Microimplant (MI) displacement pattern of the Maxillary

Skeletal Expander (MSE) studied with Cone-beam computed

tomography (CBCT)

Authors and their affiliations

Ney Paredes1,2, Ausama Gargoum2, Ramon Dominguez-Mompell3, Ozge Colak4, Joseph

Bui2, Tam Duong2, Maya Giannetti5, Fernanda Silva2, Kendra Brooks2, Won Moon6,7
1
Private Practice, Innova Orthodontics, Houston, TX.
2
UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room
63-082 CHS, 10833 Le Conte Ave, Box 951668, Los Angeles, CA 90095-1668.
3
Orthodontics Department, Rey Juan Carlos University, Madrid, Spain.
4
Orthodontics Department, State University of New York, at Buffalo, NY.
5
UCSF School of Dentistry, Section of Orthodontics
6
Adjunt Professor at Orthodontic and Craniofacial Development Research, Forsyth
Institute, 245 First Street, Cambridge, MA 02142.
7
Professor at AJOU University, School of Medicine, Orthodontic Department, South
Korea

Corresponding authors

Won Moon and Ney Paredes

1550 Burnett St, Houston, TX 77009.

e-mails: themoonprinciples@gmail.com and neyalbertoparedes@gmail.com

Phone numbers: 3108660814 - 4243992391

Declarations
The authors declare the absence of any conflict of interest.

Ethics approval and consent to participate

The present retrospective investigation received approval from the Institutional Review
Board at University of California, Los Angeles (UCLA). IRB number: 17-000567

Consent for publication

Not applicable.
Availability of data and materials
Data of the present study will not be shared because the same data and materials will be
used in further publications where the analysis of different midface bones and sutures will
be presented.

Competing interests
All the authors declare that they have no competing interests.

Funding
The authors declare that they have not received any sources of funding for the research.

Acknowledgements
None

Authors Information
The maxillary skeletal expander (MSE) (which is a type of micro-implant assisted rapid
palatal expander) used in the present study has been developed and used since 2003.
Nowadays it is one of the types of MARPE that is widely used globally.
Microimplant (MI) displacement pattern of the Maxillary
Skeletal Expander (MSE) studied with Cone-beam computed
tomography (CBCT)

ABSTRACT

Objective: The aim of this study was to analyze the microimplant displacement pattern
of the MSE expander on cone-beam computed tomography (CBCT).
Methods: Thirty-nine subjects (12 male and 27 female) with a mean age of 18.2 ± 4.2
years were treated successfully with MSE II. Pre- and post-expansion CBCT records were
superimposed. Anterior and posterior inter-MI angle, neck and apical inter-MI distance,
plate angle, palatal bone thickness at MI positions, and suture opening at MIs positions
were measured and compared between the pre- and post-expansion records.
Results: The jackscrew plate slightly bends in both the anterior and posterior area. There
was no significant difference between the amount of anterior and posterior suture opening
at MIs positions (P>0.05). The posterior micro-implant to hemi-plate line was greater than
the anterior one (P<0.05). The apical distance between the posterior MIs was greater
than the anterior one (P<0.05). The palatal thickness at the anterior MIs was significantly
higher than the bone thickness at the posterior MIs. (P>0.01).
Conclusions: In the coronal plane, the angulation between the anterior micro-implants
in relation to the jackscrew plate was greater than the angulation between the posterior
micro-implants due to the differential palatal bone thickness.

Key words: expansion, microimplant-assisted rapid palatal expansion (MARPE),

maxillary skeletal expander (MSE), bone-anchored maxillary expander (BAME)
INTRODUCTION

The midpalatal suture becomes more tortuous and interdigitated with increasing age.1
Rapid palatal expansion (RPE) can obtain acceptable outcomes when performed before
the end of the adolescent growth spurt. However, dentoalveolar side effects will become
more obvious in adults.2-4 In mature patients, surgically assisted rapid palatal expansion
(SARPE) and microimplant-assisted rapid palatal expansion (MARPE) constitute
alternatives of obtaining skeletal expansion.5-9

The Midfacial Skeletal Expander (MSE) is one of these types of MARPE appliances. Its
jackscrew plate houses four microimplants (MI) that are bi-cortically engaged in the
posterior region of the palate. This characteristic contributes to the appliance’s
effectiveness in opening the midpalatal and circummaxillary sutures, promoting a more
superior and posterior expansion.10-14

However, the posterior palatal bone is relatively thin, and the MI displacement sometimes
is inevitable during the expansion when the resistance is high.15, 16 The midpalatal suture,
the zygomatic buttress and the pterygomaxillary suture are the three main resistance
structures that play an important role to achieve skeletal expansion.12-14 For this reason,
the anatomy of the palatal bone and circummaxillary structures must be properly
evaluated on CBCT prior to determining the exact position of the MSE. The above
structures pose posterior resistance, and the expansion force must be applied in the
posterior palate, with the relatively thin bone. Since the palatal bone consists of dense
cortical bone immediately lateral to the midpalatal suture, this site has been determined
as the most stable site in the maxilla for MI.16 Cortical bone thickness and density closer
to the midpalatal suture is higher compared to the middle and lateral areas of the posterior
palate. The palatal bone thickness and density also vary in the anterior and posterior
regions. Bone thickness is higher in anterior areas compared to the middle and posterior
areas.16, 17 However, the MSE jackscrew plate should be positioned at the level of the
zygomatic buttress, as this is one of the main resistance structures to be overcome during
expansion.12, 14
Finite element method (FEM) has been used in Orthodontics to evaluate stress, strain
and force distribution of different appliances delivered into craniofacial structures.18, 19
Recent studies have looked at the effectiveness of mono-cortical vs bi-cortical MI
anchorage in MSE by evaluating stress distribution and displacement.11, 20 However, this
method represents a simulation of clinical situations using simulated 3D skull models. On
the other hand, cone beam computed tomography (CBCT) allows to study the actual
pattern of movement of maxillofacial bones, dentoalveolar structures and MI, by any type
of expansion device, in three dimensions and with minimum image distortion and radiation
dosage.7, 8, 21, 22

Previous studies have observed the stability of the MI with different length and diameter.18,
23
However, studies regarding the displacement of MI during the expansion are lacking.
The aim of this study was to analyze the microimplant displacement pattern of the
Midfacial Skeletal Expander with Cone-beam computed tomography.
MATERIAL AND METHODS
This retrospective study was conducted under the Institutional review board approval (IRB
number 17-000567) by the University of California, Los Angeles (UCLA). Pretreatment
(T0) and post expansion (T1) CBCT records were obtained from 39 subjects (12 males,
27 females), who were successfully treated with MSE II (Biomaterials Korea, Seoul,
Korea) appliance with absence of any craniofacial anomaly, and no history of orthodontic
treatment. The mean age of the sample was 18.2 ± 4.2 years with maturation stage of
CS4 or more. All the patients were diagnosed with maxillary transverse deficit according
to the maxillomandibular bone width discrepancy.12 One clinician supervised the
treatment for all patients at the Section of Orthodontics, UCLA School of Dentistry. Post
expansion records were obtained after the active expansion phase was successfully
finished and before bracket bonding. CBCT scans were taken before treatment (T0) and
within 3 weeks after the completion of expansion (T1). A CBCT scanner (5G; NewTom,
Verona, Italy) with an 18 X 16 cm field of view, 14-bit grayscale, and a standard voxel
size of 0.3 mm was used to scan all the subjects.

The maxillary sagittal plane was established in the T0 scan, passing through the anterior
nasal spine, posterior nasal spine, and nasion.12 The following steps were necessary to
determine the anteroposterior position of the jackscrew and to assess the bone thickness
for the four MIs (Fig 1). First, at the level of the upper dentition on the axial view, the green
line (representing a coronal cut) was displaced from anterior towards posterior direction
until the zygomatic buttress is at its maximum expression in the coronal view. This new
anteroposterior level of the green line on the axial view represented the anteroposterior
center of the jackscrew. The orange line in the axial and coronal view represents the
sagittal axis of the jackscrew and matches the midpalatal suture. Since the holes for the
4 MIs were located in a combination of 5 mm anterior/posterior and 3 mm right/left
coordinates, the orange and green line were moved accordingly to obtain the bone
thickness at the level of the MI positions. The bone thickness associated with these 4
locations helped to determine the minimum length of the microimplants to be bi-cortically
engaged into the palate (Fig 1). The landmarks were then translated to the dental casts
for the MSE fabrication.
The MSE II appliance (Fig 2) consists of a jackscrew framework that houses four palatal
MIs of 1.8 mm diameter by 11 or 13 mm of length. In addition, two supporting arms extend
from the jackscrew and are welded to the molar bands. The rate of expansion was 4-6
turns per day (0.133 mm per turn, ≈0.5-0.8 mm. per day) until a significant diastema of 2
to 3 mm. appeared; then the rate changed to 2 turns (≈0.267 mm) per day until the
maxillary skeletal width matched or was greater than the mandibular width. The maxillary
skeletal width represented the distance between the right and left most concave points,
lying on the maxillary vestibule above the mesiobuccal cusps of the first molars. The
mandibular width was defined as the distance between the right and left buccal surface
over the furcation of first molars.12 The MSE was maintained in place with no additional
activation for at least 6 months. To assess the effects induced purely by MSE, the T1
scans were obtained immediately after the expansion and before the patient received any
other orthodontic appliances.

OnDemand3D (Cybermed, Daejeon, Korea) software was employed to superimpose the

T0 and T1 CBCT images using the anatomic structures of the entire anterior cranial base,
by voxel gray-scale pattern automated matching. After superimposition of CBCT data sets,
the maxillary sagittal plane was identified in the T0 scan.12 Then, the distances of anterior
nasal spine (ANS) and posterior nasal spine (PNS) openings were measured on the T1
axial view, and their values were converted to a ratio of PNS to ANS in order to determine
the parallelism of the suture split. Later, on the T1 scan, the anterior MIs were identified
on the axial view. The horizontal line in the axial view connecting the anterior MIs were
identified, and the anterior-coronal-MI section was determined (ACMIS) in the coronal
view (Fig 3).

Angular measurements were performed including the inter-microimplant angle which was
determined by drawing a line through the long axis of both right and left MIs (IMIA). These
two lines were projected superiorly until they intersected, and the corresponding angle
was recorded. During the expansion, the jackscrew plate often gets bent slights. The plate
angle (PA) was measured at the point of convergence of the two hemi-sections of the
jackscrew plate. The MI to hemi-plate angle was measured by connecting the long axis
of the right or left MI to the respective hemi section of the jackscrew plate (MIPA).

Linear measurements were also recorded. The inter-microimplant neck distance was
described as the distance between the right and left central part of the MI neck that is
embedded in the jackscrew plate (IMND). The inter-microimplant apical distance was
recorded as the distance from right to left MI at the apical level (IMIAD). In addition, the
ratio between the inter-microimplant neck and inter-microimplant apical distance was
obtained for both anterior and posterior MIs. The bone thickness that supported the MIs
was calculated as palatal thickness at microimplant site (PTMI). Finally, the suture
opening at the anterior and posterior MIs (SOMI) was measured as well (Fig. 4). Once all
the measurements were obtained for the anterior MIs, the posterior coronal MI section
was determined (PCMIS) and the measurement process was repeated.

Statistical analysis
Based on the findings of a previous study,12 the minimum sample size for revealing
significant changes after MSE for this study was calculated as 14 patients. This was
based on a power of 0.85, an alpha of 0.05, and a mean difference of 1.0 ± 1.0 mm for
lateral displacement of the zygomaticomaxillary complex after expansion. Therefore, the
patient sample size of 39 patients was determined to be sufficient to determine
significance. Measurements were taken for all the parameters studied on 10 randomly
selected patients, by 2 raters, to assess method reliability. Measurements were then
repeated after 4 weeks by the same operators to compute reliability parameters.
Descriptive statistics were performed. Distribution tests were applied. T-independent and
Mann-Whitney U tests were used to compute the p value to find the difference between
anterior and posterior MI displacement pattern. Additionally, T-independent tests were
performed to assess any difference between male and female subjects. Finally, Pearson
correlation coefficient was established to determine if there was any correlation between
the amount of ANS-PNS opening with the MI displacement pattern and the palatal
thickness.
RESULTS
The average amount of activation of the MSE expansion jackscrew was 9.2 ± 1.6 mm.
The average amount of ANS opening was 5.0 ± 2.1 and PNS opening was 4.9 ± 2.5. The
PNS to ANS ratio accounted for 0.99 ± 0.41. There was no significant difference between
right and left: anterior MI to plate angle (P=0.758), posterior MI to plate angle (P=0.572),
anterior palatal thickness at MI position (P=0.973) and posterior palatal thickness at MI
position (P=0.503) (Table I).

When the right and left values were combined, the posterior MI to plate angle was
significantly greater than the anterior one (P=0.029*), and the anterior palatal thickness
at MI position was found to be significantly greater than the posterior one (P=0.006**).
There was no statistical difference between the anterior and posterior: inter-micro-implant
angle (p=0.076), plate angle (p=0.552), suture opening at the MI positions (p= 0.695),
inter-micro-implant neck distance (P=0.157) and the inter-micro-implant neck to inter-
micro-implant apical distance ratio (P =0.089). However, the posterior inter-micro-implant
apical distance was significantly greater than the anterior one (P=0.034*). (Table II).

Male and female patients had similar age distribution (p>0.05). The palatal thickness at
the MI position was significantly higher for the male subjects on both the anterior (p<0.01)
and posterior regions (p<0.05) There was no significant difference between males and
females for all the other MI displacement pattern variables (p>0.05) (Table III).

There was a strong positive correlation between the age and the anterior inter-micro-
implant angle 0.670 (p<0.01), and a low positive correlation with the posterior inter-micro-
implant angle 0.372 (p<0.05). There was a low negative correlation between the
magnitudes of posterior palatal thickness at the MI position with the posterior micro-
implant to plate angle -0.347 (p<0.01). There was only a moderate negative correlation
between the magnitude of the posterior inter-micro-implant angle and the PNS to ANS
ratio -0.418 (p>0.01). For the considered parameters, the intra-class correlation
coefficient (ICC) value was 0.93 showing that measurements were highly reliable.
DISCUSSION

The MSE is one type of MARPE appliance that corrects transverse maxillary deficiency
by opening the midpalatal and circummaxillary sutures.12-14, 19, 24, 25 The MSE produces a
more superior and posterior maxillary expansion due to the posterior and bicortical
placements of MIs in the palatal bone. The micro-implants in the MSE are the palatal
bone anchor for the jackscrew. The length of the micro-implants chosen in MSE treatment
plays an important role. In general, 11 to 13 mm are needed to achieve bicortical
engagement. The bicortical engagement of the 4 microimplants provides an important
foundation to the MSE system in order to overcome the main posterior resistance against
expansion, the zygomatic buttresses and pterygopalatine sutures. This posterior position
of the MSE disarticulates the pterygopalatine suture allowing a more parallel expansion.13
For these matters, the anteroposterior position of the jackscrew is fundamental. This
posterior site is often coincident with the sagittal location of the upper first molars. This
study presented the steps to achieve the recommended anteroposterior position of the
jackscrew, at the level of the maximum expression of the zygomatico-maxillary buttress
on CBCT assessment. Based on this reference, the position for the 4 micro-implants were
planned: 3 mm lateral from the maxillary sagittal plane (coincident with the midpalatal
suture) and 5 mm anterior and posterior from the coronal center of the jackscrew. This is
the first article that investigates the different displacement pattern of the anterior and
posterior MIs during the MSE expansion.

As described in the literature, the palatal bone is thicker in the anterior area and tapers
towards the posterior nasal spine.16, 17 Interestingly, the palatine processes of the maxilla
are connected in their posterior end with the thin horizontal plates of the palatine bone
forming all together the hard palate. For this reason, a different displacement pattern
between anterior and posterior MIs after micro-implant supported rapid maxillary
expansion with MSE would be anticipated. In fact, some MSE cases display clinically a
wider expansion of the jackscrew at the posterior micro-implant position (Figure 5).
In the coronal plane, the jackscrew plate bent slightly by 2.5-3º, with no difference
between the anterior and posterior segments. The jackscrew is a very rigid structure at
the beginning as it has to support the forces that need to be built before achieving the
midpalatal suture split. Once expansion continues in order to achieve its maximum level,
the rigidity of the anterior and posterior guiding bars and the central screw become loose,
and the entire complex bends as the zygomatico-maxillary complex rotates.12, 14 Although
there was no statistically significant difference in the inter-micro-implant angle between
the anterior (18.5±9.8º) and posterior (14.4±10.2º) MIs (p>0.05), the angle between MI
and hemi-base plate was significantly different at the anterior and posterior sites. The
concomitant rotational movement of the zygomatico-maxillary complex12, 14 must have
played in the angular changes, increasing the inter-microimplant angle value for both
anterior and posterior MIs. On the other hand, the bending of the jackscrew plate would
produce the underestimated angular changes in MIPA. It appears the thinner bone in the
posterior area allows more translatory displacement, and the thicker bone in the anterior
area produces more tipping displacement of the MI during the MSE treatment.

There was no significant difference in palatal bone thickness at the site of the micro-
implants between the right and left sides, for both anterior and posterior regions.
Consequently, the MIPA between the right and left sides was not significant for both the
anterior and posterior palate. For this reason, the right and left sides were combined as
the anterior or posterior values. When comparing the angle between the micro-implants
and the jackscrew plate, the anterior MIs had a statistically lower value than the posterior
MIs. Although there was no significant difference in the neck inter-micro-implant distance
between anterior and posterior regions at, the posterior apical inter-micro-implant
distance was significantly higher (p<0.05). The above findings clearly demonstrated a
translatory displacement pattern of posterior MI and a tipping displacement pattern of
anterior MI. The anterior palatal bone thickness at the micro-implant site was greater than
the posterior palatal thickness (p<0.01). The differential thickness of the palatal bone
could have accounted for the different patterns of displacement between the anterior and
posterior MIs. In mature patients, a cumulative force is required to achieve the adequate
level of expansion to overcome the resisting anatomical structures. Until the
circummaxillary sutures are disarticulated, this continuous cumulative force will produce
mounting force against the implants and surrounding structures. When the anchor bone
is thin, as in the posterior palate, this mounting force against MI may not be countered by
the weak anchor bone, and MI could cut through the bicortical layers, producing
translatory displacement. In the anterior region, the anchor bone could withstand this
assault more effectively and prevent the MI from cutting through the bicortical layers.
Since the expansion force is generated from the inferior aspect of the palatal bone, the
palatal cortical bone would suffer the consequences more, producing a tipping
displacement pattern. This concept supports the loss of parallelism of both anterior and
posterior MIs. The lower angulation of anterior MIs to the plate and lower anterior inter-
micro-implant apical distance could be associated due to the difference of bone thickness
between anterior and posterior regions. The Pearson correlation tests found a
significantly negative correlation between the magnitudes of posterior palatal thickness
at the MI site with the posterior micro-implant to hemi-plate -0.347 (p<0.01),
demonstrating that a thicker bone produces more tipping displacement and thinner bone
produces more translatory displacement.

One essential factor that could affect the parallelism of the MI is the insertion depth of the
microimplants. Previous studies have shown that bicortical MI engagement provides
significantly greater resistance to screw deflection and greater stability than monocortical
MI engagement in the maxillary and the mandibular bone.10, 26 The bicortical engagement
ensures more support and retention area for the MI. However, this stability is also related
to the palatal bone thickness at the insertion area. A bicortical engagement in 3.5 mm
bone would produce more stability than with a 1.2 mm bone This investigation presents
the mean values of palatal bone thickness at the ideal location of the MI for 39 subjects
treated successfully with MSE. The mean anterior palatal thickness for the anterior MIs
accounted for 3.57±1.47 mm, and the mean posterior palatal thickness for the posterior
MIs accounted for 2.89±1.60 mm. When dividing the sample by gender, the palatal
thickness was significantly higher for the male subjects (4.53±1.25 mm) in comparison to
female subjects (3.14±1.36 mm) at the anterior MI site (p<0.001). Also, the palatal
thickness was significantly higher for the male subjects (3.47±1.50 mm) in comparison to
female subjects (2.62±1.58 mm) at the posterior MI site (p<0.05). These values are in
accordance with previous studies describing the maxillary bone topography, being the
anterior bony segments thicker than posterior segments, and male subjects presenting
thicker bone than female subjects.15-17 However, the presented values are related to the
more posterior position of the MSE, in comparison to other MARPE, and to the specific
site of the MI placement with a bicortical engagement.

As expected, there was no significant difference in the suture opening between the
anterior and posterior MI sites. The different displacement pattern between anterior and
posterior MIs to hemi-plate, inter-micro-implant apical distance and palatal thickness at
the micro-implant site was not correlated to the amount of suture split parallelism
expressed through the amount of ANS or PNS opening. This indicates that the observed
displacement pattern was produced prior to the disarticulation of sutures. Once the initial
split is obtained with MSE treatment, the subsequent movement would be a parallel
expansion described in the previous studies.13, 25 Clinicians should not be concerned
about the differential MI displacement pattern of the MIs once the expansion has occurred,
as it would not affect the anteroposterior parallelism of the expansion. The observed
displacements are of interest when the split does not occur, and one must manage any
negative consequences of these side effects.

There was a strong positive correlation between the age and the anterior inter-micro-
implant angle 0.670 (p<0.01) and a low positive correlation with the posterior inter-micro-
implant angle 0.372 (p<0.05). This could be explained because with age the sutures
become less patent, and a heavier orthopedics force is needed which causes more
displacement of MIs. Also, there was a moderate negative correlation between the
magnitude of the posterior inter-micro-implant angle and the PNS to ANS ratio -0.418
(p>0.01). With more posterior inter-micro-implant angle, we could expect to find less
parallel suture split from ANS to PNS. However, the PNS to ANS ratio accounted for 0.99
± 0.41 demonstrating that this correlation is not clinically significant. Further studies of the
displacement pattern of MI according to a broader sample of gender, racial and age
differences are needed. As all the current study subjects were successfully treated with
MSE, it would be interesting to compare these values to failed MSE expansion subjects.

CONCLUSIONS

1.- In the coronal plane there was more translatory displacement with the posterior MIs
and more tipping displacement with anterior MIs.
2.- The palatal thickness at the anterior MI site was significantly higher than in the
posterior MIs site, producing the above patterns of displacements.
3.- Despite the differences in displacement patterns, MSE produced a parallel expansion
at ANS and PNS, and at anterior and posterior MI sites.
4.- The palatal thickness was significantly higher in males than in females for both
anterior and posterior MIs regions.
5.- The jackscrew plate slightly bends while performing maxillary skeletal expansion.
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Figure Legends:

Figure 1: CBCT Landmarks for MSE fabrication. A. Green line on the axial view is at the
level of greater extension of the zygomatic buttress (seen in the coronal view). B. Orange
line in axial view matches the midpalatal suture. Planned MSE jackscrew position on axial
and sagittal view. C. Bone thickness measurements on the coronal and sagittal cuts at
the level of insertion of the right anterior MI.
Figure 2: MSE II device. One MSE II expansion turn is equivalent to 0.133 mm. 1
revolution = 6 turns = 0.8 mm of activation at the jackscrew. MSE II - 12 means its
expansion size is 12 mm = 90 turns.

Figure 3: Anterior-coronal-MI section (ACMIS) identified in the coronal view.

Figure 4: Parameters evaluated in the study. Angular Measurements: IMIA, inter-
microimplant angle; PA, plate angle; MIPA, microimplant to plate angle. Linear
Measurements: SOMI, suture opening at microimplant level; IMIND, inter-microimplant
neck distance; IMIAD inter-microimplant apical distance; PTMI, palatal thickness at
microimplant level.

Figure 5: A. MSE expansion showing a more parallel displacement of the anterior and
posterior MIs. B. MSE expansion displaying a wider displacement pattern for the posterior
MIs.
TABLES

Table I. Right vs left MI to plate angle and palatal thickness at MI level

Right Left
n Unit Mean SD Mean SD p value
o
Anterior MI to plate angle 39 81.93 5.20 82.3 5.5 0.758
o
Posterior MI to plate angle 39 84.34 5.13 83.66 5.54 0.572
Anterior Palatal thickness at MI level 39 mm 3.57 1.45 3.56 1.50 0.973
Posterior Palatal thickness at MI level 39 mm 3.01 1.60 2.76 1.61 0.503

MI: micro-implant

Table II All MI linear and angular measurements

Anterior Posterior
n Unit Mean SD Mean SD p value
MI angular measurements
o 18.55 9.84 14.46 10.20 0.076
Inter MI angle 39
o 177.08 2.82 177.46 2.60 0.552
Plate angle 39
o 82.12 5.35 84.01 5.32 0.029 *
MI to plate angle 78
MI linear measurements
Suture opening at MI level 39 mm. 5.01 1.90 4.84 1.94 0.695
Inter-MI neck distance 39 mm. 12.96 1.92 13.60 2.04 0.157
Inter-MI apical distance 39 mm. 9.99 2.37 11.22 2.68 0.034 *
Inter-MI neck to apical ratio 39 mm. 0.77 0.13 0.82 0.14 0.089
Palatal thickness at MI level 78 mm. 3.57 1.47 2.89 1.60 0.06

* p < 0.05
** p < 0.01
MI: micro-implant

Table III. Male vs female palatal thickness at MI level

Male (n=12) Female (n=27)

Mean SD Mean SD p value
Age 18.08 4.81 18.07 4.34 0.995
Anterior palatal thickness at MI level (mm) 4.53 1.25 3.14 1.36 < 0.001***
Posterior palatal thickness at MI level (mm) 3.47 1.50 2.62 1.58 0.031*

* p < 0.05
*** p < 0.001
MI: micro-implant