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Buccal cortical bone thickness at miniscrew placement sites in patients with different vertical skeletal patterns

Bukkale Kortikalisstärken an Minischrauben-Insertionsstellen bei Patienten mit unterschiedlichem vertikalem Schädelaufbau

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Abstract

Objective

Cortical bone thickness plays an important role in the primary stability of miniscrews. The purpose of this study was to evaluate the buccal cortical bone thickness in adolescent subjects with different vertical skeletal patterns using cone-beam computed tomography (CBCT).

Materials and methods

We examined the CBCT images of 75 patients (30 males, 45 females; mean age 16.5 years; range 15.3–17.7 years) in the present study. High-, average- and low-angle subgroups were generated according to SN-GoMe angle. On volumetric images, we measured the buccal cortical bone thickness from canine to the second molar teeth at heights of 5, 7 and 9 mm from cemento-enamel junction (CEJ). For statistical evaluation, the Wilcoxon signed rank, Kruskal–Wallis and Tukey HSD tests were applied at the p < 0.05 level.

Results

Buccal cortical bone was thickest in the low-angle group. We observed statistically significant differences in the maxilla between the high- and low-angle groups at all levels. In the mandible, we noted statistically significant differences between high-angle and low-angle groups in the canine–first premolar regions at heights of 5 and 7 mm, and in the second premolar–first molar region at 7 mm height from CEJ. Significant differences were also present between the first and second premolars at heights of 7 and 9 mm. Average cortical bone thickness ranged from 1.10–1.37 mm in the maxilla and 1.20–3.28 mm in the mandible for all groups.

Conclusion

Buccal cortical bone thickness in adolescents varied in different vertical skeletal patterns and was greater in the mandible than in the maxilla, with the distance increasing from the CEJ to the apex. As the buccal cortical bone is thinner in high-angle patients, patient-specific measures should be taken when performing miniscrew treatment.

Zusammenfassung

Studienziel

Ein wesentlicher Faktor für die Primärstabilität von Minischrauben ist die Stärke der Kortikalis. Gegenstand dieser Studie waren die bukkalen Kortikalisstärken bei Heranwachsenden mit unterschiedlichem vertikalem Schädelaufbau.

Material und Methoden

Ausgewertet wurde Bildmaterial von prätherapeutischen DVT(digitale Volumentomographie)-Untersuchungen an 75 jungen Frauen (n = 45) und Männern (n = 30) im mittleren Alter von 16,5 (15,3–17,7) Jahren, die in 3 Gruppen − starker, neutraler oder schwacher Kieferbasiswinkel (SN/GoMe) − eingeteilt wurden. Auf entsprechenden 3-D-Visualisierungen wurden jeweils in beiden Kiefern auf unterschiedlichen Höhen apikal der Schmelzzementgrenze (5, 7 und 9 mm) beidseitig vom Eckzahn bis zum zweiten Molaren die bukkalen Kortikalisstärken vermessen. Die Auswertung erfolgte per Wilcoxon-Vorzeichen-, Kruskal-Wallis- und Tukey-HSD-Test (Signifikanzniveau: p ≤ 0,05).

Resultate

Die ausgeprägtesten Kortikalisstärken fanden sich in der winkelschwachen Gruppe. Im Oberkiefer bestanden zwischen der winkelstarken und – schwachen Gruppe auf allen Messhöhen durchwegs signifikante Unterschiede. Eine Ausnahme bildeten lediglich die Messungen auf 9 mm Höhe im Areal 4–5 (zwischen erstem und zweitem Prämolaren) und 6–7 (zwischen dem erstem und zweiten Molaren). Im Unterkiefer wurden signifikante Unterschiede zwischen der winkelstarken und –schwachen Gruppe im Areal 3–4 (zwischen Eckzahn und erstem Prämolaren) auf 5 und 7 mm Höhe sowie im Areal 5–6 (zwischen zweitem Prämolaren und erstem Molaren) auf 7 mm Höhe ermittelt. Die durchschnittliche Kortikalisstärke betrug für alle Gruppen im Oberkiefer 1,10–1,37 mm und im Unterkiefer 1,20–3,28 mm.

Schlussfolgerung

Die Heranwachsenden zeigten je nach vertikalem Schädelaufbau unterschiedliche bukkale Kortikalisstärken. Zudem waren diese Stärken im Unterkiefer ausgeprägter als im Oberkiefer und nahmen von der Schmelzzementgrenze nach apikal zu. Angesichts der schwächeren Kortikalisstärken bei Patienten mit großem Basiswinkel sollte bei Behandlungen mit Minischrauben patientenspezifisch vorgegangen werden.

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Compliance with ethical guidelines

Conflict of interest. I. Veli, T. Uysal, A. Baysal, and I. Karadede state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

Einhaltung ethischer Richtlinien

Interessenkonflikt. I, Veli, T. Uysal, A. Baysal und I. Karadede geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Correspondence to Prof. Dr. T. Uysal DDS, PhD.

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Veli, I., Uysal, T., Baysal, A. et al. Buccal cortical bone thickness at miniscrew placement sites in patients with different vertical skeletal patterns. J Orofac Orthop 75, 417–429 (2014). https://doi.org/10.1007/s00056-014-0235-7

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Keywords

  • Cortical bone thickness
  • Miniscrew
  • Cone beam computed tomography
  • Vertical dimension

Schlüsselwörter

  • Kortikalisstärke
  • Minischraube
  • Digitale Volumentomographie
  • Vertikale Dimension