Abstract
The aim of this study was to quantify the available maxillary alveolar bone in a group of individuals with Down syndrome (DS) to determine the best areas for orthodontic miniscrew placement. The study group consisted of 40 patients with DS aged 12–30 years. We also selected an age and sex-matched control group. All measurements were performed on cross-sectional images obtained with cone-beam computed tomography. The selected areas of interest were the 4 interradicular spaces between the distal wall of the canine and the mesial wall of the second molar, in both maxillary quadrants. We measured the vestibular-palatine (VP) and mesiodistal (MD) dimensions to depths of 3, 6 and 9 mm from the alveolar ridge. We also measured the bone density in the same interradicular spaces of interest to 6 mm of depth from the alveolar crest. VP measurements were longer in the more posterior sectors and as the distance from the alveolar ridge increased. MD measurements also increased progressively as the distance from the alveolar ridge increased. In general, both the VP and MD measurements in the DS group were similar among the male and female participants. As age increased, the MD distance increased, while the VP distance decreased. The VP distance was ≥6 mm in at least 75% of the DS group in practically all assessed interdental spaces. The MD distance was ≥2 mm in at least 75% of the DS group only between the first and second molar, to 9 mm of depth from the alveolar ridge. The safe area for inserting orthodontic miniscrews in DS patients is restricted to the most posterior and deepest area of the maxillary alveolar bone.
Highlights
Down syndrome (DS), known as trisomy 21, was first described in 1866 by John Langdon Down and represents the most common live-born human aneuploidy
The DS group had a mean age of 17.8 ± 4.0 years, 15 were female, and 25 were male
When studying the influence of sex on the bone density values in the study group, we found no significant differences between the male and female patients, except in the interradicular spaces between the first and second upper right premolar and between the first and second upper right molar, where the bone density was significantly greater in the female patients than in the male patients (Table 7)
Summary
Down syndrome (DS), known as trisomy 21, was first described in 1866 by John Langdon Down and represents the most common live-born human aneuploidy. The demand for orthodontic treatment by this group has grown progressively[2], in many cases its approach can present a considerable challenge for the dental team[3]. Technological advances, such as orthodontic temporary anchorage devices (TAD) that minimize the need for compliance for the success of dental movement techniques, can facilitate treatment in patients with special needs[4]. Their placement causes minimal trauma, and orthodontic traction force can be applied immediately or early compared with dental implants[9]
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