Original article
Vertical bone volume in the paramedian palate of adolescents: A computed tomography study

https://doi.org/10.1016/j.ajodo.2005.11.042Get rights and content

Introduction: The paramedian palate (PP) has been used as a host site for orthodontic implant anchorage. Available bone and interference of adjacent tooth roots must be considered in identifying the most appropriate locations for implantations in the PP. Methods: Cone-beam computed tomography (CBCT) scans (NewTom QR-DVT 9000; QR s.r.l., Verona, Italy) were acquired in 183 orthodontic patients (ages, 10-19 years). Views of the PP region were reconstructed at increments posterior from the incisive foramen, and measurements of bone height were made in each reconstruction laterally from the midline to describe the PP. Results: At 4 mm posterior to the incisive foramen and 3 mm lateral to the midline, 93% of the male and 91% of the female subjects met the criterion for implantation. At 8 mm posterior to the incisive foramen and 3 mm lateral to the midline, 86% of the male and 58% of the female subjects met the criterion for implantation. Conclusions: The PP contains several valid implant host sites in adolescent patients. At 4 mm distal and 3 mm lateral to the incisive foreman, 93.2% of the boys and 91.9% of the girls had sufficient vertical bone depth to host a 3-mm implant with little practical tooth interference. CBCT allows accurate assessment of the entire volume of a proposed implant site.

Section snippets

Material and methods

CBCT scans with the NewTom QR-DVT 9000 (QR s.r.l., Verona, Italy) of 183 adolescents (124 girls, 59 boys; mean age, 14 years 7 months; range, 10-19 years) collected for preorthodontic records at Edmonton Diagnostic Imaging, Edmonton, Alberta, Canada, were used as the study sample. The age range was intended to include the ages of most orthodontic patients4 and those considered to be growing. The growth criterion was the most important for the study, because, in those patients, the placement of

Results

Minimum mean bone heights for the ROI for the sexes are given in Table I.

In the boys, 5 of the 9 measuring locations yielded mean bone heights greater than the minimum 4 mm required for implantation and had a 95% confidence interval in which the lower value of the interval was still greater than 4 mm. The girls had 4 such locations. In both sexes, the best location was P4D3, followed by P8D6 and closely by P12D9 in boys, and followed by P12D9 and closely by P8D9 and P8D6 in girls. P4D6 and P8D9

Discussion

The PP was identified as a viable alternative for the placement of temporary implants for orthodontic anchorage. This is an important development because of reservations about using orthodontic implants in growing patients without an obvious host site.6 Implants designed specifically for orthodontic anchorage and the palatal area have also improved the acceptance of this technique.

The versatility of CBCT to evaluate bone availability in the PP is remarkable, allowing volumetric examination of

Conclusions

The results of this study further validate the PP region in adolescents as a host site for orthodontic implants. There are several valid host sites in adolescents, with P4D3 (4 mm distal and 3 mm lateral to the incisive foramen) identified as the best location. In our study, 93.2% of the boys and 91.9% of the girls had sufficient vertical bone depth at this location to host a 3-mm implant with little practical tooth interference. CBCT allows assessment of the entire volume of a proposed implant

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    Citation Excerpt :

    The data in the present study show that the thickest vertical bone is located 3-mm distal to the incisive foramen and 4–8-mm lateral to the mid-palatal suture and that this thickness decreased posteriorly. These findings are in agreement with those of most previous studies.3–5,7,8,16–18 In our study, 32 measuring points at each side of the palate were further divided into subgroups A–D according to the statistical results.

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Supported by grant #2003-04 from the University of Alberta Fund for Dentistry and the McIntyre Memorial Research Fund.

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