Evaluation of palatal support tissues for placement of orthodontic mini-implants in mouth breathers with high-narrow palates versus nose breathers with normal palates: a retrospective study

  • Qichao Kang
  • Chang Cha
  • Desheng Huang
  • Sihui Zuo
  • Xiulin YanEmail author
Original Article



The aim of this study was to compare the palatal total support tissues (TSTs) and bone support tissues (BSTs) at 5-mm paramedian section to the midsagittal suture between mouth breathers with high-narrow palates and nose breathers with normal palates and confirm the practicability and limitation on superimposition of lateral cephalograms and plaster models for orthodontic mini-implant (OMI) implantation in these patients.

Material and methods

The sample consisted of 27 mouth breathers with high-narrow palates (study group (SG)) and 27 nose breathers with normal palates (control group (CG)). Upper digital dental models were superimposed with corresponding cone beam computed tomography (CBCT) images; then, TSTs and BSTs vertical to the curvature of the palatal mucosa were measured on the 5-mm paramedian section to the midsagittal suture. The measuring sites were the third ruga (R) and the sites anterior and posterior to R at 2-mm interval (A2, A4, A6, and A8; P2, P4, P6, and P8) along the palatal mucosa outline. TSTs and BSTs were also measured on the superimposition of lateral cephalograms and plaster models, and the site with the largest TST value in each patient was recorded. Descriptive statistics, independent-samples t test, and hierarchical clustering heat map were used for statistical analysis.


The greatest average values of TSTs and BSTs in SG were 12.24 ± 2.63 mm and 9.59 ± 2.36 mm at P2 site, and those in CG were 12.96 ± 2.39 mm and 10.56 ± 2.38 mm at R site, respectively. The average values of both TSTs and BSTs in SG were less than those in CG at all insertion sites. Significant differences (P < 0.05) were found at A4, A6, and R for TSTs and at R and P4 for BSTs. P2 and R were clustered together for both TSTs and BSTs by the cluster analysis on heat map in both SG and CG. In both groups, only one patient from SG was found to have the insertion site with the largest TST value on 2D superimposition located in the blue area on the heat map, where the measurement values of TSTs were less than 8.5 mm and those of BSTs were less than 5 mm.


Mouth breathers with high-narrow palates may have less palatal support tissues than nose breathers with normal palates at 5-mm paramedian section to the midsagittal suture of palate. The site a little posterior to R is more suitable for OMI implantation in mouth breathers. Two-dimensional superimposition of lateral cephalograms and plaster models can provide relatively effective assessment for the site choice of OMI implantation in both mouth breathers with high-narrow palates and nose breathers with normal palates.

Clinical relevance

Three-dimensional superimposition of CBCT data and digital dental model can provide accurate information for palatal OMI implantation. Meanwhile, 2D superimposition of lateral cephalograms and plaster models can be used for assessing the implantation sites at 5-mm paramedian section to the midsagittal suture of palates in mouth breathers under most conditions even those who have less palatal support tissues.


Palatal mini-implants Mouth breathers Lateral cephalograms CBCT 



This study was funded by Project of Science and Technology Research from Department of Education of Liaoning Province (grant number LK201607).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the School of Stomatology, China Medical University (2016-6), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthodontics, School of StomatologyChina Medical UniversityShenyangChina
  2. 2.Department of Epidemiology, School of Public HealthChina Medical UniversityShenyangChina

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