Abstract
The palate is an alternative anchoring site for orthodontic implants and screws. The use of osseointegrated implants in the intermaxillary suture has recently been described as a fast, effective, and low-cost technique for patients with atrophy of the maxillae. The aim of this study was to use cone beam computed tomography (CBCT) to evaluate the thickness of the bone surrounding the intermaxillary suture in relation to the insertion of osseointegrated implants. CBCT images of 144 patients (72 males, 72 females) aged 35–86 years were evaluated. The vertical bone height of the intermaxillary suture was measured using coronal and sagittal Images , , 15, 20, and 25 mm posterior to the incisive foramen. The mean bone thicknesses from the anterior to the posterior region were 5.59, .38, .91, .95, and .94 mm, respectively. Bone thickness was significantly different among the five anteroposterior areas of the suture, but there were no significant differences between males and females, or among age groups. The highest part of the intermaxillary suture was in the anterior region. Three-dimensional imaging is recommended to accurately identify palate bone thickness for implant placement.
Implants are often needed to support the anchoring teeth for stationary anchorage in orthodontic treatment. The palate is an alternative anchoring site for orthodontic implants and screws. The use of osseointegrated implants in the intermaxillary suture has recently been described as a fast, effective, and low-cost technique for patients with atrophy of the maxillae.
It is necessary to measure the vertical bone height at the implant insertion site to avoid the risk of perforations. Several studies have assessed palatal bone volume for the placement of implants as part of orthodontic treatment in children, adolescents, and young adults. The present study was performed to evaluate palatal bone thickness in older patients aged 35–86 years using cone beam computed tomography (CBCT).
Materials and methods
This study was approved by the necessary institutional review board. A total of 144 CBCT scans obtained from patients undergoing diagnostic assessments before implant surgery were analysed. Patients were divided into the following four groups according to age: group , 35–44 years; group , 45–54 years; group , 55–64 years; group , ≥65 years. CBCT images from 36 patients (18 males and 18 females) were evaluated in each group. Each patient’s dental condition was recorded as dentate, partially edentulous, or edentulous in the maxillary arch.
The images were taken with a Galileos Comfort Plus CBCT unit (Sirona Dental Systems Inc., Bensheim, Germany). The settings were 98 kV and 15–30 mA, with a field of view of 15 mm × 15 mm. Real-time reconstruction was performed using a Sirona Sidexis XG image viewer, and the acquired image data consisted of 12-bit grey-scale images with a 0.25-mm 3 voxel size. The images were viewed on a RadiForce MX270W 27-inch .7 MP colour LCD monitor (EIZO Corporation, Ishikawa, Japan).
The CBCT evaluation was started in the sagittal plane; the section with the widest nasopalatine canal was analysed first. The section of the coronal plane with the posterior bony border of the incisive foramen was adjusted using the sagittal section as a reference. After the coronal plane was defined, measurements were obtained at 5, , 15, 20, and 25 mm posteriorly. The vertical bone height of the midsagittal suture was measured and recorded according to the coronal sections. The accuracy of the measurements was revised using the reference sagittal plane after obtaining the coronal measurements ( Figs 1 and 2 ). Patients with unsatisfactory CBCT images due to positioning errors, developmental anomalies, syndromes affecting the maxilla (e.g., cleft palate), or pathological conditions affecting the area of interest (e.g., tumours or cysts) were excluded from the study. All measurements were obtained by two examiners.
Intra-class correlation coefficients (ICC) were calculated using a one-way random-effects model to determine the degree of concordance between the two independent observers. The ICCs for the five different measurement regions were estimated to be 0.986, 0.999, 0.943, 0.996, and 0.974, respectively; an ICC of ≥0. was considered satisfactory.
The Shapiro–Wilk test was used to evaluate whether the data followed a normal distribution; normally distributed continuous data were expressed as the mean ± standard deviation (SD). The data were then analysed using a three-way repeated measures analysis of variance (ANOVA), with a Tukey HSD post hoc test also applied. Analyses were performed using IBM SPSS Statistics for Windows version 21.0 software (IBM Corp., Armonk, NY, USA). A P -value of <0.05 was taken to indicate statistical significance.
Results
The mean bone thicknesses from the anterior to the posterior region were 5.59, .38, .91, .95, and .94 mm, respectively. Bone thicknesses 5 mm posterior to the incisive foramen were significantly greater than those at the other locations. No significant differences were observed in the mean bone thicknesses at 15, 20, and 25 mm from the incisive foramen.
Bone thicknesses did not differ significantly between males (4.53 ± 0.17 mm) and females (4.20 ± 0.14 mm), among the different age groups (35–44 years: 3.97 ± 0.21 mm; 45–54 years: 4.75 ± 0.24 mm; 55–64 years: 4.17 ± 0.24 mm; ≥65 years: 4.57 ± 0.17 mm), or by dental condition (dentate: 4.15 ± 0.33 mm; partially edentulous: 4.47 ± 0.10 mm; edentulous: 4.34 ± 0.20 mm) ( P > 0.05) ( Table 1 ). However, there was a significant interaction effect between gender and measurement location.
| Sex ( S ) | Dental condition ( DC ) | Age, years ( A ) | n | Region 1 | Region 2 | Region 3 | Region 4 | Region 5 |
|---|---|---|---|---|---|---|---|---|
| Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | ||||
| Male | Dentate | 35–44 | 3 | 5.89 ± 1.38 | 5.04 ± 0.61 | 4.03 ± 0.63 | 3.75 ± 0.87 | 3.94 ± 0.36 |
| 55–64 | 1 | 4.77 | 4.14 | 3.30 | 4.03 | 3.15 | ||
| Partially edentulous | 35–44 | 15 | 6.30 ± 1.14 | 4.37 ± 1.04 | 3.64 ± 0.79 | 3.49 ± 1.05 | 3.63 ± 0.87 | |
| 45–54 | 16 | 6.53 ± 1.58 | 4.94 ± 1.09 | 4.32 ± 0.86 | 4.12 ± 0.78 | 4.15 ± 0.79 | ||
| 55–64 | 10 | 6.86 ± 1.48 | 4.90 ± 1.66 | 4.22 ± 1.66 | 4.27 ± 1.91 | 4.29 ± 2.07 | ||
| ≥65 | 7 | 6.31 ± 1.40 | 4.92 ± 0.86 | 4.47 ± 1.12 | 4.57 ± 0.68 | 4.61 ± 0.69 | ||
| Edentulous | 45–54 | 2 | 5.68 ± 0.60 | 4.58 ± 0.09 | 4.46 ± 0.09 | 4.27 ± 0.17 | 4.21 ± 0.78 | |
| 55–64 | 7 | 5.36 ± 1.26 | 4.09 ± 1.09 | 3.36 ± 0.93 | 3.19 ± 0.49 | 3.29 ± 0.59 | ||
| ≥65 | 11 | 6.85 ± 2.51 | 5.05 ± 2.01 | 4.15 ± 1.61 | 4.22 ± 1.47 | 4.24 ± 1.41 | ||
| Female | Dentate | 35–44 | 8 | 5.33 ± 1.15 | 3.82 ± 0.99 | 3.39 ± 1.05 | 3.63 ± 0.65 | 4.02 ± 0.21 |
| 45–54 | 3 | 5.13 ± 0.73 | 4.35 ± 0.95 | 4.35 ± 0.89 | 3.55 ± 0.69 | 3.52 ± 0.21 | ||
| Partially edentulous | 35–44 | 8 | 4.51 ± 0.74 | 4.23 ± 0.97 | 3.59 ± 0.79 | 3.79 ± 0.86 | 3.89 ± 1.25 | |
| 45–54 | 13 | 5.09 ± 1.54 | 4.13 ± 1.20 | 4.14 ± 1.42 | 4.15 ± 1.59 | 3.96 ± 1.22 | ||
| 55–64 | 12 | 5.21 ± 1.25 | 4.10 ± 0.95 | 4.10 ± 0.93 | 4.41 ± 1.37 | 4.33 ± 1.40 | ||
| ≥65 | 12 | 5.45 ± 0.87 | 4.12 ± 0.83 | 3.51 ± 1.20 | 3.66 ± 1.14 | 3.65 ± 1.15 | ||
| Edentulous | 35–44 | 2 | 3.96 ± 2.00 | 3.05 ± 1.56 | 2.51 ± 1.11 | 2.44 ± 1.03 | 3.05 ± 0.34 | |
| 45–54 | 2 | 6.93 ± 0.30 | 5.54 ± 0.24 | 5.39 ± 0.20 | 5.85 ± 0.04 | 5.56 ± 0.43 | ||
| 55–64 | 6 | 4.27 ± 1.24 | 3.61 ± 1.17 | 3.67 ± 0.97 | 3.88 ± 1.18 | 3.59 ± 0.70 | ||
| ≥65 | 6 | 5.80 ± 1.41 | 4.33 ± 0.73 | 3.75 ± 0.88 | 3.93 ± 0.96 | 3.95 ± 0.85 | ||
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