Original Article

3-D image analysis on palate growth changes from birth to 1

month in healthy infants
Fusae Ishida
a,c
, Masanori Mashiko
a,c
, Ikuko Shimabukuro
b
, Seiko Yamamoto
c
,
Kunihiko Shimizu
c
, Takahide Maeda
c,
*
a
Ishida Dental Clinic, 28-16 Inarimae, Tsukuba, Ibaraki 305-0061, Japan
b
Osamu Family Dental Clinic, 1-31-2 Kyuuna, Ginowan, Okinawa 901-2222, Japan
c
Department of Pediatric Dentistry, Nihon University School of Dentistry at Matsudo, 2-870-1 Sakaecho-nishi, Matsudo, Chiba 271-8587,
Japan
a r t i c l e i n f o
Article history:
Received 3 October 2012
Received in revised form
26 December 2012
Accepted 21 January 2013
Available online 25 April 2013
Keywords:
Newborn
1-month-old infants
Palate
Growth changes
3-D measurement
a b s t r a c t
In order to study the relations of malocclusion formation and feeding behavior as a sci-
entic research project, we measured the 3-D morphology of 31 healthy newborns within 7
days of birth and 1 month later using dental casts. Nine characteristics were selected and
the developmental changes were analyzed using specialized software for investigating
palatal development in detail. The results revealed that the palatal width, 3 palatal
characteristics relating to depth, maximum slope location, and mean slope increased
signicantly during the 1 month, but there were no signicant changes observed in palate
length, cuspid ratio, and maximum slope. There was a signicant correlation between
palate depth and maximum depth point location, suggesting that the deeper points tended
to be located further back. No signicant correlations were observed between newborns
within 7 days of birth and 1 month after birth for cuspid ratio, maximum depth point
location, and maximum slope. Our observation of inter-characteristics correlations
revealed 7 signicant (P < 0.01) combinations out of a total of 33 combinations were
observed in newborns within 7 days of birth, while only 4 were observed in 1-month-old
infants. This appears to have been because of morphological changes occurring between
individuals due to growth. Thus, it was claried that not only size but shape (cuspid ratio,
maximum slope point location, and the mean slope) also changes over the rst month
after birth.
2013 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.
1. Introduction
Malocclusion in children has become an increasing problem
in recent years. Malocclusion is caused by a combined inu-
ence of genetic and environmental factors. As genetic factors,
Weinberger recognized that most cases of malocclusion and
hypoplasia of palate occurred at 2e3 weeks in embryo, and
were not caused by feeding behavior [1]. Hellman noted that
the disturbance existed in the bone originally, while the teeth
only help us for its recognition [2]. The environmental factors
include oral muscle activity and oral habits. Their major
functions in infants are breathing and suckling. In particular,
suckling inuences the morphology of the palate soon after
birth.
* Corresponding author. Fax: 46 47 360 9429.
E-mail address: maeda.takahide@nihon-u.ac.jp (T. Maeda).
Available online at www.sciencedirect.com
Pediatric Dental Journal
j ournal homepage: www. el sevi er. com/ l ocat e/ pdj
p e d i a t r i c d e nt a l j our na l 2 3 ( 2 0 1 3 ) 3 7 e4 3
0917-2394/$ e see front matter 2013 The Japanese Society of Pediatric Dentistry. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.pdj.2013.03.006
Leighton measured the shape variations of palate in 6-
month-old 109 infants, involving 30 pairs of twins, and stated
that shape variations were affected by physical sucking force
more than heredity [3]. While Nagaishi et al. measured palatal
morphology in predental period infants of 3 months or older
and reported that different types of feeding during infancy did
not affect changes in palatal morphology [4], Takekoshi and
Hayama reported that feeding method did affect palate length
in 6-month-old infants [5]. Hohoff et al. measured palatal
width, depth, and capacity in infants aged from within 1 week
to older than 1 year by stereo photography method at 3-month
intervals [6]. The authors believe that while the interval was
too long to observe the changes in detail, also their measure-
ments cannot show 3-D morphological changes.
The inuence of postnatal environment in palatal mor-
phology is thought to be insignicant in newborns within 7 days
of birth, who therefore formed the starting point for palatal
morphologyinthisstudy. Ingeneral, embryological sciencestates
that younger subjects exhibit greater morphological changes and
Leighton[3] andvander Lindenhadreportedthat markedgrowth
occurs in the jaw during infancy [7]. So we analyzed infants 1
month after birth to observe the growth change.
This study involved taking dental casts within 7 days of
birth (the starting point) and 1 month later, measuring them
with 3-D measuring equipment, selecting 9 characteristics of
palatal changes andanalyzingthesewithspecializedsoftware.
The focus of the study was placed on the changes in palatal
morphology in newborns from within 7 days of birth to 1
month after birth without considering environmental factors.
2. Subjects and methods
The subjects for this study were 31 dental casts taken from 20
male and 11 female Japanese full-term infants, weighing 2500 g
or more but less than 4000 g at birth (mean male weight: 3089 g,
mean female weight: 2982 g) within 7 days of birth (mean age
3.6 days) (hereafter referred to as newborn) and dental casts
taken from the same infants 1 month after birth (hereafter
referred to as 1-month-old infants). In this study, previously
made impressions were used, and no new impression taking
was done. Nevertheless, it is worth noting the process of how
impression taking for newborns was conducted. Although it is
difcult to take oral impressions directly after birth, we
conrmed the safety by taking impressions from newborns
within 7 days of birth with breathing and circulation manage-
ment. Before the impression taking of the infants, we rst
conrmed that at least one hour had passed since the last
suckling. Ostron trays were prepared before impression taking.
Silicon heavy body type impression materials were used and
insertion time within the oral cavity was kept within 30 s. The
amount of impression material to be used was decided by close
attention to infants posture and we made sure that materials
did not owback into their throats. Then dental plaster models
were created from the thus acquired impressions.
The following methods were applied in this study. When
investigating 3-D palatal morphology, 3-D measurement was
conducted with a laser oscillator (LK-080, Keyence Corpora-
tion, Osaka, Japan) and a stage controller (CP-500, COMS Co.
Ltd., Amagasaki, Japan) and E-Measure software (COMS Co.,
Ltd.). When conducting measurements, 3 points were used as
standards: M: the most prominent part of the alveolar crest in
the central incisor segments. R: cross point of right lateral
sulcus and alveolar crest. L: cross point of left lateral sulcus
and alveolar crest. These are the points where impressions
could be taken clearly. The measurement of these points was
conducted manually with a measuring machine using X, Y,
and Z as coordinates. The plane passing through these 3
points was set as the reference plane for 3-D measurements
and then we scanned the entire dental casts. The range of the
scanning was 40,000 mm in the X-axis (frontal plane), and
50,100 mm in the Y-axis (sagittal plane). Measurement pitch
was set at 200 mmfor the X-axis and 300 mmfor the Y-axis. The
X, Y, and Z coordinates at each measurement point were
saved in text le on a personal computer. The 3-D measure-
ment was conducted by the same person (the rst author). In
addition, when a line was drawn (hereafter, center line) from
M, joining the midpoint O between R and L, measurement
range in the anterior direction was set as M. Left and right
measurement range was set as top of alveolar crest, with
posterior direction set as 1.2 times the distance from M to the
maximumdepth point. Image analysis and statistical analysis
of 3-D data was conducted with dental cast analysis Dentist2
software (Yasuo Ukai, unreleased) developed independently
by a collaborator in this study.
The following 9 characteristics were investigated during
the analysis of dental casts. See Figs. 1 and 2 for reference.
1. Width (RL): Distance from R to L (mm)
2. Length (H): Distance fromMto a point where perpendicular
lines drawn to the line segment R-L (mm)
3. Cuspid ratio (CR): a ratio width/length
4. Maximum depth (max dep): Distance from reference plane
to maximum depth point above the center line (mm)
5. Maximum depth point location (loc dep): Distance from M
on the center line to the maximum depth point (mm)
6. Mean depth (mean dep): Mean depth (mm) along the center
line from M to the maximum depth point
7. Maximum slope (max slp): Maximum increase (mm) of the
depth per pitch (200 mm) along the center line from M to the
maximum depth point
Fig. 1 e Denition of the characteristics width (char. 1) and
length (char. 2). M: The most prominent part of the alveolar
crest in the central incisor segments. R: Cross point of right
lateral sulcus and alveolar crest. L: Cross point of left lateral
sulcus and alveolar crest. (1) Width (RL): Distance from R to
L (mm). (2) Length (H): Distance from M to a point where
perpendicular lines drawn to the line segment R-L (mm). (3)
Cuspid ratio (CR): Width/Length.
p e d i a t r i c d e nt a l j o ur na l 2 3 ( 2 0 1 3 ) 3 7 e4 3 38
8. Maximum slope location (loc slp): Location of point exhib-
iting maximum slope on the center line from M (mm)
9. Mean slope (mean slp): Mean increase of depth (mm) per
pitch on the center line
3. Statistical analysis
We calculated correlations between newborn and 1-month-
old infants (correlation over the growth period) for the 9
characteristics in addition to inter-characteristic correlations
in newborn and 1-month-old infants. We also performed the
paired t-test for differences in the mean values in newborn
and 1-month-old infants.
We used the t-test to examine gender differences in the
newborns and 1 month after birth. This study was conducted
with the approval of the Ethics Committee of the Nihon Uni-
versitySchool of Dentistryat Matsudo(Approval code: EC12-007).
4. Results
4.1. Correlations between newborn and 1-month-old
infants for the 9 characteristics
1) There was signicant correlation (P < 0.01) for the 4 char-
acteristics i.e. width (char. 1), maximum depth (char. 4),
mean depth (char. 6), and mean slope (char. 9) (Table 1).
2) The correlations for length (char. 2) and maximum slope
location (char. 8) were signicant (P < 0.05).
3) The correlations for cuspid ratio (char. 3), maximum depth
point location (char. 5), and maximum slope (char. 7) were
not signicant.
4.2. Inter-characteristic correlations in newborn and
1-month-old infants
1) The correlation between width (char. 1) and length (char. 2)
was highly signicant in newborn (P < 0.01) (Table 2) and
also signicant (P < 0.05) in 1-month-old infants (Table 3).
2) Ahighlysignicant negativecorrelationP<0.01wasobserved
between length (char. 2) and cuspid ratio (char. 3) in both
newborn and 1-month-old infants.
3) The correlation between maximum depth (char. 4) and
maximum depth point location (char. 5) was signicant in
newborn (P < 0.01) and in 1-month-old infants (P < 0.05).
Maximum depth was correlated with its location from the
point M. Namely, thedeeper themaximumdepth, the further
back the location of the maximum depth was located.
4) In newborns, highly signicant correlations were observed
for 7 out of the 33 combinations of the characteristics, while
only 4 combinations were highly signicant in 1-month-old
infants.
4.3. Mean, standard deviations, and coefcients of
deviation of the 9 characteristics for newborn and 1-month-
old infants and paired t-test for the differences between the
2 types of infants
Compared to the early infant period, the 1-month-old
period exhibited a highly signicant (P < 0.01) increase in
Fig. 2 e A gure showing characteristics (4), (5), (7) and (8).
(4) Maximum depth (max dep): Distance from reference
plane to maximum depth point above the center line (mm).
(5) Maximum depth point location (loc dep): Distance from
M on the center line to the maximum depth point (mm). (6)
Mean depth (mean dep): Mean depth (mm) along the center
line from M to the maximum depth point. (7) Maximum
slope (max slp): Maximum increase (mm) of the depth per
pitch (200 mm) along the center line from M to the
maximum depth point. (8) Maximum slope location (loc
slp): Location of point exhibiting maximum slope on the
center line from M (mm). (9) Mean slope (mean slp): Mean
increase of depth (mm) per pitch on the center line.
Table 1 e Correlations between newborn and 1-month-
old infants for 9 characteristics.
Characteristics r df
a
1 RL 0.720** 29
2 H 0.378* 29
3 CR 0.316 29
4 Max dep 0.646** 28
5 Loc dep 0.097 28
6 Mean dep 0.494** 28
7 Max slp 0.09 29
8 Loc slp 0.382* 29
9 Mean slp 0.679** 29
R: Cross point of right lateral sulcus andalveolar crest. L: Cross point
of left lateral sulcus and alveolar crest. Width (RL): Distance from R
to L (mm). Length (H): Distance from M to a point where perpendic-
ular lines drawn to the line segment R-L (mm). Cuspid ratio (CR):
Width/Length.
Maximum depth (max dep): Distance from reference plane to
maximum depth point above the center line (mm). Maximum depth
point location (loc dep): Distance from M on the center line to the
maximum depth point (mm). Mean depth (mean dep): Mean depth
(mm) along the center line from M to the maximum depth point.
Maximumslope (max slp): Maximumincrease (mm) of the depth per
pitch (200 mm) along the center line from M to the maximum depth
point. Maximum slope location (loc slp): Location of point exhibit-
ing maximum slope on the center line from M (mm). Mean slope
(meanslp): Mean increase of depth (mm) per pitch onthe center line.
a Degrees of freedom.
*Signicant at 5% level.
**Signicant at 1% level.
p e d i a t r i c d e nt a l j our na l 2 3 ( 2 0 1 3 ) 3 7 e4 3 39
the mean for width and 3 depth characteristics (maximum
depth, maximum depth point location, and mean depth)
and 2 slope characteristics (maximum slope location and
mean slope). No signicant differences in mean for length,
cuspid ratio, and maximum slope were observed (Table 4).
4.4. Gender differences for the 9 characteristics in
newborn and 1-month old infants
Innewborns, there were highlysignicant differences (P <0.01)
inwidth, the maximumdepth, andmeandepthbetweenmales
and females (Table 5). In addition, the width of males was
signicantly larger than females while the maximum depth
andmeandepthof femaleswerelarger thanmales. In1-month-
old infants, signicantly larger mean for males was observed
onlyfor widthandnogender differenceswererecognizedinthe
other 8 characteristics.
4.5. Cuspid ratio
Mean cuspid ratio in newborns was 3.75 (Table 6). The mini-
mum value was 3.21 and the maximum value was 4.59. Four
newborns (13%) had a cuspid ratio of less than 3.3. and 2 of
them had an even lower cuspid ratio when they were
1-month-old infants.
5. Discussion
5.1. Measurement points and the reference plane
When measuring alveolar parts and palatal morphology in the
predental period, difculties are encountered setting the
reference plane. Kojo [8] and Nagaishi et al. [4] set the 2 points
apart from the incisive papilla, in the maxillary tuberosity
Table 2 e Correlations between characteristics in newborn.
Characteristics Size Depth Slope
2 3 4 5 6 7 8 9
1 RL 0.463** 0.068 0.187 0.156 0.195 0.138 0.197 0.108
2 H 0.847** 0.002 0.216 0.089 0.066 0.418* 0.172
3 CR 0.106 0.329 0.013 0.043 0.337 0.123
4 Max dep 0.518** 0.928** 0.228 0.105 0.768**
5 Loc dep 0.573** 0.311 0.226 0.142
6 Mean dep 0.337 0.166 0.654**
7 Max slp 0.017 0.063
8 Loc slp 0.299
R: Cross point of right lateral sulcus and alveolar crest. L: Cross point of left lateral sulcus and alveolar crest. Width (RL): Distance fromR to L (mm).
Length (H): Distance from M to a point where perpendicular lines drawn to the line segment R-L (mm). Cuspid ratio (CR): Width/Length.
Maximum depth (max dep): Distance from reference plane to maximum depth point above the center line (mm). Maximum depth point location
(loc dep): Distance from M on the center line to the maximum depth point (mm). Mean depth (mean dep): Mean depth (mm) along the center line
fromMtothe maximumdepthpoint. Maximumslope (maxslp): Maximumincrease(mm) of the depthper pitch(200 mm) along the center line from
M to the maximum depth point. Maximum slope location (loc slp): Location of point exhibiting maximum slope on the center line from M (mm).
*Signicant at 5% level.
**Signicant at 1% level.
Table 3 e Correlations between characteristics in 1-month-old infants.
Characteristics Size Depth Slope
1 2 3 4 5 6 7 8
1 RL 0.412* 0.072 0.072 0.135 0.16 0.128 0.448* 0.183
2 H 0.925** 0.188 0.383* 0.172 0.148 0.314 0.258
3 CR 0.144 0.328 0.127 0.206 0.122 0.184
4 Max dep 0.387* 0.814** 0.09 0.079 0.549**
5 Loc dep 0.305 0.03 0.360* 0.550**
6 Mean dep 0.089 0.1 0.440*
7 Max slp 0.363* 0.092
8 Loc slp 0.236
R: Cross point of right lateral sulcus and alveolar crest. L: Cross point of left lateral sulcus and alveolar crest. Width (RL): Distance fromR to L (mm).
Length (H): Distance from M to a point where perpendicular lines drawn to the line segment R-L (mm). Cuspid ratio (CR): Width/Length.
Maximum depth (max dep): Distance from reference plane to maximum depth point above the center line (mm). Maximum depth point location
(loc dep): Distance from M on the center line to the maximum depth point (mm). Mean depth (mean dep): Mean depth (mm) along the center line
fromMtothe maximumdepthpoint. Maximumslope (maxslp): Maximumincrease(mm) of the depthper pitch(200 mm) along the center line from
M to the maximum depth point. Maximum slope location (loc slp): Location of point exhibiting maximum slope on the center line from M (mm).
*Signicant at 5% level.
**Signicant at 1% level.
p e d i a t r i c d e nt a l j o ur na l 2 3 ( 2 0 1 3 ) 3 7 e4 3 40
region when setting the reference plane for 3-D dental cast
measurement of infants. In the dental casts taken from
newborns, the maxillary tuberosity region is located in a low
position and is unclear due to lack of development, as was
reported by Freiband [9] and Ashley-Montagu [10]. Therefore,
it is difcult to establish a reference point. When the maxillary
tuberosity region is used as a reference plane, it is not suitable
for observing anterior region changes because the anterior
region is warped by the maxillary tuberosity region being in a
much lower position than the incisive papilla region. More-
over, impression taking too far toward the back of the palate is
dangerous and places a heavy burden on infant subjects.
There are no other clear points on the alveolar crest apart
from the 3 points used by the authors that can be used to
analyze the dental casts of newborn. Takekoshi and Hayama
[5], who investigated 6-month-old infants, used the summit of
the deciduous cuspid eruption site, but this point is often not
clear in the dental casts of newborns. Although Tamura [11]
examined the palates of subjects aged 8 years and older, he
recommended reference point T6 (point extending from inner
edge of the rst rugae of the hard palate to the midline pala-
tine raphe) on the palate as being a point that does not change
due to development, in newborns the rugae of the hard palate
is also not clear enough to be selected as a reference point.
Therefore, creation of the palate reference plane in the
present study was based on Sillmans [12], Freibands [9],
Ashley-Montagus [10], and Leightons ndings [3], and we set
a point that could be clearly distinguished in both newborn
and 1-month-old infant dental casts. We selected the incisive
papilla point at the top of the alveolar crest (M), and cross
point of lateral sulcus and alveolar crest. (R, L). The plane
passing through these 3 points was set as the reference plane.
5.2. Length changes
Although Kojo reported the palatal length increment using 3-D
measurement was seen from 1 month to 12 months [8], the
increment was not found from the rst to second month after
Table 4 e Change in the values of the 9 characteristics between newborn and 1-month-old infants and paired t-test for the
differences.
Characteristics Newborn 1-month-old infants Magnitude of
change
Rate of
change (%)
c
t
Mean SD
a
C.V. (%)
b
Mean SD C.V. (%)
1 RL 25,333 1489.6 5.88 26675 1513.1 5.67 1342 5.3 6.15**
2 H 6824 781.9 11.45 7070 1130.9 15.99 245 3.6 1.34
3 CR 3.75 0.4 10.66 3.86 0.619 16.03 0.11 3 0.76
4 Max dep 7475 1260 16.85 8873 850.2 9.58 1397 18.7 9.07**
5 Loc dep 14,209 1553.3 10.93 15621 1515.4 9.7 1412 9.9 4.33**
6 Mean dep 3854 762.8 19.79 4382 564.4 12.87 527 13.7 4.78**
7 Max slp 258 86.6 33.56 321 130.7 40.71 36 12.6 1.23
8 Loc slp 6744 1614.6 23.94 7591 1410.9 18.58 847 12.6 2.78**
9 Mean slp 105 15.1 14.38 114 12.1 10.61 9 8.6 4.09**
R: Cross point of right lateral sulcus and alveolar crest. L: Cross point of left lateral sulcus and alveolar crest. Width (RL): Distance from R to L
(mm). Length (H): Distance from M to a point where perpendicular lines drawn to the line segment R-L (mm). Cuspid ratio (CR): Width/Length.
Maximum depth (max dep): Distance from reference plane to maximum depth point above the center line (mm). Maximum depth point location
(loc dep): Distance from M on the center line to the maximum depth point (mm). Mean depth (mean dep): Mean depth (mm) along the center line
from M to the maximum depth point. Maximum slope (max slp): Maximum increase (mm) of the depth per pitch (200 mm) along the center line
from M to the maximum depth point. Maximum slope location (loc slp): Location of point exhibiting maximum slope on the center line from M
(mm). Mean slope (mean slp): Mean increase of depth (mm) per pitch on the center line.
a Standard deviation.
b C.V. (%) coefcient of variation (%) SD/mean 100.
c Rate of change (%) magnitude of change/value of newborn 100.
**Signicant at 1% level.
Table 5 et-test for gender differences in the newborn and
1-month-old infants.
Characteristics Newborn 1-month-old infants
t df T df
1 RL 2.933** 29 2.665* 29
2 H 1.4 29 0.478 29
3 CR 0.085 29 0.447 29
4 Max dep 2.604* 29 0.852 29
5 Loc dep 1.852 29 0.648 29
6 Mean dep 2.273* 29 0.638 29
7 Max slp 0.227 29 0.297 29
8 Loc slp 0.153 29 0.274 29
9 Mean slp 1.434 29 0.106 29
R: Crosspoint of right lateral sulcusandalveolar crest. L: Cross point of
left lateral sulcus and alveolar crest. Width (RL): Distance from R to L
(mm). Length(H): DistancefromMtoapoint whereperpendicular lines
drawn to the line segment R-L (mm). Cuspid ratio (CR): Width/Length.
Maximum depth (max dep): Distance from reference plane to
maximum depth point above the center line (mm). Maximum depth
point location (loc dep): Distance from M on the center line to the
maximum depth point (mm). Mean depth (mean dep): Mean depth
(mm) along the center line from M to the maximum depth point.
Maximum slope (max slp): Maximum increase (mm) of the depth per
pitch (200 mm) along the center line from M to the maximum depth
point. Maximum slope location (loc slp): Location of point exhibiting
maximum slope on the center line from M (mm). Mean slope (mean
slp): Mean increase of depth (mm) per pitch on the center line.
*Signicant at 5%level.
**Signicant at 1%level.
p e d i a t r i c d e nt a l j our na l 2 3 ( 2 0 1 3 ) 3 7 e4 3 41
birth by his gures. There were no signicant differences in the
palatal lengthbetweennewbornand1-month-oldinfants inthis
study. It revealed that the lengthincrement was not observedin
the very early stage of palatal growth and development.
5.3. Changes in morphology of the palate
Nagaishi et al. reported that fewchanges during the predental
period development in palate depth and area were observed
[4]. Kojo reported that although palate depth tended to in-
crease somewhat with age, it remained fairly unchanged
throughout the observation period from1 month after birth to
12 months after birth [8]. Although Kojos measurement re-
gion was not strictly the maximumdepth used by the authors,
it was close to the same area. Furthermore, the present study
indicated that maximum depth increased signicantly
(P < 0.01) in the period from newborn to 1 month after birth.
While both Kojo and Nagaishi et al.s investigations included
predental period infants, their conclusions leave out the most
important reference period, that is the rst month of the
newborn period.
Nagaishi et al. also did not examine the rst 3 months of
the newborn period and concluded that it became clear that
only in the predental period, breastfeeding, bottle feeding, and
mixed breast and bottle feeding methods do not affect
development of the alveolar arch and palate [4]. In the present
study, large individual variation in palatal morphology
occurred commonly in newborn to 1-month-old infants.
Therefore, when investigating the palate of predental infants,
it is important to consider the early infancy period as a
starting point.
Although the present study mainly investigated the
anterior region of the palate, growth changes were not uni-
form. Leighton reported that, genetics inuence the shape of
the palate of 6-month-old infants and physical forces such as
suckling and tooth eruptive force alter its state prior to tooth
eruption [3], and this was conrmed as occurring from within
the rst month after birth. Thus, analysis of the changes in
the morphology of the palate could require observational
research from the early infancy period in the case of term
infants.
In addition, Melsen and Melsen conducted a historic
microradiographic study involving histological study of bone
autopsy material and asserted that bone absorption addition
occurs until late age in not only the palatine bone seam area
but also the surface [13,14]. The newborn period is one of
dynamic change and we believe that models should be
considered with this possibility in mind.
5.4. Gender differences
There are several reports on gender differences in palatal
formation. Hohoff [6], Kojo [8], and Nagaishi et al. [4] reported
there were no gender differences in morphology of palate.
Takekoshi and Hayamas results of 6-month-old infants
showed gender differences in width and length of palate.
Leighton noted that in 6-month-old infants, although there
were no gender differences with length, there were differ-
ences observed with width [3].
In this study, width, the maximum depth, and mean depth
showed signicant gender differences in newborns. Width of
palate in males was larger than females, while the maximum
depth and mean depth in females were larger than males. In
1-month-old infants, only width of palate showed signicant
gender differences, and there were no signicant gender dif-
ferences of palatal length in both newborns and 1-month-old
infants. Although our results of width and length changes
were similar to Leightons in gender differences, palatal depth
of female newborns was larger than in male newborns, and
the differences disappeared 1 month later.
5.5. Cuspid ratio
The importance of cuspid ratio for predental period was pro-
posed by Ishida [15]. Cuspid ratio is the value of cuspid area
width divided by length and can be used to display charac-
teristics of anterior portion morphology of the palate. Cuspid
ratio can be easily measured with vernier calipers, and is
easily evaluated clinically.
In newborns, there was no correlation between length and
maximum depth point location, but in 1-month-old infants a
signicant positive correlation (P < 0.05) was observed. This
suggests that length enlargement led to enlargement of
maximum depth point location. There was a signicant nega-
tive correlation between cuspid ratio and length (P < 0.01)
(Fig. 3).
Table 6 e Cuspid ratio of the subjects in newborn and 1-
month-old infants.
Case No. Newborn 1-month-old infants
1 3.9 4.2
2 3.2 3.1
3 4.2 5.1
4 3.2 3.1
5 3.7 3.7
6 3.4 3.4
7 3.6 3.6
8 3.8 3.4
9 3.4 3.4
10 3.5 4.3
11 4.6 4.3
12 3.5 5.2
14 3.6 4.1
15 4.5 4.3
16 4.5 3.0
17 3.5 3.5
18 3.3 4.3
19 4.2 3.6
20 4.4 4.5
21 3.3 3.3
22 3.5 3.5
23 4.0 3.2
24 3.7 4.0
25 3.4 3.7
26 3.5 3.7
27 3.5 3.9
28 3.6 4.0
29 4.3 5.5
30 3.5 3.2
31 4.1 3.8
Mean 3.75 3.86
p e d i a t r i c d e nt a l j o ur na l 2 3 ( 2 0 1 3 ) 3 7 e4 3 42
6. Conclusion
Whenwe investigatedpalatal morphology innewborns andthe
mean values and correlative relationships in 9 characteristics,
we observed signicant palate morphology changes in infants
during the short period of the rst month after birth. There was
great individual variation among infants. Although the mean
values for all 9 characteristics increased during the 1 month, a
signicant increase (P < 0.01) was recognized for 5 character-
istics including width and no signicant change was observed
in length, cuspid ratio, and maximum slope. Length and width,
which are size factors, also maintained inter-individual differ-
ences observed for newborns during the 1 month. However, the
lack of increasing changes in palate shape factors (cuspid ratio,
maximum slope point location, and mean slope) indicated the
importance of studying newborns as the starting point for un-
derstanding the phases of palate growth in infants.
Disclosure
None of the authors have any conicts of interest that should
be disclosed.
Acknowledgments
Image analysis of 3-D measurement data, software develop-
ment, and statistical analysis were conducted by Dr. Yasuo
Ukai, former Professor of the Graduate School of the Univer-
sity of Tokyo. Dr Nobuko Takagi assisted in the creation of the
dental casts analyzed in this study and Dr. Keiko Shoji (Peri-
natal Clinic) aided in particular with impression taking. We
would like to express our deepest gratitude to all those
mentioned here who cooperated in this study.
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Fig. 3 e Cast models. A: Cuspid ratio of No. 4 boy was 3.3 at
newborn (1D), and decreased to 3.1 at 1-month-old infant
stage (1M). B: Cuspid ratio of No. 16 girl was 4.5 at newborn
(4D), but decreased to 3.0 at 1-month-old infant stage (1M).
This is a case where the biggest change of cuspid ratio was
observed. C: Cuspidratioof No. 14boywas3.6at newborn(4D,
a little smaller than the average), but increased to 4.1 at 1-
month-old infant stage (1M, a little bigger than the average).
p e d i a t r i c d e nt a l j our na l 2 3 ( 2 0 1 3 ) 3 7 e4 3 43