Korean J Orthod.  2018 May;48(3):133-142. 10.4041/kjod.2018.48.3.133.

Three-dimensional morphological evaluation of the hard palate in Korean adults with mild-to-moderate obstructive sleep apnea

Affiliations
  • 1Department of Orthodontics, Medical College of Xiamen University, Xiamen, China.
  • 2Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, Korea. bravortho@gmail.com

Abstract


OBJECTIVE
The purpose of this study was to evaluate differences in three-dimensional (3D) morphology of the hard palate between Korean adults with and without mild-to-moderate obstructive sleep apnea (OSA) using cone-beam computed tomographic (CBCT) data.
METHODS
The protocol for the two-dimensional (2D) and 3D mathematical modeling was established by analyzing CBCT images of 30 adults with OSA and 30 matched controls without OSA, using MIMICS software. The linear and angular measurements were also determined using this software. The measurements were repeated for 30 palates, by the same operator, to assess reliability.
RESULTS
The palates of OSA patients were higher in the posterior part and narrower in the anterior-superior part than those of the control group (p < 0.05). The nasal cavities of patients with OSA were narrower (p < 0.05) than those of controls. The increasing angle of the first molar palatal root is a compensation of the upper dental arch to improve occlusion. However, for most palatal measurements, there were no significant differences between the OSA and control groups (p > 0.05). The results of 2D and 3D mathematical models were consistent for linear and angular measurements, indicating that 2D and 3D mathematical modeling of the palate is a reliable methodology.
CONCLUSIONS
OSA is a multifactorial disease; the palates of adults with mild-to-moderate OSA do not have specific morphological features distinct from those of healthy controls.

Keyword

Cone-beam computed tomography; Hard palate; Morphology; Obstructive sleep apnea

MeSH Terms

Adult*
Compensation and Redress
Cone-Beam Computed Tomography
Dental Arch
Humans
Models, Theoretical
Molar
Nasal Cavity
Palate
Palate, Hard*
Sleep Apnea, Obstructive*

Figure

  • Figure 1 A, Lateral cephalometric radiograph illustrating the cephalometric landmarks, and linear and angular measurements used for the cephalometric analysis. ∠ANB, This angle represents the anteroposterior position of the maxilla to the anteroposterior position of the mandible; ∠FMA, the mandibular plane-Frankfort horizontal plane angle represents the cant of the mandibular plane to the Frankfort horizontal plane; Upper pharynx width, the width is measured from a point on the posterior outline of the soft palate to the closest point on the posterior pharyngeal wall; Lower pharynx width, the width is measured from the intersection of the posterior border of the tongue and the interior border of the mandible to the closest point on the posterior pharyngeal wall. B, Reorientation for the measurement of hard palate morphology. Horizontal plane, the tangent plane of the maxillary alveolar bone at its most inferior level; sagittal plane, the plane perpendicular to the horizontal plane and through the ANS-PNS line; coronal plane, the plane perpendicular to both horizontal plane and sagittal plane.

  • Figure 2 A, Linear and angular measurement for hard palate morphology and the first molar. 1 and 2, Measurement of palatal length, width, and height; 3, the width of the nasal cavity and the angle of the first molar palatal root on the first molar coronal plane; 4, the palatal slope inclination and the width of the palate roof (upper width) on the first premolar and first molar coronal plane. B, The three-dimensonal (3D) surface set up using generalized additive models with integrated smoothness estimation based on the cone-beam computed tomography (CBCT) data set. 1, ANS-PNS was divided into 14 pieces in the sagittal section; 2, in each coronal section corresponding to these 14 pieces, along the contour line of the palatal bone, 8 points were chosen; 3, in total, 113 points were chosen for establishing the 3D surface of palatal bone; 4 and 5, 3D surface of palatal bone. C, A nonlinear curve approximation model of the palatal bone contour line in the first premolar (1), first molar (2), palatal suture (3), and palatal undersurface section (4) were set up based on the CBCT data set.

  • Figure 3 A, Comparison of the three-dimensional (3D) palate of the obstructive sleep apnea (OSA) and control groups. 1, The 3D palate of the OSA group; 2, the 3D palate of the control group; 3 and 4, superimposition of the OSA and control groups; 5 and 6, the color map of the difference between the OSA and control groups. The blue color means that the hard palate of the OSA group is higher than that of control group, and the red color means the opposite. B, The twodimensional comparison of the palates of the OSA and control groups in the first premolar (1), first molar (2), palatal suture (3), and palatal undersurface section (4). Red, OSA group; blue, control group.


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