Sagittal Maxillary Fracture: Diagnosis and Management

Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.

SPECIFIC FEATURES OF VARIANT ANATOMY AND MORPHOMETRIC CHARACTERISTICS OF THE PALATAL VAULT IN ADULTS WITH DIFFERENT GNATHIC AND DENTAL TYPES OF ARCHES

Cone-beam computed tomograms of 68 people (age — 21–35) with physiological occlusion and various gnathic dental arches were analyzed by a method developed for identifying the palatal arch index, taken as a height (depth)-to-width dimension ratio. The results of the study revealed that palatal parameters are determined by main variants (types) of the palatal vault. In case of the mesopalatal type of the arch (index value — 35–45%), the width parameters exceeded the depth values by an average of 2.4 times, while the divergence angle of alveolar processes was 116.7 ± 5.6°. The dolichopalatal type of the arch (index value – above 45%) featured domination of the width parameters over the depth-related ones, by an average of 1.8 times, while the alveolar processes divergence angle made up 127.6 ± 6.1°. As far as the brachypalatal type of the arch is concerned (index value — below 35%), the width parameters exceeded the depth parameters by 4.0 times on average, the divergence angle of the alveolar processes being 113.5 ± 5.3°. The obtained data can be used in clinical orthodontics when diagnosing pathologies of the palatal vault, as well as to interpret data from additional methods of examination and to choose the right treatment for issues related to the dental arch shape and size.

Accuracy and reliability of maxillary digital model (MDM) superimposition in evaluating teeth movement in adults compared with CBCT maxillary superimposition

Superimposition of 3D maxillary digital dental models of different time points based on palatal vault region has been used to evaluate tooth movement during orthodontic treatment. This study evaluated the accuracy and reliability of 3D maxillary digital model (MDM) superimposition in adults by comparing it with CBCT maxillary superimposition. In CBCT maxillary superimposition, voxel-based superimposition was firstly conducted, and MDMs were matched with corresponding CBCT models (CBCT-MDM superimposition). MDM superimposition (palatal vault regional superimposition) were performed on another pair of pre- and posttreatment MDMs. The position and orientation of upper first molars (U6s) and upper central incisors (U1s) on the posttreatment MDMs were compared to assess the accuracy of the MDM superimposition methods. The reliability was validated in both MDM superimposition and CBCT maxillary superimposition. In terms of accuracy, the average linear deviations in U6 and U1 positions were less than ± 0.3 mm, the average angular deviations of U6s and U1s were less than ± 0.2°, both have no significant difference from zero. The ICCs for MDM superimposition ranged from 0.85 to 0.99. The ICCs for CBCT-MDM superimposition were larger than 0.99 in all items. MDM superimposition was an efficient, accurate and reliable method for evaluating teeth movement in adults, although its reliability is slightly lower than CBCT maxillary superimposition.

Class II subdivision with skeletal transverse maxillary deficit treated by single-sitting bone-borne appliance:

ABSTRACT This case report describes orthodontic treatment including both skeletal maxillary expansion and unilateral distalization by means of a single bone-borne appliance followed by clear aligner therapy in a young adult patient. A surgical guide was digitally designed and three-dimensionally printed to facilitate the placement of four miniscrews in the palatal vault. The miniscrews were fitted and the bone-borne appliance was delivered in a single clinical appointment. The postexpansion photographic records and models demonstrate the opening of the palatal median suture, the pure skeletal expansion, and the resolution of the left crossbite after 40 activations. Specifically, left molar Class I was obtained in about 5 months without any loss of anterior anchorage, and the subsequent aligner phase achieved all of the objectives established in the treatment plan. This case report shows clearly how careful digital planning of miniscrew insertion and the delivery of a pure bone-borne appliance in a single sitting enabled good clinical outcomes to be achieved in an acceptable timeframe, without side effects, even in a young adult patient.

Palatal Soft Tissue Thickness on Maxillary Posterior Teeth and Its Relation to Palatal Vault Angle Measured by Cone-Beam Computed Tomography

Objective. Analyzing palatal soft tissue thickness in cone-beam computed tomography (CBCT) images and evaluating the relationship between tissue thickness and palatal vault angulation. Methods. Out of 1,737 CBCT images, fifty-six images met the inclusion criteria and were included in this cross-sectional study. The palatal vault angle on the maxillary first molar was measured and divided the images into 3 groups. The soft tissue thickness between the maxillary first premolar and second molar was measured at a distance of 3, 6, 7, 8, and 9 mm from the cementoenamel junction. All the image measurements were performed using CBCT-viewer software. Result. In this study, 56 CBCT images with full permanent maxillary posterior teeth and absence of light scattering were found. The mean age of the patients was 31.59 ± 13.92 years. The moderate and deep palatal vault angle patterns had the greatest and least prevalence, respectively. The average thickness on shallow, moderate, and deep palatal vault groups was 4.02 ± 0.58, 3.75 ± 0.73, and 3.43 ± 0.38 mm, respectively. Furthermore, the mean palatal mucosal thickness was statistically different between the deep and shallow palatal vault angle groups (p<0.05, power of test 0.8). Based on the Pearson correlation coefficient, there was a negative correlation between the palatal mucosal thickness and palatal vault angle (p<0.05, power of test 0.85). Conclusion. A negative correlation between the palatal mucosal thickness and palatal vault angle was observed. Furthermore, this study suggested that the shape of the palatal vault can be one of the supporting data for evaluating the graft dimensions.

Sexual Dimorphism Via Palatal Vault Morphometric Analysis on A Sample Peruvian Population

Objective: Determine sexual dimorphism precision via palatal vault morphometric analysis in craniums sourced from the Laboratorio de Investigación Forense del Equipo Forense Especializado (EFE) de Ayacucho del Ministerio Público - Perú. Materials and Methods: Cross-sectional design consisting of a sample of 43 skulls with pre-established biological gender, (24 males and 19 females). Sexual dimorphism was established by means of the method proposed by Meera Jacob and co., based on palatal width and length measurements, after which the palatal index was calculated, establishing the method’s precision and accuracy. The inferential analysis was made with a level of significance of 5% through the T student test, Shapiro Wilk and Pearson’s coefficient. Results: Palatal width had a mean of 3.43 (+0.31cm) for males and 3.62 (+0.25) for females and in palatal length a mean of 5.07 (+0.44) cm. for males and 4.79 (+0.41) cm. for females is established; on palatal index, 100% of the male skulls correspond to hard narrow palate and on females 73.7% to narrow, 21% to intermediate and 5.3% to wide. Furthermore, it was determined that there were statistically significant differences between width and length of palatal vault for both genders, and a discriminating analysis formula was proposed. Conclusion: Morphometric analyses of palatal vaults establish an 83.72% precision on the estimation of sexual dimorphism.

Morphometric analysis of the palatal shape and arch dimension in subjects with buccally displaced canine

Summary Objectives To analyse morphological variations of the palate shape and maxillary arch dimension between a group of subjects with unilaterally or bilaterally buccally impacted maxillary canines and a control group (CG) by means of 3D geometric morphometric (GMM). Materials Pre-treatment records of 50 subjects (16 males and 34 females; mean age 13.9 years ± 1.8) with one or both canines buccally displaced were collected retrospectively. A CG of 50 subjects was selected from a list of orthodontic patients at the same dental hospital. The experimental group, buccally displaced canine (BDC) was divided in two groups: unilateral buccally displaced canine (UBDC) and bilateral buccally displaced canine (BBDC). To analyse the palate’s shape and maxillary arch dimension, study casts were scanned. To study the entirety of the palatal shape, 3D GMM analysis was used. To analyse the maxillary arch dimension, the virtual three-dimensional models were measured with a specific software (VAM, Vectra, Canfield Scientific, Fairfield, New Jersey, USA). Results When comparing the groups with the GMM analysis, patients with BDC showed a statistically significant narrower and higher palatal vault. About the analysis of linear measurements, the intercanine width, the anterior and posterior segment length were significantly smaller in BDC, UBDC, and BBDC subjects when compared with the controls and there were no differences between UBDC versus BBDC groups. Conclusions Patients with buccally displaced permanent canine tended to have maxillary transverse constriction and variation in palatal vault morphology. The morphometric variation of the palatine vault and arch dimensions can be considered a clinical factor associated with the presence of BDC.

RELATIONSHIP BETWEEN SATISFACTION WITH COMPLETE DENTURES AND BASAL SEAT CHARACTERISTICS

Aim: To investigate the relationship between patients self perceived satisfaction and basal seat characteristics in edentulous patients attending a teaching hospital in Lagos.Materials and Methods: Consecutive edentulous patient seen for 6 months in Lagos University Teaching Hospital, Lagos were recruited for this longitudinal study. The data collected were basal seat characteristics and self perceived satisfaction.Results: A total of 30 patients were seen but only 24 complied with the study protocol. The use of objective assessment in classifying maxillary residual ridge showed that there was a significant association (P=0.045) between the ridge and self perceived satisfaction. There was no significant association between self perceived satisfaction and shape of mandibular ridge, palatal vault and vestibular depth.Conclusion: There was a significant association between shape of maxillary residual ridge and self perceived satisfaction. Objective preclinical assessment of residual ridge may help to project satisfaction and determine treatment option.

Space conditions, palatal vault height, and tooth size in patients with and without palatally displaced canines: A prospective cohort study

ABSTRACT Objectives: To assess palatal vault height, tooth size, and dental arch dimensions in patients with unilateral and bilateral palatally displaced canines compared with a control group. Materials and Methods: A sample of 66 patients (mean age: 11.5 ± 1.0 years) with 22 unilateral palatally displaced canines (UPDCs), 22 bilateral palatally displaced canines (BPDCs), and 22 controls (C) were consecutively recruited. All three groups had dental casts that were scanned digitally using the OrthoX three-dimensional model scanner. Tooth size, palatal vault height, dental arch width, dental arch depth, dental arch length, and dental arch space were measured by the same examiner using the GOM software. Remeasurements were made in 10 randomly identified patients. Results: The palatal vault height was significantly lower in the BPDC group compared with controls. A significantly smaller mesial-distal crown width and, in general, more spacing in the maxilla were found in the UPDC and BPDC groups. No differences in arch length or arch width at the molar region were seen between the groups, while the arch length at the canine region was smaller in the UPDC and BPDC groups. However, this was observed in BPDC patients with both deciduous canines present and in most UPDC patients where the deciduous canine was present, compared with the control group, who had more permanent canines present. Conclusions: Patients with PDC had greater reduction in tooth size compared with the control group. The arch length and arch width were similar in patients with and without PDC.