Abstract
BackgroundOrthodontic implants have found widespread use as means of maximum skeletal anchorage in fixed orthodontic treatment, their optimal insertion location in the hard palate, however, is still controversial. The aim of this study was therefore to assess mean bone height across the hard palate and possible age- and sex related differences to identify the most favourable location according to maximum bone height, optimizing primary stability and survival of inserted orthodontic implants.MethodsIn this retrospective cross-sectional study, maxillary pretreatment CBCT scans of 180 healthy orthodontic patients (95♀, 85♂, age 8–40 years) were analysed with regard to vertical palatal bone height in the midpalatal area at 88 validated points distanced 2 mm from each other forming a grid of 0–14 mm posterior to the incisive foramen and 10 mm lateral of the midpalatal suture. Differences in bone height regarding sex and topographical location were assessed by three-way ANOVA.ResultsIn general, the midpalatal suture as well as the anterior-lateral palatal region showed distinctly higher mean palatal bone height with its maximum 4 mm posterior of the incisive foramen, whereas bone height was limited at the posterior region of the midpalatal suture. Women generally had significantly decreased palatal bone height compared to men at all measurement points. Higher age was associated with a decrease of bone height in the anterior and posterior lateral palatal region and the median palatal raphe with significant age differences.ConclusionsThe midpalatal suture as well as the anterior lateral palate seem to be most suitable for the insertion of orthodontic implants. Palatal bone height, however, was found to be sex- and age-specific, thus sex- and age-related differences should be taken into account, particularly regarding implant length. The ideal insertion site in the palate with sufficient bone height for orthodontic implants is 0-8 mm (men) or 0-6 mm (women) posterior to the incisive foramen and 10 mm lateral to the midpalatal suture.Trial registraionThis study has been registered and approved by the Ethics Committee of the University of Witten/Herdecke, Germany (12/2016).
Highlights
The development and clinical usage of orthodontic implants (OI) as means of skeletal orthodontic anchorage has had a major impact on orthodontic therapy and extended the scope of treatment possibilities [26]
Maximum bone height was found in the area of the midpalatal suture as well as in the anterior part of the palatal bone with the maximum at P28 (M3, R0L0, M ± standard deviations (SD) 9.7 mm ± 2.8 mm)
When examining the measuring points in sagittal direction, a decrease in vertical bone height was apparent from anterior (M3) to posterior (M8) direction
Summary
The development and clinical usage of orthodontic implants (OI) as means of (maximum) skeletal orthodontic anchorage has had a major impact on orthodontic therapy and extended the scope of treatment possibilities [26]. Various recommendations for the optimal implant location in the maxilla exist [33], the palate is generally considered to be ideal for OI insertion being far from the roots of the teeth, rich with attached gingiva, functionally stable without ample deformation or muscular strain and allowing easy access and topography for OI insertion [19] with orthodontic success rates exceeding 90% [30]. Orthodontic implants have found widespread use as means of maximum skeletal anchorage in fixed orthodontic treatment, their optimal insertion location in the hard palate, is still controversial. The aim of this study was to assess mean bone height across the hard palate and possible age- and sex related differences to identify the most favourable location according to maximum bone height, optimizing primary stability and survival of inserted orthodontic implants
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