Allauddin Siddiqi Jules A. Kieser Rohana K. De Silva Andrew McNaughton Warwick J. Duncan Could the median-palate accommodate wide-bodied implants in order to support maxillary over-dentures? A radiomorphometric study of human cadavers Authors’ affiliations: Allauddin Siddiqi, Oral Implantology Research Group, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand Jules A. Kieser, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand Rohana K. De Silva, Department of Oral Diagnostic & Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand Andrew McNaughton, Department of Anatomy and Structural Biology, School of Medical Sciences, Otago Centre for Confocal Microscopy, University of Otago, Dunedin, New Zealand Warwick J. Duncan, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand Corresponding author: Allauddin Siddiqi Sir John Walsh Research Institute, Faculty of Dentistry University of Otago PO Box 647, Dunedin 9054, New Zealand Tel.: +64 3 479 5664 Fax: +64 3 479 5661 e-mail: siddiqidr@gmail.com Key words: bone micro-architecture, bone resorption, complete edentulism, implant overden- ture, median-palatal region, micro-CT Abstract Introduction: Atrophy of the alveolar bone is an irreversible multifactorial phenomenon, the rate of which varies between individuals and between the jaws. This atrophy of the alveolar ridges presents severe limitations for the oral rehabilitation of the edentulous patients and poses a clinical challenge to the prosthodontists and implant surgeons. The present research aimed to investigate whether the median-palate of elderly edentulous subjects is anatomically suitable for implant placement. Materials and methods: A total of 32 samples were harvested from the maxillae of 16 human cadavers. One dentate male subject was included for contrast. Bone quality and quantity were analysed at two regions: the median-palate and the edentulous maxillary alveolar ridge. Samples were scanned through micro-CT, and the region of analysis (ROA) identified and dissected. Bone volume to tissue volume ratio (%BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp) and trabecular bone pattern factor (Tb.Pf) were evaluated for the two regions using Skyscan CTAn ® . Results: The results of bone volume fraction obtained from CTAn ® of the median-palatal region show higher values than the respective premolar sites in 12 of 15 (80%) edentulous samples. However, this difference was statistically non-significant (P = 0.06). Similarly, the trabecular number for 10 of 15 samples (66.6%) from the median-palate shows greater values than the respective premolar site (P = 0.07). Trabecular thickness of 10 of 15 (66.6%) premolar samples is larger than in the median-palatal region. However, these differences were also statistically non-significant (P = 0.25). Statistically significant difference (P = 0.04) was found between the Tb.Sp values of the two regions. Conclusion: The results indicate that the anterior median-palate is structurally better than their respective maxillary premolar region in elderly edentulous persons, and an implant can be placed to anchor an overdenture. The best site for a wide-body implant was established to be 6–8 mm posterior to the incisive foramen in elderly edentulous patients. Loss of teeth leads to irreversible atrophy of the alveolar bone, the rate of which varies between individuals and between the jaws (mandible and maxilla) (Atwood 1979; Ulm et al. 1999, 2009). Alveolar ridge atrophy limits the oral rehabilitation of edentulous patients and thus poses a clinical challenge to prosthodontists and implant surgeons. One of the most significant paradigms in implant dentistry is to improve the quality of life of edentulous elders (Awad et al. 2003; Petersen & Yamamoto 2005). Dental implants offer a predictable treatment modal- ity for oral rehabilitation, with implant- supported overdentures having been proposed as the standard of care in the rehabilitation of edentulous patients with its resultant improvement in the quality of life (Mericske- Stern 1998; Feine et al. 2002; Awad et al. 2003; Stanford 2007). Whilst much attention has been paid to the implant design features such as length, diameter and surface, novel implant sites and the quality of bone at these sites have received relatively less attention. Date: Accepted 8 September 2012 To cite this article: Siddiqi A, Kieser JA, De Silva RK, McNaughton A, Duncan WJ. Could the median-palate accommodate wide-bodied implants in order to support maxillary over-dentures? A radiomorphometric study of human cadavers. Clin. Oral Impl. Res. 25, 2014, 101–109 doi: 10.1111/clr.12050 © 2012 John Wiley & Sons A/S 101