We thank Dr Thangabalu and Dr Geevee for their thoughtful commentary on our article, “Anatomic assessment of palatal temporary skeletal anchorage devices insertion sites among patients with cleidocranial dysplasia vs controls” ( Am J Orthod Dentofacial Orthop 2026;169:67–74). We appreciate the opportunity to clarify several points and expand on the rationale and methodology of our work. Below, we address each of the concerns raised.
1. Clarification of the biological rationale and hypothesis: The commentary noted an apparent inconsistency between previous literature suggesting increased bone density in cleidocranial dysplasia (CCD) and our hypothesis that palatal bone thickness might be reduced.
Our hypothesis was intentionally conservative, reflecting the multifactorial skeletal abnormalities characteristic of CCD. The RUNX2 gene mutation results in impaired osteoblast differentiation and defective ossification, which can theoretically manifest as either increased density or altered morphology, including reduced cortical thickness in certain regions. Prior literature demonstrates this variability: although jaw bone density may be increased, the pattern is not universally predictable, and palatal morphology specifically has not been quantitatively studied in CCD.
Thus, our hypothesis did not contradict existing knowledge but reflected the uncertainty surrounding palatal bone characteristics in CCD—an area in which published data are extremely limited. Ultimately, we found that palatal thickness was greater in CCD in several regions, and we explicitly acknowledged this in the Discussion section as a meaningful and somewhat unexpected finding.
2. Clarification of the sampling grid description: We appreciate the opportunity to clarify the grid structure. As shown in Figures 3 and 4 and described in the Methods, our measurement grid consisted of anteroposterior positions: 0-24 mm posterior to the incisive foramen at 4 mm intervals and transverse positions: 0, 2, 4, and 6 mm from the midpalatal suture.
This results in a 7 × 7 grid with 49 measurement points, which were subsequently aggregated into 9 zones following the validated Ryu et al classification (midline/medial/lateral × anterior/middle/posterior).
The commentary correctly notes that the sentence “total of 288 mm” may create ambiguity. This refers to the cumulative grid span rather than a surface area.
3. Reliability reporting (intraclass correlation coefficient terminology and model): We acknowledge the terminology correction: “intraclass correlation coefficient” is the correct term.
4. Application and interpretation of Bonferroni-adjusted α: The Bonferroni-adjusted significance threshold of <0.005 was applied consistently across all statistical analyses. As stated in the Statistical analysis section, the adjusted α was derived from 9 regional comparisons, and all determinations of statistical significance were made using this threshold. In Table II and throughout the Results section, P values ≤0.005 were interpreted as statistically significant, whereas values exceeding this threshold were not.
5. Conceptual scope of the study: The commentators suggested that a mixed quantitative-qualitative design might have been appropriate. We agree this could be valuable in future studies; however, our goal—stated explicitly in the Introduction—was to quantitatively evaluate palatal bone thickness using an established measurement grid and to validate an anatomic zone classification. Given the small global prevalence of CCD, our study provides the first quantitative dataset for this specific anatomical region.
We also explicitly addressed limitations, including small sample size, inability to match groups demographically, and the need for additional dimensions of bone quality, such as density, in future research.
We again thank Dr Thangabalu and Dr Geevee for their thoughtful engagement with our work. We believe the clarifications provided above reinforce the validity of our methodology and the relevance of our findings. Our study represents an initial step toward understanding palatal morphology in CCD—a clinically important but understudied population—and we hope it encourages further research in this area.
Reference
Stay updated, free dental videos. Join our Telegram channel
Leave a Reply
VIDEdental - Online dental courses
