Alternative to the median region of the palate for placement of an orthodontic implant

Abstract

Tooth-borne anchorage may be one of the greatest limitations of modern orthodontic treatment, because teeth move in response to forces. Previous investigators have placed temporary implants in the median-sagittal palate in order to establish maximum anchorage. This area, however, may be characterized by relatively low vertical bone support. The aim of this study was therefore to find an alternative palatal implant site which offers a higher amount of bone support. This study comprised 22 patients wishing for maximum anchorage underwent presurgical diagnostic evaluation by means of low-dose dental CT. The measuring results regarding vertical bone volume and the position of the neighbouring tooth roots were used as the basis for further treatment. The statistical data analysis indicated an area suitable for implant placement in the group of patients examined. This area was located 6 to 9 mm posterior to the incisive foramen and 3 to 6 mm paramedian, under avoidance of the mid-palatal suture. The patients showed such a great range of variation in vertical bone volume that a preoperative diagnostic evaluation also seems to be recommendable when very short implants are used in order to avoid perforations of the lower nasal duct.

Morphologic evaluation of the incisive canal and its proximity to the maxillary central incisors using computed tomography images

“…20,21,30,31 Anatomical features of the incisive canal have been studied in connection with rehabilitation of the maxillary anterior region [18][19][20][21][22][23][24] and the placement of orthodontic mini-implants. 30,[32][33][34] However, the consequences or the possibilities of incisor roots being in contact with the incisive canal following tooth movement are poorly documented in the orthodontic literature. Similar to the example presented in Figure 1, it was recently noted through 3D evaluation that the maxillary central incisor root in direct contact with the incisive canal following anterior retraction was associated with severe root resorption, but without any neurologic symptoms.…”

Palatal Bone Density in Adult Subjects: Implications for Mini-Implant Placement

“…5,6 It has also been reported that a suitable bone thickness of the palate for miniimplants should be greater than 4 mm. 7 The success of mini-implants has been commonly reported to range between 70% and 89%. For miniimplants placed in the palate, however, success rates near 100% have been reported, although the comparison of different studies had its limitations.…”

“…Many studies have assessed bone quantity in the palate, but only a few have examined palatal bone densities. [5][6][7]11 Therefore, the purpose of this study was to quantitatively evaluate bone density in the palate so as to provide guidelines for mini-implant placement that are essential for implant site selection and implant success prediction.…”

“…Similar variation in bone thickness of the palate has been found in other studies. 7,11 When both bone quantity and the quality of mini-implant placement are taken into account, the posterior and lateral regions of the palate should be considered so the possibility of perforation and loosening of the implant can be reduced.…”

The use of an osseointegrated implant for orthodontic anchorage to a class II Div 1 malocclusion.

“…To solve this problem, alternative implant sites have been used such as the retromolar 4,8) and ramus regions 6,9) in the mandible and the mid-palatal area 3,5,10) in the maxilla. Bernhart et al 1) stated that the median-sagittal region of the hard palate as a suitable location for implant placement is surgically very well accessible and offers a higher amount of bone support and excellent peri-implant conditions due to the attached mucosa. In Japan, however, there have been few reports on orthodontic treat- ment using a palatal implant for maximum anchorage.…”