Bone quality in relation to skeletal maturation in palatal miniscrews insertion sites

Abstract

This study aimed to investigate the relationship between bone density and quantity at the insertion sites of palatal miniscrews and skeletal maturation-evaluated with the middle phalanx maturation method-in growing patients. Sixty patients were analyzed as having a staged third finger middle phalanx radiograph and a cone-beam computed tomography of the maxilla. On the cone-beam computed tomography, a grid was designed to parallel the midpalatal suture (MPS) and posterior to the nasopalatine foramen, both on the palatal and lower nasal cortical bones. Bone density and thickness were measured at the intersections, and medullary bone density was also calculated. Of patients in MPS stages 1-3, 67.6% showed a mean palatal cortical thickness of<1 mm, whereas in 78.3% of the patients in stages 4 and 5, it was>1 mm. The nasal cortical thickness showed a similar trend (MPS stages 1-3: 62.16%<1 mm; MPS stages 4 and 5: 65.2%>1 mm). There was a significant difference in the density of the palatal cortical bone between MPS stages 1-3 (1272.05 ± 191.13) and stages 4 and 5 (1572.33 ± 274.89) and in nasal cortical density between MPS stages 1-3 (1428.09 ± 198.97) and stages 4 and 5 (1597.97 ± 267.75) (P<0.001). This study revealed a correlation between skeletal maturity and maxillary bone quality. MPS stages 1-3 have lower palatal cortical bone density and thickness but high nasal cortical bone density values. MPS stage 4 and, even more, stage 5 show increasing palatal cortical bone thickness and palatal and nasal cortical bone density values.