Maxillary Morphology Research Articles

Maxillary Intercanine Width in a South Sumatran Population: Implications for Maxillofacial Reconstruction

Introduction: The maxilla is a crucial bone in the facial skeleton, contributing significantly to both aesthetics and function. Understanding the morphometric variations of the maxilla, particularly the intercanine width (ICW), is vital for successful maxillofacial reconstruction procedures. This study aimed to investigate the ICW in a South Sumatran population, considering its implications for reconstructive surgeries. Methods: This retrospective study analyzed computed tomography (CT) scans of 96 adult patients (60 males, 36 females) from South Sumatra. The ICW was measured using 3D reconstruction software, and the data were analyzed for gender-based differences. The findings were compared with existing literature to understand regional variations in maxillary morphology. Results: The mean ICW for males was 3.58 ± 0.27 cm and for females was 3.44 ± 0.18 cm. Males exhibited a significantly larger ICW than females (p < 0.05). These findings are consistent with previous studies indicating sexual dimorphism in maxillary morphology. Conclusion: This study provides valuable data on maxillary intercanine width in a South Sumatran population. The observed gender-based differences highlight the importance of considering patient demographics in maxillofacial reconstruction. This information can aid surgeons in achieving optimal functional and aesthetic outcomes.

Digital matching of palatal rugae patterns for forensic identification in edentulous denture wearers.

Identifying edentulous victims in forensic contexts poses a significant challenge. It has been reported that having a denture to reproduce and compare Palatal Rugae (PR) patterns is crucial for identifying edentulous individuals, yet there are no validated protocols for conducting this procedure. In this study, a new method was developed and validated for plaster molding of the internal surface of upper dentures, along with a protocol involving focus-stacked photographs and reference scales. Thirty-eight edentulous subjects participated in the study, obtaining plaster models of the patients (PM), and their dentures (AM) were standardized. The AM/PM model was highlighted and photographed with ten shots in different z-focuses for each model, using standard lighting and aligning the position of the PR perpendicular to the photographic axis using tubular spirit levels and modeling clay. The images were processed using the stacking technique and analyzed by three observers through the proposed protocol using Adobe® Photoshop®. The results were analyzed based on the intra-observer and inter-observer agreement levels, with a 95% confidence interval. This study demonstrated high-precision intra-observer and inter-observer agreement (k = 1) in the matching of Palatal Rugae (PR) and maxillary morphology obtained from participants and their dentures. The protocol is simple, cost-effective, and precise. It enables standardization of the technique for obtaining plaster models, and the exposure of PR and photographic protocol minimizes the presence of artifacts in the images, thereby reducing the likelihood of errors and promoting the reproducibility of both the recording technique and the comparison of the PR.

Craniofacial Morphology and Knowledge of the Stability in Class III Malocclusion Growing Subjects

Introduction: to investigate the palatal and craniofacial relationship in Class III growing patients between successful and failed treated groups. Methods: Thirty-one patients treated with RME/FM/BB were enrolled (inclusion criteria: Caucasian ancestry, III Class malocclusion, maturation stage CS1-CS2, mixed dentition). Digital cast and cephalometric analysis were performed on pre-treatment and post-treatment records. Statistical analysis and a discriminant analysis was performed. GMM was used on digital dental casts with Procrustes analysis to assess the covariation between palatal and craniofacial morphology. Two groups (relapse, R, 19 and success S, 12) were identified. Results: R group showed a greater maxillary-anterior transversal width at T0. At T1 R showed a shorter maxillary-anterior length than S. A larger maxillary-anterior and posterior-transversal widths was found in both groups. S had greater maxillary-anterior and posterior-sagittal length. A larger mandibular-anterior and posterior-transversal widths was shown in R, while S showed no differences in mandibula. Maxillary-anterior and maxillary-posterior length were two predictive variables found by discriminant analysis. The PC1 showed significant changes in the palatal morphology and revealed differences for the craniofacial vertical components. Palatal and craniofacial shapes showed a significant covariation, linking the palatal width to skeletal divergence. Discussion: In Class III malocclusion increases in vertical divergence are correlated with a higher palatal vault and narrower width. A wider and shorter maxillary morphology could be a relapse factor for Class III orthopedic treatment, while the lack of mandibular modification could be predisposing for treatment success.

Evaluation of the relationship between maxillary canine impaction with arch dimensions and maxillary sinus dimensions using Cone Beam Computed Tomography (CBCT ).

We aimed to evaluate the morphology of maxilla and sinus dimensions in subjects with unilaterally and bilaterally impacted canine using cone beam computed tomography (CBCT) records. CBCT records taken during 2020-2022 of 120 patients were obtained to investigate the relationship between impacted canine and maxillary morphology as well as sinus dimensions. The CBCT images were then divided into three groups: control, unilaterally canine impaction and bilaterally canine impaction. Then morphology-related variables (arch circumference, arch length, inter molar width, inter first premolar width, palatal depth, anterior posterior dimension of the right and left sinuses, and mediolateral dimension of the right and left sinuses) were analyzed and compared between groups. All measurements were done by Ondeman 3D dental software. Statistical analysis was carried out by SPSS software version 21 using one-way ANOVA. There were meaningful differences in patients with canine impaction compared with control group in arch circumference (P value= 0.004) and arch length (P value= 0.001), inter molar width (P value= 0.001), inter first premolar width (P value= 0.001), mediolateral dimension of the right (P value=0.001) and left (P value= 0.001) sinuses of maxilla. Furthermore, Palatal depth and anterior posterior dimension of the right and left sinuses did not show statistically significant difference between groups. Canine impaction can considerably affect the morphology of maxillary and sinuses dimensions. Nevertheless, future studies are needed to determine the exact structural and molecular effects of the canine impaction on maxillary sinuses and neighboring tissues.

Adaptable cascaded registration for personalized maxilla completion and cleft defect volume estimation.

Cone-beam computed tomography (CBCT) images provide high-resolution insights into the underlying craniofacial anomaly in patients with cleft lip and palate (CLP), requiring non-negligible annotation costs to measure the cleft defect for the guidance of the clinical secondary alveolar bone graft procedures. Considering the cumbersome volumetric image acquisition, there is a lack of paired CLP CBCTs and normal CBCTs for learning-based anatomical structure restoration models. Nowadays, the registration-based method relieves the annotation burden, though one-shot registration and the regular mask are limited to handling fine-grained shape variations and harmony between restored bony tissues and the defectedmaxilla. This study aimed to design and evaluate a novel method for deformable partial registration of the CLP CBCTs and normal CBCTs, enabling personalized maxilla completion and cleft defect volume prediction from CLPCBCTs. We proposed an adaptable deep registration framework for personalized maxilla completion and cleft defect volume prediction from CLP CBCTs. The key ingredient was a cascaded partial registration to exploit the maxillary morphology prior and attribute transfer. Cascaded registration with coarse-to-fine registration fields handled morphological variations of cleft defects and fine-grained maxillary restoration. We designed an adaptable cleft defect mask and volumetric Boolean operators for reliable voxel filling of the defected maxilla. A total of 36 clinically obtained CLP CBCTs were used to train and validate the proposed model, among which 22 CLP CBCTs were used to generate a training dataset with 440 synthetic CBCTs by B-spline deformation-based data augmentation and the remaining for testing. The proposed model was evaluated on maxilla completion and cleft defect volume prediction from clinically obtained unilateral and bilateral CLPCBCTs. Extensive experiments demonstrated the effectiveness of the adaptable cleft defect mask and the cascaded partial registration on maxilla completion and cleft defect volume prediction. The proposed method achieved state-of-the-art performances with the Dice similarity coefficient of 0.90 0.02 on the restored maxilla and 0.84 0.04 on the estimated cleft defect, respectively. The average Hausdorff distance between the estimated cleft defect and the manually annotated ground truth was 0.30 0.08 mm. The relative volume error of the cleft defect was 0.08. The proposed model allowed for the prediction of cleft defect maps that were in line with the ground truth in the challenging unilateral and bilateral CLP CBCTs. The results suggest that the proposed adaptable deep registration model enables patient-specific maxilla completion and automatic annotation of cleft defects, relieving tedious voxel-wise annotation and image acquisitionburdens.

Three-dimensional Analysis of Maxillary Morphology in Infants with Unilateral Cleft Lip and Palate.

To three-dimensionally (3D) analyze the maxillary morphology of infants with unilateral cleft lip and palate (UCLP) and preliminarily classify the alveolar arch to assist in personalization of sequence therapy. Retrospective study. Patients with UCLP referred to outpatients' clinic. 84 nonsyndromic infants with complete UCLP were recruited (58 boys, 26 girls, mean age 29.48 days). Morphometric analysis was conducted on 3D maxillary models. Principal component analysis (PCA) and cluster analysis were combined to classify maxillary phenotypes preliminarily. The Wilcoxon Signed Rank test and the Kruskal-Wallis test were used to compare differences between variables. A P value less than .05 was considered statistically significant. The maxilla was divided into three types: narrow, homogenous and broad, accounting for 9.52%, 23.81% and 66.67% respectively. The alveolar cleft site (median value) was located in 61% of the total length of the alveolar arch. In the comparison of anterior and total alveolar lengths, the non-cleft side had longer alveolar bone than the affected side, a difference of approximately 2 mm. Pairwise comparisons of variables describing alveolar symmetry revealed significant differences in all subjects; whereas type C had poorer arch symmetry than types A and B, mainly in terms of anterior and overall symmetry. In infants with UCLP, the maxillary alveolar arch was inherently asymmetrical with partially bone missing (about 2 mm). Significant differences in alveolar bone morphology and symmetry exist between different types of infants, with individuals with broad clefts (type C, the largest proportion) having the worst maxillary development.

Maxillary morphology of chimpanzees: Captive versus wild environments.

Morphological studies typically avoid using osteological samples that derive from captive animals because it is assumed that their morphology is not representative of wild populations. Rearing environments indeed differ between wild and captive individuals. For example, mechanical properties of the diets provided to captive animals can be drastically different from the food present in their natural habitats, which could impact cranial morphology and dental health. Here, we examine morphological differences in the maxillae of wild versus captive chimpanzees (Pan troglodytes) given the prominence of this species in comparative samples used in human evolution research and the key role of the maxilla in such studies. Size and shape were analysed using three-dimensional geometric morphometric methods based on computed tomography scans of 94 wild and 30 captive specimens. Captive individuals have on average larger and more asymmetrical maxillae than wild chimpanzees, and significant differences are present in their maxillary shapes. A large proportion of these shape differences are attributable to static allometry, but wild and captive specimens still differ significantly from each other after allometric size adjustment of the shape data. Levels of shape variation are higher in the captive group, while the degree of size variation is likely similar in our two samples. Results are discussed in the context of ontogenetic growth trajectories, changes in dietary texture, an altered social environment, and generational differences. Additionally, sample simulations show that size and shape differences between chimpanzees and bonobos (Pan paniscus) are exaggerated when part of the wild sample is replaced with captive chimpanzees. Overall, this study confirms that maxillae of captive chimpanzees should not be included in morphological or taxonomic analyses when the objective is to characterise the species.

The Effect of Cleft Width on Maxillary Morphology in Newborn with Unilateral Cleft Lip and Palate

Objective: This study aims to investigate the impact of cleft width on maxillary morphology in newborns with unilateral cleft lip and palate (UCLP). Materials and Methods: Plaster models from 35 newborns with unilateral cleft lip and palate (UCLP) (17 boys, 18 girls) and 35 newborns with isolated soft palate cleft (CP) (16 boys, 19 girls) were examined. The measured parameters included C-C' , T-T', arch circumference, arch length, G-L, a-a', and b-b'. Statistical analyses were conducted using an independent samples t-test and Mann–Whitney U test for normally and non-normally distributed data, respectively. Pearson Correlation assessed the correlation between G-L and other measurements. The analysis was performed at a significance level of 0.05 using R software, version 4.0.5. Results: Statistically significant differences were found in C-C' (p < 0.001) and T-T' (p < 0.05) between the two groups. UCLP newborns showed a significant increase in arch length (28.4 ± 2.9 mm) compared to CP (25.0 ± 2.6 mm, p < 0.001). Both (a-a') and (b-b') demonstrated a significant increase in UCLP (p < 0.001). A significant correlation was observed between (G-L) and (C-C') and (a-a') (p < 0.01), and between (T-T') and (a-a') and (b-b') (p < 0.01). The correlation between arch circumference and (b-b') was significant at the 0.05 level. Conclusion: In UCLP newborns with increased anterior cleft width, the anterior alveolar arch width increases, affecting maxillary morphology. While early orthopedic and surgical interventions prove effective in managing severe clefts, the initial severity of the cleft width significantly influences dental arch relationships and treatment outcomes. Consequently, initiating maxillary expansion and protraction interventions during the early primary dentition period becomes crucial.

OPG gene-modified adipose-derived stem cells improve bone formation around implants in osteoporotic rat maxillae

BackgroundOsteoporosis is a significant barrier to the use of dental implants in the elderly for the treatment of tooth defects. Adipose derived stem cells (ADSCs) have demonstrated extensive potential for tissue repair and regeneration. The present study aimed to investigate the effectiveness of ADSCs engineered to express high levels of osteoprotegerin (OPG) for the treatment of bone loss in implant dentistry caused by estrogen deficiency. MethodsA rat model of osteoporosis was established through double oophorectomy, and the rats were treated by gene modified cells Adv-OPG-ADSCs. The effects of the treatment on maxilla tissue changes were evaluated using HE staining and micro-CT. Additionally, ALP and TRAP staining were used to assess osteoblast and osteoclast alterations. Finally, the changes in related osteoblast and osteoclast indicators were measured by RT-qPCR, Western blot, and ELISA. ResultsThe successfully generated high-OPG-expressing ADSCs led to increase of cell viability, proliferation, and osteoblast differentiation. Treatment with Adv-OPG-ADSCs significantly ameliorated maxillary morphology, trabecular volume reduction, and bone mineral density decline in the model of estrogen-deficient maxillary implant dentistry. Furthermore, the treatment was beneficial to promoting the generation of osteoblasts and inhibiting the generation of osteoclast. Adv-OPG-ADSCs increased OPG, ALP, OCN, and Runx-2 expressions in the maxilla while suppressing RANKL expression, and also increased the concentration of COL I and PINP, as well as decreased the concentration of CTX-1. ConclusionAdv-OPG-ADSCs promote the formation of osteoblasts and inhibit the generation of osteoclasts, thereby inhibiting bone absorption, facilitating bone formation, and promoting the repair of maxillary bone after dental implantation in the presence of osteoporosis-related complications, especially in the setting of estrogen deficiency, providing scientific basis for the application of Adv-OPG-ADSCs in the treatment of implant related osteoporosis.

Comparative Analysis of Skeletal Changes, Occlusal Changes, and Palatal Morphology in Children with Mild Class III Malocclusion Treated with Elastodontic Appliances and Bimaxillary Plates.

The aim of the present study was to compare the changes observed in children after the early treatment of mild class III malocclusion using bimaxillary removable plates supported by class III elastics and elastodontic devices. Twenty children (mean age 7.6 ± 1.1 years) with signs of class III malocclusion were treated using by-maxillary plates (PG group) with class III elastics (10 subjects = mean age 7.9 ± 1.3 years) or using class III elastodontic devices (EG group) (10 subjects = mean age 7.4 ± 0.8 years). Digital models and lateral cephalograms were obtained before treatment (T0) and at the end of treatment (T1). The digital models were analyzed to assess occlusal changes and maxillary morphology using the surface-to-surface matching technique. Changes in cephalometric parameters were also analyzed. The data outcomes were statistically analyzed using the paired Student's t test for inter-timing assessments and the independent Student's t test for inter-group assessments. Both groups showed correction of class III malocclusions, with a significant increase in the ANB angle and the overjet (p < 0.05). Subjects in the PG group exhibited a greater reduction in the inter-incisal angle compared to the EG group (p < 0.05). The children in the EG group had a significantly lower percentage of palatal morphology matching between T0 and T1 compared to the PG group (p < 0.05), suggesting greater morphological changes in the palate. Elastodontic appliances (EAs) and bi-maxillary plates successfully correct class III malocclusions in children. However, elastodontic devices significantly improved the morphology of the palate, both in the transverse and anteroposterior directions.

What changes in maxillary morphology from distraction osteogenesis maxillary expansion (DOME) correlate with subjective and objective OSA measures?

To correlate skeletal and airway measures on imaging with polysomnographic and self-reported measures after distraction osteogenesis maxillary expansion (DOME), in the effort to identify clinically relevant sites of expansion to guide treatment for adult patients withobstructive sleep apnea(OSA). This is a retrospective study reviewing subjects who underwent DOME and had the complete set of the following data: peri-treatment cone-beam computed tomography (CBCT) scans, polysomnography (PSG), Epworth Sleepiness Scale (ESS), and nasal obstruction symptom (NOSE) scores. Of 132 subjects who underwent DOME, 35 met inclusion criteria (71% men, mean age 27.7 ± 6.5years, mean BMI 26.0 ± 6.4kg/m2)and were enrolled in the study.There was a significant reduction in the NOSE score from 11.4 ± 5.5 to 3.6 ± 3.1, in the ESS score from 12.0 ± 4.6 to 7.1 ± 4.7, and in the apnea-hypopnea index (AHI) from 17.1 ± 15.8 to 7.01 ± 6.2 (p < 0.0001), after DOME. Nasal floor width at the nasopalatine canal level showed a statistically significant correlation with AHI reduction (p < .0001). DOME is significantly associated with reduction of nasal obstruction, sleepiness, and severity of OSA. The findings suggest that expansion at the anterior third of the bony nasal passage, specifically where the nasopalatine canal is located predicts its clinical efficacy. This site may be a useful target anatomically via imaging.

Maxillary lateral incisor agenesis is associated with maxillary form: a geometric morphometric analysis

Background and objectiveAgenesis of the maxillary lateral incisor occurs in up to 4% of all individuals and requires multidisciplinary treatment. Its developmental origins, however, are not fully understood. Earlier studies documented genetic factors contributing to agenesis but also an association with craniofacial morphology. In this study, we assessed the association between maxillary morphology and lateral incisor agenesis by a geometric morphometric approach to disentangle the roles of developmental plasticity and genetic factors.Materials and methodsWe quantified the maxillary alveolar ridge by 19 two-dimensional landmarks on cross-sectional images of 101 computed tomography scans. We compared the shape and size of the alveolar ridge across patients with unilateral or bilateral agenesis of maxillary lateral incisors and patients with extracted or in situ incisors.ResultsThe maxillary alveolar ridge was clearly narrower in patients with agenesis or an extracted incisor compared to the control group, whereas the contralateral side of the unilateral agenesis had an intermediate width. Despite massive individual variation, the ventral curvature of the alveolar ridge was, on average, more pronounced in the bilateral agenesis group compared to unilateral agenesis and tooth extraction.ConclusionsThis suggests that pleiotropic genetic and epigenetic factors influence both tooth development and cranial growth, but an inappropriately sized or shaped alveolar process may also inhibit normal formation or development of the tooth bud, thus leading to dental agenesis.Clinical relevanceOur results indicate that bilateral agenesis of the lateral incisor tends to be associated with a higher need of bone augmentation prior to implant placement than unilateral agenesis.

Observation of Palatal Wound Healing Process Following Various Degrees of Mucoperiosteal and Bone Trauma in a Young Rat Model.

Simple SummaryThe exact correlation of palatal trauma to maxillary inhibition has not been demonstrated. This paper determines the influence of different degrees of palatal trauma on maxillofacial growth and assesses whether usage of ADM can help rescue the inhibited growth during palatal wound healing. This research would help the surgeons comprehensively understand the impact of palatal trauma on maxillary growth and the therapeutic effect of the ADM.The accidental injury or surgery on soft and hard palatal tissue has an adverse impact on normal maxillary morphology. To design a single-factor experiment that excludes other interfering factors on maxillary growth, a young rat model was established to simulate the various degrees of palatal trauma. Eight maxillary parameters were measured to evaluate the impact of palatal trauma on maxillary growth. Furthermore, the acellular dermal matrix (ADM) was applied to cure the palatal trauma and alleviate the adverse impact of bone denudation on the maxillary growth. Micro-CT scanning and histology analyses were used. One-way ANOVA with least significant difference (LSD) post-test was used to evaluate the statistical significance. The palatal trauma mainly disturbed the transverse development of the maxilla. ADM promotes mucosa healing, but there is still an inhibitory effect on maxillofacial growth.

Assessment of Dentofacial Characteristics in Individuals with Different Midfacial Skeletal Morphologies

Abstract Introduction An orthodontist's primary objective is to diagnose and describe the characteristics of any particular malocclusion. It has been reported that when the anteroposterior dimension of the maxilla is either reduced or increased, the measured dentoalveolar and skeletal parameters gets affected in other dimensions also. Aim This study aims to assess and compare the dentofacial characteristics in individuals with different skeletal morphology (normal, retrognathic, and prognathic maxilla). Materials and Methods A total of 194 individuals in the age group of 18 to 32 years were grouped as group I (34 males, 33 females) with normal maxilla, group II (30 males, 32 females) with retrognathic maxilla, and group III (34 males, 31 females) with prognathic maxilla. The measurements of N-A and anterior nasal spine to posterior nasal spine were the basis for selecting the individuals. The dentoalveolar characteristics were assessed using 17 lateral cephalometric and 08 posteroanterior (P-A) cephalometric parameters. Results The data of the study when analyzed statistically using sample “t” test (p &lt; 0.05), revealed significant differences between the genders within the groups. All 08 characteristics measured in the P-A cephalogram showed had significant differences. Pairwise comparison between the groups was performed using the Tukey post hoc test (p &lt; 0.05) and significant differences in various dentoalveolar characteristics were observed between the groups. Conclusion Dentoalveolar and facial parameters showed a significant degree of sexual dimorphism associated with maxillary morphology in all three groups of individuals. The majority of the parameters showed male dominance, and the differences were statistically significant. Statistically significant differences were observed in dentofacial characteristics in individuals with different skeletal morphologies

Morphological variation of the maxilla in modern humans and African apes

Differences in morphology among modern humans and African apes are frequently used when assessing whether hominin fossils should be attributed to a single species or represent evidence for taxic diversity. A good understanding of the degree and structure of the intergeneric, interspecific, and intraspecific variation, including aspects such as sexual dimorphism and age, are key in this context. Here we explore the variation and differences shown by the maxilla of extant hominines, as maxillary morphology is central in the diagnosis of several hominin taxa. Our sample includes adults of all currently recognized hominine species and subspecies, with a balanced species sex ratio. In addition, we compared the adults with a small sample of late juveniles. The morphology of the maxillae was captured using three-dimensional landmarks, and the size and shape were analyzed using geometric morphometric methods. Key observations are that 1) the maxillae of all extant hominine species and subspecies show statistically significant differences, but complete separation in shape is only seen at the genus level; 2) the degree of variation is not consistent between genera, with subspecies of Gorilla being more different from each other than are species of Pan; 3) the pattern of sexual shape dimorphism is different in Pan, Gorilla, and Homo, often showing opposite trends; and 4) differentiation between maxillary shapes is increased after adjustment for static intraspecific allometry. These results provide a taxonomically up-to-date comparative morphological framework to help interpret the hominin fossil record, and we discuss the practical implications in that context.

Effectiveness of pre-surgical orthopedics on patients with cleft lip and palate: A systematic review and meta-analysis

ObjectiveEvaluate the effectiveness of pre-surgical orthopedics (PSO) in patients with cleft lip palate (CLP) in maxillary morphology (MM), facial growth and development (FGD), occlusal alterations (OA), parental satisfaction (PS), and side effects. DesignSystematic review and meta-analysis of randomized and controlled clinical trials. Searches was performed in CENTRAL, MEDLINE, and EMBASE. ResultsFrom the eight studies included, three are randomized clinical trials, and five clinical trials are controlled. MM was evaluated by the intercanine width (Mean difference (MD) =1.44; CI95%= -0.30, 3.19; very low certainty), anteroposterior length (MD=1.32; CI95%= -0.59, 3.24; very low certainty) and intertuberocity width (MD=0.09; CI95%= -0.68, 0.49; certainty: very low). FGD was evaluated by SNA angle (MD: 1.29; P = 0.306; moderate certainty), SNB angle (MD: -0.79; P = 0.550; moderate certainty) and ANB angle (MD: 1; P = 0.362; moderate certainty). OA was evaluated by 5-years-old-index (MD= -0.09; P = 0.49; moderate certainty) and by Huddart score (MD=0.51; P = 0.736; moderate certainty). A valid questionnaire assessed PS only in one study (MD= -0.1; P = 0.199; moderate certainty). No studies reported side effects. ConclusionDue to the uncertainty of the effect of PSO on MM and the lack of clinically relevant effect on FGD, OA, or PS, it is not reasonable to include this intervention as a treatment until future studies clarify its effect.

Simultaneous Closure of the Cleft Alveolus and Hard Palate with Concomitant Bone Grafting

Summary:Cleft repair has been in constant evolution since its inception. Conventional repair of the cleft hard palate involves closure of nasal and oral mucosa without bony reconstitution. In many instances, this approach is adequate, but, particularly in complete clefts, the lack of bony support can lead to collapse of the maxillary arch, dental crowding, and posterior cross-bite. To address these shortcomings, our institution performs a two-staged palatoplasty with concomitant bone grafting of the alveolus and hard palate in the second stage. A retrospective review of children who underwent a two-staged palatoplasty at our institution was performed. These patients’ records and images were reviewed for complications and changes in maxillary morphology. Fourteen patients with complete clefts had a two-staged palatoplasty with bone grafting in the second stage. The mean age at surgery was 37.5 months, and the mean follow-up was 16 months. One patient had resorption of the alveolar bone graft requiring additional bone grafting. The remaining patients were without complications and had good consolidation of the bone graft on follow-up imaging. Our early results support that there is a low complication rate (7% regrafting) in those patients who underwent bone grafting at the time of cleft palate repair with early evidence of bony consolidation on imaging and clinical examination. Wide exposure during the repair allows complete grafting of the maxillary bony deficit, which is not possible with traditional alveolar cleft repair and may alleviate the shortcoming of soft-tissue closure only. Future study is necessary to determine long-term outcomes.

Evaluation of Maxillary Alveolar Ridge Morphology and Residual Bone for Implant Placement by Cone Beam Computed Tomography (CBCT)

The aim of this study was to assess the morphology and dimension of maxillary alveolar ridge at anterior and posterior regions using cone beam computed tomography (CBCT) prior to the placement of immediate implants. CBCT scans of 192 patients were evaluated. Measurements were taken at the cross sectional views in the maxillary central incisor, lateral incisor, canine incisor, first and second premolars and first and second molars regions. Alveolar ridge width and height, buccal plate thickness, buccal undercut, inter-root septum height, and root penetration to sinus floor were measured. Independent T-test was used for statistical analysis. The mean value of alveolar height in the maxillary incisors were higher than the posterior teeth with central incisors having the highest value of 19.23 ± 8.74 mm. At anterior maxilla, the lateral incisor with the mean value of 1.07 ± 0.64 mm exhibits the highest buccal undercut and the thinnest ridge width. At the site of posterior regions premolars had higher buccal undercut than molars. Canine with the mean value of 0.19 ± 0.31 mm thickness at the mid-alveolar of buccal plate, had the thinnest plate among other maxillary incisors. Sinus penetration and inter-root septum height were higher in premolar teeth than molars. The mean value of ridge width at all levels was significantly different between men and women, except at the level of crest in central incisor. CBCT evaluation presents accurate measurements for ridge assessment prior to immediate implant insertion. The recommended appropriate size of implant platform would be 5 mm in the incisor and almost 6 mm in premolar region.

Evolution of humans in view of maxillary canine morphology

Evolution of humans in view of maxillary canine morphology

Variations in Maxillary Frenal Morphology in a Sample of Newari Children of Bhaktapur

Introduction: Frenum attachments are fold of mucous membrane attaching the lips to alveolar mucosa and underlying periosteum. Aberrant location of attachment of maxillary labial frenum poses many clinical problems such as mucogingival problems and midline diastema.&#x0D; Objective: The study was performed to assess the variations in morphology of maxillary labial frenum in a sample of Newari children of Bhaktapur, Nepal.&#x0D; Methods: A descriptive cross-sectional study was performed enrolling 340 Newari children residing in Bhaktapur from August 14, 2020 to March 30, 2021. The study comprised both genders within age group of 6 to 16 years. The frenal attachment was recorded according to Mirko and Sewerin classification. The data was analysed with Statistical Package for the Social Sciences version 16 using descriptive statistics.&#x0D; Results: In total, 340 Newari children participated in this study. The mucosal type was observed in 204 (60%) of the participants followed by gingival type 101 (29.7%). More than 80% of the participants had simple frenum (283, 83.2%). The frenum with nodule was present in 25 (7.4%) and frenum with appendix in 22 (6.5%) of study participants. Frenum with appendix was mostly present in males 18 (10.1%) than females 4 (2.5%).&#x0D; Conclusion: Within the Newari children, the mucosal type of maxillary labial frenum was more prevalent followed by gingival type. The simple frenum was the most common type on basis of morphology.