangya School of Stomatology, Central South University, Changsha, Hunan, China.
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Non-Surgical Transversal Dentoalveolar Compensation with Completely Customized Lingual Appliances versus Surgically Assisted Rapid Palatal Expansion in Adults-The Amount of Posterior Crossbite Correction. J Pers Med 2022; 12:jpm12111893. [PMID: 36422069 PMCID: PMC9694179 DOI: 10.3390/jpm12111893] [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: 09/18/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to compare the crossbite correction of a group (n = 43; f/m 19/24; mean age 27.6 ± 9.5 years) with surgically assisted rapid palatal expansion (SARPE) versus a non-surgical transversal dentoalveolar compensation (DC) group (n = 38; f/m 25/13; mean age 30.4 ± 12.9 years) with completely customized lingual appliances (CCLA). Arch width was measured on digital models at the canines (C), second premolars (P2), first molars (M1) and second molars (M2). Measurements were obtained before treatment (T0) and at the end of lingual treatment (T1) or after orthodontic alignment prior to a second surgical intervention for three-dimensional bite correction. There was no statistically significant difference (p > 0.05) in the amount of total crossbite correction between the SARPE and DC-CCLA group at C, P2, M1 and M2. Maxillary expansion was greater in the SARPE group and mandibular compression was greater in the DC-CCLA group. Crossbite correction in the DC-CCLA group was mainly a combination of maxillary expansion and mandibular compression. Dentoalveolar compensation with CCLAs as a combination of maxillary expansion and mandibular compression seems to be a clinically effective procedure to correct a transverse maxillo-mandibular discrepancy without the need for surgical assistance.
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Correlation between cervical vertebrae maturation and midpalatal suture fusion in patients aged between 10 and 20 years: A cross-sectional and 3D study. Int Orthod 2022; 20:100659. [DOI: 10.1016/j.ortho.2022.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/15/2022]
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Gao L, Chen Z, Zang L, Sun Z, Wang Q, Yu G. Midpalatal Suture CBCT Image Quantitive Characteristics Analysis Based on Machine Learning Algorithm Construction and Optimization. Bioengineering (Basel) 2022; 9:bioengineering9070316. [PMID: 35877367 PMCID: PMC9311955 DOI: 10.3390/bioengineering9070316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Midpalatal suture maturation and ossification status is the basis for appraising maxillary transverse developmental status. Methods: We established a midpalatal suture cone-beam computed tomography (CBCT) normalized database of the growth population, including 1006 CBCT files from 690 participants younger than 24 years old. The midpalatal suture region of interest (ROI) labeling was completed by two experienced clinical experts. The CBCT image fusion algorithm and image texture feature analysis algorithm were constructed and optimized. The age range prediction convolutional neural network (CNN) was conducted and tested. Results: The midpalatal suture fusion images contain complete semantic information for appraising midpalatal suture maturation and ossification status during the fast growth and development period. Correlation and homogeneity are the two texture features with the strongest relevance to chronological age. The overall performance of the age range prediction CNN model is satisfactory, especially in the 4 to 10 years range and the 17 to 23 years range, while for the 13 to 14 years range, the model performance is compromised. Conclusions: The image fusion algorithm can help show the overall perspective of the midpalatal suture in one fused image effectively. Furthermore, clinical decisions for maxillary transverse deficiency should be appraised by midpalatal suture image features directly rather than by age, especially in the 13 to 14 years range.
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Affiliation(s)
- Lu Gao
- Department of Stomatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
| | - Zhiyu Chen
- School of Software Engineering, North University of China, Taiyuan 030051, China;
| | - Lin Zang
- Pharmacovigilance Research Center for Information Technology and Data Science, Cross-Strait Tsinghua Research Institute, Xiamen 361000, China;
| | - Zhipeng Sun
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, China;
| | - Qing Wang
- Pharmacovigilance Research Center for Information Technology and Data Science, Cross-Strait Tsinghua Research Institute, Xiamen 361000, China;
- Department of Automation, Tsinghua University, Beijing 100084, China
- Correspondence: (Q.W.); (G.Y.)
| | - Guoxia Yu
- Department of Stomatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
- National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
- Correspondence: (Q.W.); (G.Y.)
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Gao L, Sun J, Zhou X, Yu G. In vivo methods for evaluating human midpalatal suture maturation and ossification: An updated review. Int Orthod 2022; 20:100634. [DOI: 10.1016/j.ortho.2022.100634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
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Eguren M, Holguin A, Diaz K, Vidalon J, Linan C, Pacheco-Pereira C, Lagravere Vich MO. Can gray values be converted to Hounsfield units? A systematic review. Dentomaxillofac Radiol 2022; 51:20210140. [PMID: 34148350 PMCID: PMC8693322 DOI: 10.1259/dmfr.20210140] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The purpose of this systematic review was to answer the focus question: "Could the gray values (GVs) from CBCT (cone beam computed tomography) be converted to Hounsfield units (HUs) in multidetector computed tomography (MDCT)?" METHODS The included studies try to answer the research question according to the PICO strategy. Studies were gathered by searching several electronic databases and partial grey literature up to January 2021 without language or time restrictions. The methodological assessment of the studies was performed using The Oral Health Assessment Tool (OHAT) for in vitro studies and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) for in vivo studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE system) instrument was applied to assess the level of evidence across the studies. RESULTS 2710 articles were obtained in Phase 1, and 623 citations remained after removing duplicates. Only three studies were included in this review using a two-phase selection process and after applying the eligibility criteria. All studies were methodologically acceptable, although in general terms with low risks of bias. There are some included studies with quite low and limited evidence estimations and recommendation forces; evidencing the need for clinical studies with diagnostic capacity to support its use. CONCLUSIONS This systematic review demonstrated that the GVs from CBCT cannot be converted to HUs due to the lack of clinical studies with diagnostic capacity to support its use. However, it is evidenced that three conversion steps (equipment calibration, prediction equation models, and a standard formula (converting GVs to HUs)) are needed to obtain pseudo Hounsfield values instead of only obtaining them from a regression or directly from the software.
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Affiliation(s)
- Marjorie Eguren
- Master in Orthodontic Graduate Program, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Anderson Holguin
- Program of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Karla Diaz
- Stomatology Second Specialty, Universidad Privada San Juan Bautista, Lima, Perú
| | - Jose Vidalon
- Department of Stomatology, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carlos Linan
- Department of Orthodontics, Faculty of Stomatology, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Camila Pacheco-Pereira
- University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Dental Radiology, 11405-87 Ave, Edmonton, Canada
| | - Manuel Oscar Lagravere Vich
- University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Orthodontic Graduate Program, ECHA 5-524, 11405-87 Ave, Edmonton, Canada
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A CBCT Evaluation of Midpalatal Bone Density in Various Skeletal Patterns. SENSORS 2021; 21:s21237812. [PMID: 34883821 PMCID: PMC8659514 DOI: 10.3390/s21237812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate midpalatal bone density (BD) by using cone-beam computed tomography (CBCT) according to gender, age, and vertical and horizontal skeletal patterns. CBCT images from 126 subjects (64 females and 62 males) were reoriented and analyzed in order to attain BD values at the midpalatal suture. Four age groups were used for classification (adolescence, 10 ≤ early < 14 years, 14 ≤ middle ≤ 17 years, and 17 < late ≤ 21 years; adult > 21 years). Vertical skeletal pattern categories were differentiated by the Frankfort horizontal line to mandibular plane angle (hypodivergent < 22°, 22° ≤ normovergent ≤ 28°, and 28° < hyperdivergent). Horizontal skeletal pattern differentiation was defined by ANB angle (Class III < 0°, 0° ≤ Class I ≤ 4°, and 4° < Class II). Females showed significantly higher BD than males (p < 0.001). As age increased, BD increased significantly (p < 0.001). There were no significant differences between vertical skeletal patterns. Class II showed significantly less BD than Class III (p < 0.05). With this information, clinicians can better understand BD trends of the midpalatal suture and, thus, better understand our patient’s anatomy and potential hurdles in successful treatment.
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Midpalatal suture density ratio after rapid maxillary expansion evaluated by cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2021; 161:238-247. [PMID: 34563427 DOI: 10.1016/j.ajodo.2020.07.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Identifying the stage of midpalatal suture (MPS) fusion is essential for rapid maxillary expansion (RME). The objective of this study was to evaluate the relationship between MPS density ratio and the skeletal response after RME using cone-beam computed tomography (CBCT). METHODS CBCT scans of 64 patients (age, 13.81 ± 1.68 years; 42 females and 22 males) who underwent RME as part of comprehensive orthodontic treatment were used for this study. Two CBCT records were made at T1 (pre-RME) and T2 (post-RME). MPS density was assessed by gray scale and the skeletal effects through linear measurements: greater palatine foramina, the width of the nasal cavity (NW), infraorbital foramina. The data were collected at 4 different times: baseline, 24 hours, 48 hours, and 4 weeks. RESULTS There was no statistically significant correlation between MPS density ratio and greater palatine foramina or infraorbital foramina. Negative correlations with MPS density ratio are presented with the difference of age post-RME and pre-RME (r = -0.46, P = 0.033) in males, and NW (r = -0.41, P = 0.007) in females. A significant association between gender and the MPS density ratio was found (P = 0.015) in females. CONCLUSIONS There is a weak negative correlation between the MPS density ratio and the difference of age post-RME and pre-RME in males and the NW in females. Females presented greater density ratios than males. MPS density ratio through CBCT does not appear to be an adequate parameter to predict the skeletal effect in adolescent patients and young adults.
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Oliveira RDS, de Oliveira CJM, Panzarella FK, Cintra Junqueira JL. Maturation stages of the sutures in the median palatine evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2021; 160:567-572. [PMID: 34274199 DOI: 10.1016/j.ajodo.2020.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study aimed to evaluate the influence of age, sex, and facial growth patterns on the maturation stage of midpalatal sutures. METHODS We selected 90 total skull cone-beam computed tomography scans and divided them into the following 3 groups: brachyfacial (n = 30), mesofacial (n = 30), and dolichofacial (n = 30). These groups were determined using Ricketts VERT 3-dimensional cephalometric analysis. All patients were aged ≥18 years and were divided into those aged ≥30 years and >30 years. The maturational stage of the median palatine sutures was determined by evaluating the central transverse axial dimension in the maxillary-mandibular palate. Maturational stages were classified as A, B, C, D, and E. RESULTS Of the 90 images reviewed, 55 (61.1%) were female patients, and 35 were male patients (38.9%). The age of patients ranged from 18 to 59 years, with 55 patients aged <30 years (61.1%) and 35 aged ≥30 years (38.9%). Regarding the maturational stages, 3.3% of brachyfacial, 6.7% of mesiofacial, and 16.7% of dolichofacial subjects (P = 0.032) were classified as stages B and C. CONCLUSIONS The patients' facial patterns were found to be a significant signal for the maturation stage of midpalatal sutures. Adult dolichofacial patients are the most likely to have stage B and C.
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Affiliation(s)
- Rudyard Dos Santos Oliveira
- Department of Dentistry, Postgraduate Program in Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil.
| | | | - Francine Kühl Panzarella
- Department of Dentistry, Postgraduate Program in Imaging and Oral Radiology, São Leopoldo Mandic College, Campinas, São Paulo, Brazil
| | - José Luiz Cintra Junqueira
- Department of Dentistry, Postgraduate Program in Imaging and Oral Radiology, São Leopoldo Mandic College, Campinas, São Paulo, Brazil
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Christovam IO, Lisboa CDO, Vilani GNL, Brandão RCB, Visconti MAPG, Mattos CT, Ruellas ACDO. Tomographic analysis of midpalatal suture prior to rapid maxillary expansion. Dental Press J Orthod 2021; 26:e2119300. [PMID: 34231834 PMCID: PMC8279114 DOI: 10.1590/2177-6709.26.3.e2119300.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 03/04/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In Orthodontics and Facial Orthopedics, the timing of treatment onset may be critical and individual analysis should be applied to promote a favorable treatment planning. In this study, individual analysis of midpalatal suture (MS) and palatal measurements were performed in teenagers and young adult patients treated with rapid maxillary expansion (RME). DESCRIPTION Twenty-six patients submitted to RME with a tooth-supported appliance (Hyrax) were evaluated. The inclusion criteria were: minimum age of 14 years, presenting all posterior teeth, diagnosed with transverse maxillary discrepancy, and with a clinical indication for maxillary expansion. The pretreatment CBCT scans of these patients were assessed to obtain the stages of MS maturation (MSM); density ratio (MSD); and palatal length, thickness (anterior, intermediate and posterior) and sagittal area. RESULTS The maturation stages present were C, D or E; the density ranged from 0.6 to 1, and lower density (MSD < 0.75) and higher density (MSD ≥ 0.75) groups were determined. Individuals with higher MSD presented smaller sagittal area, compared to the lower density group. Individuals in D and E MSM stages presented smaller sagittal area and intermediate thickness, compared to stage C. CONCLUSIONS Smaller palatal sagittal area was observed in the high MSD groups and in the stages D and E of MSM.
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Affiliation(s)
- Ilana Oliveira Christovam
- Universidade Federal do Rio de Janeiro, Faculdade de Odontologia, Departamento de Ortodontia (Rio de Janeiro/RJ, Brazil)
| | | | | | | | | | - Claudia Trindade Mattos
- Universidade Federal Fluminense, Faculdade de Odontologia, Departamento de Ortodontia (Niterói/RJ,Brazil)
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Chávez-Sevillano MG, Tenorio Estrada J, Blanco-Victorio DJ, Lagravère Vich MO, Abdo Quintão CC, Palomino-Gómez SP. Evaluation of the suture ossification level according to age and sex in children, adolescents, and adults. A cross-sectional and observational 3D study. Int Orthod 2021; 19:67-75. [PMID: 33531276 DOI: 10.1016/j.ortho.2020.12.002] [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: 10/15/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the ossification level of the midpalatal suture (MPS) in children, adolescents and adults from a Peruvian sample; according to the method proposed by Angelieri et al. with cone-beam computed tomographies (CBCTs). MATERIAL AND METHODS The sample consisted of 315 CBCTs of 168 females and 147 males. The total sample was divided into 3 groups according to age and sex: children (n=77), adolescents (n=113) and adults (n=125). The images were mainly assessed in the axial plane using the Real Scan 2.0 software. The different periods of ossification of the MPS at the level of the vertical half of the palate was defined according to the five stages of Angieleri method (from A to E). The Student t-Test, Chi-square test, Kruskal-Wallis test and Spearman's Rho test were applied. RESULTS Chi2 test results showed that the stages of MPS ossification depended on the age of the patient by age ranges (P<0.005). Multiple comparison tests affirmed that male and female subjects in the children group had fewer ossification stages than the adolescent and adult groups (P<0.001). Meanwhile, there were no statistically significant differences between the two older age groups. Finally, there was a moderate positive correlation between the stages of ossification of the MPS and the age in the male group (Rho=0.511). CONCLUSIONS The onset of MPS ossification was significantly related to subjects up to 12 years of age and more frequently in stages B and C in both sexes. There was no difference in MPS ossification in adolescents and adult subjects.
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Classification of the midpalatal suture maturation in individuals older than 15 years: a cone beam computed tomographic study. Surg Radiol Anat 2020; 42:1043-1049. [PMID: 32556669 DOI: 10.1007/s00276-020-02518-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to classify the maturation of the midpalatal suture (MPS) in a sample of individuals aged 15 years and older. METHODS Tomographic images in axial sections of the MPS of 289 female individuals and 198 male individuals aged between 15 and 40 years were analyzed and classified in stages of maturation (A, B, C, D, and E), stage A represents the earliest maturation stage of the suture and in stage E the fusion of the MPS has occurred in the maxilla. The Kruskal-Wallis and Student-Newman-Kells tests were used to compare the chronological ages among different maturation stages. Spearman's correlation coefficient was used to assess the correlation between patient's age and the maturation stages of the MPS. RESULTS Stage A was not observed in the sample. Stages B and C represent, respectively, 1.03% and 34.09% of the sample, stage D was found in 16.63% of the sample while stage E was the most prevalent stage found (48.25%). For females, it was revealed no statistically significant difference in the mean ages among stages C, D and E (p = 0.4753). For males, a statistically significant difference was observed, with the mean age of individuals in stages D and E of the MPS maturation higher than in other stages (p = 0.0001). There was a significant, but weak, correlation between patient's age and the maturation stages of the suture (rs = 0.11/p = 0.01). CONCLUSION No individuals in stage A of suture maturation were found and stage B was identified in only 1% of the sample. The majority of the patients (64.88%) presented at least partial fusion of the MPS (stages D and E).
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Akbulut S, Bayrak S, Korkmaz YN. Prediction of rapid palatal expansion success via fractal analysis in hand-wrist radiographs. Am J Orthod Dentofacial Orthop 2020; 158:192-198. [PMID: 32471664 DOI: 10.1016/j.ajodo.2019.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This study aimed to evaluate the efficacy of fractal analysis of hand-wrist radiography in the decision of conventional or surgery-assisted rapid palatal expansion (RPE). METHODS The study included 48 patients who underwent the RPE procedure. Study groups were as follows: group 1 (successful conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.85 ± 0.97 years]) and group 2 (failed conventional RPE [n = 24, 5 male and 19 female patients; mean age ± standard deviation, 15.96 ± 1.08 years]). Fractal dimension (FD) analysis was conducted on hand-wrist radiographs of the patients for 4 different regions: the epiphysis-diaphysis line of the radius bone and the proximal, medial (MP3), and distal (DP3) phalanxes of the middle finger. A Student t test was performed to compare fractal values between the groups. A receiver operating characteristic analysis was applied to determine the optimal cutoff value of FDs. In addition, a Pearson correlation coefficient was calculated to evaluate the relationship between the fractal values and either age or hand-wrist stage in a second sample group (n = 90; age range, 8.7-18.7 years). RESULTS Fractal values of the radius, MP3, and DP3 were significantly increased in the failed conventional RPE group (P <0.05). The optimal cutoff value of the FD for predicting the success of conventional RPE was 1.16 in the radius, 1.18 in proximal phalanxes, 1.29 in MP3, and 1.08 in DP3. There was a positive correlation between fractal values of the radius and age or hand-wrist stages (P <0.05). CONCLUSIONS Within the limits of this study, results revealed that fractal analysis of hand-wrist radiographs might be considered a significant tool in the prediction of RPE success.
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Affiliation(s)
- Sibel Akbulut
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey.
| | - Seval Bayrak
- Department of Oral Radiology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Yasemin Nur Korkmaz
- Department of Orthodontics, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Andrucioli MCD, Matsumoto MAN. Transverse maxillary deficiency: treatment alternatives in face of early skeletal maturation. Dental Press J Orthod 2020; 25:70-79. [PMID: 32215481 PMCID: PMC7077945 DOI: 10.1590/2177-6709.25.1.070-079.bbo] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 12/04/2022] Open
Abstract
Transverse deficiencies should be a priority in orthodontic treatment, and should be corrected as soon as diagnosed, to restore the correct transverse relationship between maxilla and mandible and, consequently, normal maxillary growth. Corrections may be performed at the skeletal level, by opening the midpalatal suture, or by dentoalveolar expansion. The choice of a treatment alternative depends on certain factors, such as age, sex, degree of maxillary hypoplasia and maturation of the midpalatal suture. Thus, the present study discusses different treatment approaches to correct maxillary hypoplasia in patients with advanced skeletal maturation.
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Affiliation(s)
- Marcela Cristina Damião Andrucioli
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Curso de Especialização em Ortodontia (Ribeirão Preto / SP, Brasil)
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Corticopuncture Facilitated Microimplant-Assisted Rapid Palatal Expansion. Case Rep Dent 2019; 2018:1392895. [PMID: 30627452 PMCID: PMC6305058 DOI: 10.1155/2018/1392895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/10/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Microimplant-assisted rapid palatal expansion (MARPE) has been considered an alternative to avoid extensive surgical procedures. In order to obtain skeletal results of MARPE, force should be enough to overcome areas of resistance and the first one that is required to be disrupted is the midpalatal suture, which becomes increasingly interdigitated after adolescence. Objective The present study aimed at providing a novel approach using a minimally invasive method called corticopuncture (CP) in association with MARPE illustrated by a case report of a 35-year-old Brazilian female Caucasian patient presenting maxillary transverse deficiency. Method Treatment plan started with an orthopedic correction of the transverse problem using a MARPE device. After many unsuccessful attempts to activate MARPE, corticopunctures were performed along the midpalatal suture. CP procedure at the midpalatal suture included 8 perforations (2 mm apart), performed after previous predrilling followed by miniscrew insertion (5 mm thread length and 1.8 mm diameter). Results After CP and new activation protocol, the opening of the midpalatal suture was observed by CBCT images, showing skeletal results, suture split of 3.14 mm (premolar area) and 2.06 (molar area), an increase of 4.3 mm (premolar) and 3.03 mm (molar) in basal bone width, 4.43 mm (premolar) and 3.1 mm (molar) in cortical bone width, and minimal dental effects (mean of 1.2° of tooth tipping). Conclusion The combination of MARPE and corticopuncture method was proved to be a nonsurgical treatment option to correct maxillary transverse deficiency in an adult patient. CP was able to weaken suture interdigitation thus facilitating the split.
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Abo Samra D, Hadad R. Midpalatal suture: evaluation of the morphological maturation stages via bone density. Prog Orthod 2018; 19:29. [PMID: 30101400 PMCID: PMC6087705 DOI: 10.1186/s40510-018-0232-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background To investigate the relationship between the morphological maturation stages of the midpalatal suture and its bone densities. Methods The sample consisted of 91 subjects aged 8–18 years who underwent cone beam computed tomography. All images were examined to classify morphological maturation of the midpalatal suture to five groups according to Angelieri et al. Bone density of the midpalatal suture was measured at the maxillary and palatal regions. Kruskal-Wallis and Mann-Whitney U tests were used to analyze the difference between groups. Results Bone density of the midpalatal suture was significantly higher in the palatal region in E stage and in the maxillary region in D and E stages. Conclusions It is concluded that the change in bone density of the midpalatal suture between the morphological maturation stages supports their reliability in clinical application.
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Affiliation(s)
- Dani Abo Samra
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Medicine, Damascus University, AlMazzah Street, Damascus, Syria.
| | - Rania Hadad
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Medicine, Damascus University, AlMazzah Street, Damascus, Syria
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