J Stomatol Oral Maxillofac Surg 119 (2018) 196–198

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Original Article

Utility of CBCT for the measurement of palatal bone thickness

R. Bonangi *, G. Kamath, H.S. Srivathsa, M. Babshet
Department of oral medicine and radiology, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India

A R T I C L E I N F O A B S T R A C T

Article history: Introduction: The palate is an alternative anchoring site for orthodontic implants. Adequate bone at mini-
Received 19 December 2017 implant placement site can influence the success or failure of anchorage. Hence, it is imperative to
Accepted 14 February 2018 measure the thickness of the palatal bone.
Available online 24 February 2018
Materials and methods: CBCT scans of 30 subjects in the age range of 12 to 28 years were retrospectively
analyzed with the objective of measuring the palatal bone thickness. Thirty sites were identified on each
Keywords: CBCT scan with incisive foramen as a landmark and measurements were obtained anteroposteriorly as
CBCT
well as mediolaterally, using Carestream 3D imaging software. The data collected was analyzed using
Palatal bone thickness
Incisive foramen
one-way ANOVA.
Mini-implants Results: Statistical analysis revealed higher palatal bone thickness at the median and paramedian regions
of anterior palate, 4 mm and 8 mm distal to incisive foramen.
Conclusion: CBCT is an ideal modality for measuring palatal bone thickness and can be utilized for
locating the ideal site for placement of orthodontic mini-implants.
C 2018 Elsevier Masson SAS. All rights reserved.

1. Introduction effective, and low-cost technique for patients with atrophy of

CBCT allows depiction of the area of interest in three
dimensions, from which slices can be displayed from any angle
in any part of the imaged region and archived digitally. So, CBCT is
an ideal modality for measuring palatal bone thickness and can be
utilized for locating the ideal site for placement of orthodontic
mini-implants [1,2].
The factors that should be considered during the selection of
site for mini-implants includes anatomical factors such as
intraroot space, sinus morphology and nerve location, soft-tissue
anatomy and the total thickness of bone. Therefore, the bone
condition has to be considered for the location of mini-implants
placement [3]. Mini-implants are commonly inserted in the
interseptal region, retromolar area and the palate. The palate is
probably the most favourable area for mini-screw placement
because there is easy access, low risk of damaging important
anatomical structures and there is attached keratinized tissue
along its entire length [4]. The mid-palatal and paramedian regions
of the anterior palate are potential sites of mini-implant placement
as these regions are devoid of major blood vessels and nerves
[5]. Further, the use of osseo-integrated implants in the
intermaxillary suture has been recently described as a fast,
* Corresponding author.
E-mail address: ravibonangi@gmail.com (R. Bonangi).
the maxilla. It is necessary to measure the vertical bone height at
the implant insertion site to avoid the risk of perforations [6].
Cone-beam computed tomography (CBCT), has replaced the
traditional two dimensional radiographs in current practice
[1]. Hence, the present study was performed for measurement
and comparison of total palatal bone thickness at different sites
using cone-beam computed tomography images to confirm the
most appropriate location for mini-implant placement.
2. Materials and methods
The sample consisted of 30 CBCT scans from the database of
patients visiting the department of oral medicine and radiology.
Patients of both genders with an age range of 12 to 28 years were
included in the study. Patients with any craniofacial malforma-
tions, missing teeth and pathologies of palate were excluded from
the study.
The cone-beam CT images of all the subjects were taken using a
Kodak-9000 CBCT unit with the following specifications:
18  21 cm field of view; 90 kVp, 10 mA, exposure time:
15 seconds with a spatial resolution of 10 line pairs/cm and
0.2 mm voxel size. The images were reconstructed with CareS-
tream 3D Imaging software which has an inbuilt measurement tool
to measure total palatal bone thickness.

https://doi.org/10.1016/j.jormas.2018.02.009
2468-7855/ C 2018 Elsevier Masson SAS. All rights reserved.
 R. Bonangi et al. / J Stomatol Oral Maxillofac Surg 119 (2018) 196–198 197

Fig. 1. Sagittal reference image used to locate incisive foramen and the points.
Fig. 3. Composite picture showing the 30 palatal bone sites measured.

Fig. 4. Palatal bone thickness in mm at 30 different palatal locations.

Fig. 2. Coronal CBCT image used to make measurements of median and paramedian
sites.

After locating the incisive foramen, a line was drawn through

incisive foramen in the midline in axial section. This line was
tracked by sagittal and axial views simultaneously. Palatal region
was reconstructed at 4, 8, 16, 20 and 24 mm posterior to the distal
wall of the incisive foramen (Fig. 1). Measurements were made in
vertical direction in coronal section. In each coronal reconstruc-
tion, measurements were made from distal wall of incisive
foramen, from anterior to posterior region in these three
designated mediolateral areas: the midline area at the midpalatal
suture, the medial area at the reference lines 3 mm and 6 mm
bilateral to the midpalatal suture (Fig. 2). The bone thickness was
measured in millimetres at each of the 30 designated points in the
palate of each CBCT scan (Fig. 3).
The anterior area of the palate was represented at 4 mm and Fig. 5. Genderwise comparison of palatal bone thickness.
8 mm; the middle area at 12 mm and 16 mm; and the posterior
area at 20 mm and 24 mm, posterior to the incisive foramen. Fig. 5 shows genderwise comparison for palatal bone thickness,
from anterior to posterior region. The palatal bone thickness was
3. Statistical analysis significantly higher in males than females (P < 0.05).

One-way analysis of variance was used to test for differences in 5. Discussion

palatal bone thickness. Independent sample t-test was used for
genderwise comparison. P < 0.05 was considered as statistically CBCT produces three-dimensional anatomical images with
significant. relatively high resolution and high contrast, with low radiation
dose to the patient. The palate is reported to be a reliable and stable
4. Results placement site for temporary skeletal anchorage devices because it
offers both sufficient quality and quantity of bone. In particular,
Fig. 4 shows the mean palatal bone thickness measured at palatal bone thickness is considered to be a key factor for the
30 points on the palate. success of temporary skeletal anchorage devices.
198 R. Bonangi et al. / J Stomatol Oral Maxillofac Surg 119 (2018) 196–198
The palatal bone thickness was found to be highest at median
and paramedian regions 4 mm from the incisive foramen, followed
by area at 8 mm from the incisive foramen. The palatal bone
thickness was the least at 24 mm posterior to the incisive foramen.
The palatal bone thickness reduced considerably from the anterior
to the posterior region of the palate. Our study results are similar to
King et al. [9], who evaluated the palatal bone volume for
placement of implants using computed tomography. Holm et al.
found that bone thickness was highest in the lateral anterior palate
[7]. Manjula et al. also reported similar results [1].
Sumer et al. (2016) [6], Gracco et al. (2008) [8], King et al. (2007) [9]
and Ching Poon et al. (2015) [5] reported more palatal bone thickness in
men than in women, which is similar to this study finding.
Clinical examination, panoramic and cephalometric radio-
graphs have limitations when assessing the palatal bone thickness.
CBCT produces high resolution images which are not magnified nor
distorted in size and shape without any superimposition. Thereby,
CBCT is a good method to evaluate the bone site most suitable for
mini-implant placement.
6. Conclusion
CBCT is a good aid to evaluate palatal bone thickness. Our study
found palatal bone thickness to be more in men than women. The
most suitable area for receiving mini-implants were located at
4 mm posterior to incisive foramen at midline and paramedian
sites of the palate. CBCT imaging has given dental fraternity a
diagnostic tool, which is capable of providing accurate measure-
ment of palatal bone thickness.
Disclosure of interest
The authors declare that they have no competing interest.
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