Palatal Region Research Articles

Assessment of rugaoscopic pattern to compare with gender identifi cation in Andhra Pradesh population: An institutional study

Background: Palatal rugae are anatomically asymmetrical and irregular ridges in the anterior palatal region. The palatal ruages were demonstrated to be useful in the field of forensic dentistry. This study was taken to assess the ruage patter to compare with gender identification in those who had attended dental institutions in Andhra Pradesh. Materials and Methods: A total of 40 subjects were included in the present study, those who attended a dental institution as a prospective cross sectional study. The rugae patterns were marked and classified according to Kapali et al., 1997, based on morphological pattern. Results: Female participants were more numerous in study samples when compared with males. The palatal ruage in female participants showed a higher incidence of wavy, circular, and divergent patterns, while male participants showed straight, curved, wavy, and convergent rugae patterns. Comparison of gender with respect to the mean number of rugae patterns on the right and left sides using a student t-test revealed that there was no stastically significant (p≥0.05). Conclusion: The rugae pattern can be one of the important aspects in the field of forensic odontology. The palate represents a suitable landmark for unique and identifying features, with the additional benefit of survival in most post-mortem events that can disrupt or change other body parts. Key word: Gender identification, Identification, Palatal rugae, Palatoscopy

Speech and swallowing function following microsurgical reconstruction of palatal defects in a series of six pediatric patients.

Reconstruction of extensive palatal defects in growing patients aims to restore speech intelligibility and swallowing function while avoiding excessive scarring formation that may cause growth disturbances in the palate and midface region. Free flaps transfer healthy, well-vascularized tissue to the defect area, and their combination with pharyngeal flaps allow for restoration of the velopharyngeal function. We examined speech and swallowing after microsurgical palate reconstruction in a series of six pediatric patients. Radial forearm free flaps were used in all cases, in combination with a superiorly based pharyngeal flap in five cases. Mean age at surgery was 10.7 years. Etiologies included recurrent oronasal fistula due to failed primary cleft palate repair (n=4), embryonal rhabdomyosarcoma of the maxilla (n=1), and inflammatory fibrous hyperplasia (n=1). Speech evaluations (with the Hirose standard and listener ratings) and swallowing assessments (based on videofluoroscopy swallowing studies and patient-reported swallowing and diet) were performed in average 44 months postoperatively. All flaps survived without major postoperative complications. Speech intelligibility was graded as "excellent" in four patients and "moderate" in two. Hypernasality and nasal obstruction were each judged as "none/minimal" in five cases and "moderate" in one case. All patients tolerated oral diet without significant nasal regurgitation. In five of six patients, the swallowing assessment showed good motion and velopharyngeal closure. Microsurgical reconstruction of extensive palatal defects using radial forearm free flap, with or without a superiorly based pharyngeal flap, is a reliable technique that can deliver substantial improvement of speech and swallowing in pediatric patients.

Eosinophilic granuloma with metachronous actinomycosis – A case report with literature review

Eosinophilic granuloma (EG) is a type of histiocytosis X with uncertain etiology. The lesion manifests as single or multiple areas of bone destruction with mild-to-severe pain or may be asymptomatic in some cases. In this article, a case of EG with actinomycosis is reported which occurred in an 11-year-old male in the left buccal vestibule extending from 22 to 24. Histopathologically, it showed dense, cellular infiltrate in the connective tissue composed of abundant eosinophils intermixed with atypical cells. After 4 months, the same patient reported with a recurrence in the palatal region. Histopathologically, the section showed some colonies of actinomycosis along with the features of EG. EG with metachronous actinomycosis is very rare in the literature. This article reports a new case of EG with actinomycosis and reviews previously reported cases of actinomycosis associated with other lesions.

Correlation between cortical bone thickness at mini-implant insertion sites and age of patient.

ABSTRACTIntroduction: Orthodontic mini-implants (MI) are a reliable alternative to provide temporary orthodontic anchorage. Prior to miniscrew insertion, the best approach would be to evaluate each possible insertion site and measure the cortical bone thickness, and verify whether it would provide adequate primary stability. Objective: This study aimed to evaluate the difference in cortical bone thickness in areas of mini-implants insertion in patients of different ages, by means of cone beam computed tomography (CBCT). Methods: The sample of this retrospective study was composed of 123 CBCT scans, which were used to measure cortical bone thickness in the buccal and palatal inter-radicular space in the mesial region of the first permanent molars. These measures were compared by using the Student’s t-test, ANOVA/Tukey tests, and Linear regression between male and female subjects, from 12 to 30 years old. Results: No significant difference was found in cortical bone thickness between sex, race and sagittal facial patterns. Significantly higher measurement values were observed in patients older than 12 years of age at all sites evaluated. The coefficient β at the adjusted linear regression analysis showed that at each increment in age, mean cortical thickness values increased by 0.06mm in the mandible, 0.03mm in the buccal region and 0.02mm in the palatal region of the maxilla. Conclusions: The increase in cortical bone thickness was positively associated with age; that is, the more advanced the patient’s age was, the less chance there was of failure due to primary stability.

Split Buccal Fat Flap in Modified Furlow Palatoplasty: Surgical Technique and Early Result.

Encouraging results have been described for the use of pedicled buccal fat pad flap in primary cleft palate repair. This retrospective study describes the surgical technique and early results of a technical innovation utilizing the split buccal fat flaps in modified Furlow palatoplasty with small double-opposing Z-plasty. This technique introduces buccal fat tissue for coverage of lateral denuded palate surfaces to reduce the bone exposure and scar formation to potentially attenuate maxillary growth interference and for reinforcement of the palatal areas of high tension or with incomplete closure to decrease the risk of postoperative dehiscence and oronasal fistula formation. Consecutive nonsyndromic patients (n = 56) with cleft palate were treated with this method, all of whom demonstrated fast mucosalization of lateral palatal recipient regions within 3 weeks postoperatively and showed no fistula with 12 months' follow-up. Of 19 patients (33.9 percent) who underwent auditory-perceptual assessment, 15 (78.9 percent) had normal resonance. Surgeons could add this alternative surgical maneuver to their armamentarium during the primary palatoplasty, in which coverage of lateral surfaces and reinforcement with fat tissue in the anterior soft palate space are of paramount relevance. Therapeutic, IV.

Palatal mucosa thickness and palatal neurovascular bundle position evaluation by cone-beam computed tomography-retrospective study on relationships with palatal vault anatomy.

BackgroundMeasuring the thickness of the palatal mucosa at the planning of the surgical procedure is an important step in order to obtain the maximum width and thickness of the graft from the appropriate area. The aim of this study is to determine whether there is a relationship between palatal angle (PA) or palatal depth (PD) and palatal mucosa thickness (PMT) or palatal neurovascular bundle distance (PNBD).MethodsPMT, PNBD, PD and PA were measured on cone-beam computed tomography (CBCT) images of maxillary posterior region of 200 male and 200 female patients. The mean of all parameters according to gender was compared and the significance of the difference detected between groups was evaluated. Potential relationship between PMT or PNBD and PA or PD was also evaluated.ResultsIn females, the palatal mucosa was significantly thinner at all tooth regions (p < 0.005), and PNBD was lower only at the level of the second molar (p < 0.001). In addition, it was found that there was a significant inverse correlation between the palatal depth value and the palatal mucosal thickness, and palatal depth was correlated with the palatal neurovascular bundle distance (p ≤ 0.001).DiscussionConsistent with previous studies, it was observed that the thickest mucosa in the palatal region was located in the region of the premolar teeth, and women had thinner palatal mucosa. In addition, in patients with a deeper palate vault, the palatal mucosa was thinner, but the palatal neurovascular bundle was more distant from the cemento-enamel junction.

The remarkable dynamics in the establishment, rearrangement, and loss of dentition during the ontogeny of the sterlet sturgeon.

Sturgeons belong to an early-branching lineage often used as a proxy of ancestor-like traits of ray-finned fishes. However, many features of this lineage, such as the transitory presence and the eventual loss of dentition, exemplify specializations that, in fact, provide important information on lineage-specific evolutionary dynamics. Here, we introduce a detailed overview of the dentition during the development of the sterlet sturgeon. The dentition is composed of tooth fields at oral, palatal, and anterior pharyngeal regions. Oral fields are single-rowed, non-renewed and are shed early. Palatal and pharyngeal fields are multi-rowed and renewed from the adjacent superficial epithelium without the presence of the successional dental lamina. The early loss of oral fields and subsequent establishment of palatal and pharyngeal fields leads to a translocation of the functional dentition from the front to the rear of the oropharyngeal cavity until the eventual loss of all teeth. Our survey shows the sterlet dentition as a dynamic organ system displaying differential composition at different time points in the lifetime of this fish. These dynamics represent a conspicuous feature of sturgeons, unparalleled among extant vertebrates, and appropriate to scrutinize developmental and evolutionary underpinnings of vertebrate odontogenesis.

Gingival hyperplasia treatment using diode laser gingivectomy in a child with cerebral palsy: case report

Gingival hyperplasia is associated with several factors, such as chronic inflammation due to the large accumulation of biofilm and medications including anticonvulsants. The aim of this study is to report a clinical case of a 4-year-old spastic quadriplegic cerebral palsy patient with gingival hyperplasia in the palatal region of the upper teeth induced by the use of high doses of anticonvulsant medications. The patient attended the Dental Assistance Center for People with Disabilities, with fibrotic gingival hyperplasia in the upper posterior region, covering the dental crowns on the palatal and occlusal surfaces. Oral hygiene instructions were previously carried out using chlorhexidine gluconate solution (0.12%) on the teeth with the aid of a cotton swab, twice a day for seven days, to reduce bacterial plaque levels and control periodontal inflammation. Gingivectomy was performed using a gallium aluminum arsenide diode laser (GaAlAs; 808±10 nm, 2.5 W output power, continuous mode). Following the surgical procedures, photobiomodulation therapy was performed with a low-level aluminum gallium indium phosphide diode laser (InGaAlP; 660±10 nm, 100 mW, 3 J) at three points (anterior, middle and posterior region of surgical wound). The patient returned at 7 and 30 days after surgery presenting accelerated wound healing. It was concluded that the high-level diode laser associated with photobiomodulation therapy were effective for performing a conservative and safe procedure in a patient with severe neurological disorder.

Optimization of Loading Condition for Maxillary Molar Intrusion with Midpalatal Miniscrews by Using Finite Element Analysis

An anterior open bite is one of the most difficult malocclusions in orthodontic treatment. For such malocclusion, orthodontic miniscrew insertion into both buccal and palatal alveolar regions has been indicated for molar intrusion, but it involves a risk of tooth root injury. To solve the problem, a midpalatal miniscrew-attached extension arm (MMEA) is adopted. However, this method causes palatal tipping of the molar because intrusive loads were applied only from the palatal side. Currently, a transpalatal arch is added to avoi0d tipping movement, but it induces the patient’s discomfort. Hence, the objective of this study was to evaluate the loading conditions for maxillary molar intrusion without tipping movement, only by MMEA through finite element (FE) analysis. FE models of maxillary right first molar and surrounding tissues were created. Three hook positions of MMEA were set at 6.0 mm perpendicular intervals in the occluso-apical direction along the mucosal contour. An intrusive unit load was applied from the palatal side of the molar, and various counter loads were applied from the buccal side. An optimal counter load for molar intrusion without palatal tipping was observed in each hook position. In conclusion, an ideal maxillary molar intrusion can be achieved only by MMEA with an optimal counter load.

Necrotic lesion in the palate

A 38-year-old female patient was referred to our department of oral pathology with a chief complaint of a painless and nonhealing “hole in her palate” with an evolution time of 30 days. Clinical examination revealed an area of necrosis affecting the left posterior region of the hard palate (Figure 1), and imaging examinations demonstrated no sign of oronasal communication. No palpable cervical lymph node was found. The patient reported a 3-year history of cigarette smoking, approximately 40 cigarettes per day, and she presented with a nonproductive cough lasting for 6 months, considered a complication of the smoking habit.

Revised Description of the Early Permian Recumbirostran “Microsaur” Nannaroter mckinziei Based on New Fossil Material and Computed Tomographic Data

The early Permian Richards Spur locality of Oklahoma has produced abundant material of numerous terrestrial fossil tetrapods, including various “microsaurs,” several of which are considered to belong to the clade Recumbirostra. We present a new partial skull of the recumbirostran “microsaur”Nannaroter mckinziei; through computed tomography (CT) analysis of both this new specimen and the holotype, we provide an updated description of the taxon. This new description provides novel information regarding several regions that could not be examined previously due to either being absent in the holotype or difficult to access. This includes missing and obscured aspects of the skull roof, braincase, lower jaw, and the palatal region. Furthermore, the new information obtained from this description was used to update phylogenetic character codings ofNannaroter, and a revised phylogenetic analysis was conducted. The results of this updated analysis are congruent with those of other recent phylogenetic analyses of recumbirostran “microsaurs.” This new information adds to the ever-growing body of early tetrapod CT data, which has been, and will continue to be, important in revealing details regarding early tetrapod anatomy, interrelationships, paleoecology, and evolution.

Pleomorphic adenoma of the palate

A woman 43 years, presented with 9 years history of a painless swelling in the palatal region, slow-growing. Her medical history was not significant. On intraoral examination, a median ovoid mass measuring 4 cm diameter was found at the junction of hard and soft palate. The mass was firm, with smooth surface. No radiographic evidence of bone involvement was seen on the CT scan (Figure A). Surgical excision under general anesthesia: excision of the mass was carried out, the overlying mucosa was healthy, so conserved (Figure B,C&amp;D). Histopathologic report confirmed the lesion to be “pleomorphic adenoma”. The lesion has not recurred after four years follow-up.

PEDIATRIC PALATAL FOCAL FIBROUS HYPERPLASIA

Fibroma is a common soft tissue lesion of the oral cavity, however, the origin of broma in a palatal region is rare. It may arise as a hyperplastic inammatory reaction in response to a local inciting agent, inammatory source, or chronic traumatic injury. These masses represent hyperplasia instead of true neoplasm. We present a case of broma present on the palatal region in an 8- year-old child diagnosed based on clinical, radiological, and histological features.

Intraoral scanners for capturing the palate and its relation to the dentition

Proper superimposition of intraoral scan generated 3D models enables detailed assessment of soft and hard tissue surface changes. This requires accurate 3D models and stable structures as superimposition references. In the maxilla, different reference areas have been proposed, mostly located at the palatal region. In this in vivo study we evaluated the precision of two intraoral scanners (TRIOS 3, 3Shape and CS 3600, Carestream) at the maxilla, focusing on the palate itself and also on its spatial relation to the dentition, following palatal superimposition. Precision was tested through the superimposition of repeated scans on the palate and the dental arch. Overall, the median precision of both scanners was high (< 0.1 mm). Scanner precision was comparable when the palatal area was tested individually. However, TRIOS 3 showed higher precision regarding the assessment of the dental arch, following superimposition of repeated models on the palate (median difference: approximately 40 μm). In few cases, local areas of higher imprecision were present for both scanners, exceeding 0.3 mm. Thus, scanner precision seems to be high in small, but slightly reduced considering larger areas, with differences between scanners. However, the effect on individual tooth position relative to the palate was for both scanners limited.

Posthatching ultrastructural development of the oropharyngeal cavity roof in five age‐stages of Coturnix coturnix (Linnaeus, 1758)

Recent literature has demonstrated only adult avian palate, albeit there has been only limited focus on the postnatal development of the avian oropharyngeal cavity roof. Hence, the current investigation was designed to obtain the full ultrastructure postnatal description of the oropharyngeal roof during the five developmental age-stages of Coturnix coturnix by employing assessments using gross morphometric analysis and stero and scanning electron microscopy. The elongated triangular oropharyngeal roof has a spoonful rounded beak tip. The palate region is subdivided into the rostral ridged area and the choanal area. The palate has eight longitudinal palatine ridges (seven nonpapillated and one papillated median) and four transverse papillary rows (one slightly oblique row and three transverse papillary crests). The median palatine ridge continuous caudally and is then divided into three ridges: one median and two paramedian ridges (forming the lateral boundaries of the choanal field). The choanal field had three regions (rostral, middle, and caudal). The finger-like projection papillary region has five papillae. The choanal cleft has two unequal parts (rostral and caudal). The rostral nonpapillated short choanal part is subdivided by transverse papillary row into rostral narrow straight and caudal diamond portions. The caudal wide papillated choanal part is further divided by a second transverse crest into rostral long (encircled by interdigitated papillae) and caudal short wider part (not encircled by interdigitated papillae). The infundibular cleft is not bordered by any papillae, while the pharyngeal region has numerous papillae and openings of the salivary glands. Moreover, the morphometric analysis revealed a higher value with increasing age for all dimensions. Our findings indicated a higher degree of functional adaptation between the five developmental age stages of quail. Our observations suggest that adaptations such as these may increase the efficiency of food prehension with increasing age.

Biomechanical evaluation of maxillary protraction with an orthodontic anchor screw: a three-dimensional finite element analysis

ABSTRACT Purpose The purpose of this study was to biomechanically evaluate maxillary protraction using an orthodontic anchor screw. We conducted three-dimensional finite element analysis to determine the initial displacement and stress distribution during maxillary protraction by comparing a conventional method involving fixation on teeth with maxillary protraction using an orthodontic anchor screw. Materials and methods We used X-ray computed tomography data obtained from Hellman Dental Age IIIA dry human skulls to create a skeletal anchorage model and a dental anchorage model as finite element models. In each model, a load of 6 N was applied in the anteroinferior direction at 0°, 10°, 20°, 30°, and 40° to the occlusal plane by means of a traction hook and the initial displacement and stress distribution were analysed. Results For the anterior nasal spine (ANS) sagittal displacement was greater in the skeletal anchorage model than in the dental anchorage model. In the central incisors and first molars, greater sagittal displacement was observed in the dental anchorage model compared with the skeletal anchorage model. In both models, vertical displacement was 20°, indicating maximum suppression of rotation in the maxilla. The zygomaticomaxillary and zygomaticofrontal sutures demonstrated high stress at 0° and 10° in the dental anchorage model, and at 20°, 30°, and 40° in the skeletal anchorage model. Conclusions These results indicate that tooth and bone–borne maxillary protraction using an orthodontic anchor screw inserted in the palatal region may be of value for the early mixed dentition period in patients with maxillary deficiency.

Influence of Preparation Design, Restorative Material and Load Direction on The Stress Distribution of Ceramic Veneer in Upper Central Incisor

Objective: Evaluate the effect of four preparation designs, two ceramic materials, and two occlusion contact types on the stress distribution of ceramic veneer in upper central incisor. Material and methods: 3D-models were performed in the modeling software containing enamel, dentin, pulp, periodontal ligament and a base of polyurethane resin. The designs were modeled and exported to the computer aided engineering software to perform the static structural analysis. For the mesh, a total of 155429 tetrahedron elements and 271683 nodes were used, after a 10% convergence test. Two materials, lithium disilicate and feldspathic ceramics, were simulated. A static load of 100 N on 45º was applied on the incisal and middle thirds of the palatal tooth region, guided by the occlusal plane. The base was constrained in all directions. The Maximum Principal Stress was the failure criteria chosen for the analysis. Results: The Finite Element Analysis showed that the most conservative designs presented less stress concentration on the ceramic veneer. However, the highest tensile stress concentrations were observed on lithium disilicate veneer with extend design, on the middle third. The type of occlusal contact presented different stress patterns among the preparation designs; the incisal contact showed higher stress concentration compared to middle third contact regardless the ceramic material. Conclusions: To perform a ceramic veneer in upper central incisor, the feldspathic ceramic presented promising results and should be recommended when the extended design was done. Regarding contact types, the incisal contact is more prone to failure regardless the ceramic and preparation design. Keywords Ceramics; Dental veneers; Finite element analysis.

Monomorphic Adenoma of Posterior Palate: A Rare Case Report

Background: Minor salivary gland benign tumors account for a very small percentage of salivary gland tumors of which monomorphic adenomas are a rare entity. Methods and Findings: The present case report discusses a rare case report of an 18-year-old female patient diagnosed with monomorphic adenoma of the posterior palatal region. The diagnosis was reached after thorough radiographical and pathological investigations. Conclusion: Monomorphic Adenoma in a younger individual is a rare disorder and can be used as a collective term for benign or malignant tumors comprising of one type or even two types of cells.

Effect of natural latex membranes on wound repair of palate donor areas: A pilot randomized controlled trial study, including the membranes characterization

The aim of the present study was to evaluate the use of an exclusively developed latex membrane, to act as physical barrier to aid wound healing, epithelization, and pain in the palate region after free gingival graft harvesting. Latex membranes were physically, chemically, and mechanically characterized before application. Twenty-four patients (age 30–70 years, mean 45 years), requiring free gingival graft were sequentially selected, and randomly divided in two groups according to type of protection utilized on the donor site, control group (14 patients)- The wound in palate was covered with acrylic plate and surgical cement only and test group (10 patients) - The wound in palate was covered with the experimental latex membrane. The palate region was evaluated on the surgery day and 3, 7, 15, and 30 days after the surgical procedure for wound healing area, epithelization, bleeding, and self-reported pain (VAS). Wound reduction between periods was calculated, as percentage. The membrane had smooth surface, high elasticity, and nanoscale porosity, as expected for biomedical application. At 15 days, control group patients presented a fully healed wound, while mean wound closure was 98.6 % in the latex group. At 30 days, both groups presented complete wound closure. Also, at 30 days, there was no significant epithelization difference between the groups, and all patients in both presented fully epithelized wounds. As for bleeding, at 7 days it was positive for 21.4 % of the patients in the control group, while it was already negative for all patients in the latex group. Regarding reported pain, VAS values were larger in the control group, although with no statistical significance. Latex membranes did not delay the healing of the palate or caused visible adverse effects (i.e. allergies, discomfort, or injury to the patient), when compared to the control group.

Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment

This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults. The sample comprised 17 patients (mean age, 26±11years) selected for the MARPE group and 15 (mean age, 28.5±10.5years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups. MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE. The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.