Download - Rawan Thesis1!1!2014 - Copy
Chapter One
1. Introduction:
This study explored changes that occurred to palatal rugae area during orthodontic treatments.
They are considered to be irregular, asymmetric ridges of the mucous membrane of hard palate.
Extending laterally from the incisive papilla and the anterior part of the median palatal raphe
(Sumathi et al, 2012;Anukool et al,2011; Manashvini et al, 2008;Standring, 2008 and Baily et
al,1996). According to the Glossary of Prosthodontic Terms, rugae are anatomical folds or
wrinkles (usually used in the plural sense); the irregular fibrous connective tissue located on the
anterior third of the palate. They are also called “plica palatinae” or “rugae palatine.”(Saraf et al,
2011). It is assumed that the rugae facilitate food transport through the oral cavity, prevent loss of
food from the mouth, and participate in food crushing. Because of the presence of tactile and
gustatory receptors, rugae contribute to perception of taste, mechanical food qualities, and tongue
position(Bhullar et al, 2011).
Researchers have always shown interest in the evolutionary development of the folds of tissue
found in the roof of the human mouth—the palatine rugae (Anukool et al, 2011). Winslow (1955)
seems to have been the first to describe them, and the earliest illustration of them is probably by
Santorini in 1775. After that a lot of researchers considered palatal rugae or plica palatine in their
studies and researches to get deeper understanding of their importance of their presence in
mammals and most specifically in humans.
Palatal rugae patterns have been studied extensively in multivariate populations. Many of the
previous studies investigated gender-related and ethnicity-related differences in palatal rugae
patterns (Kapali et al, 1997). Most importantly, some of the previous studies explored the
individuality of palatal rugae patterns ( Shukla et al,2011;Saraf et al,2011). The findings of such
studies suggested that palatal rugae are highly individual and can be used as a tool in individual
identification. However, some events can contribute to changes in rugae pattern, including trauma,
extreme finger sucking in infancy and persistent pressure with orthodontic treatment and dentures.
(Eboh, 2012; Sassouni, 1957).
The current study is the first to shed the light on morphometric changes occurred due to
orthodontic treatment including different criteria such as segmentation, unification as expression
for the change in number, change in orientation, change in shape, change in length, change in
volume, displacement of lateral end (in anteroposterior and mediolateral direction) and
displacement in medial end (in anterioposterior and mediolateral direction). Furthermore, the
percentages of casts that had every one of these changes will be counted.
In addition, the other goal of this study is to further test the individuality of palatal rugae and
their value as a tool in individual identification. This goal is achieved by analyzing the
morphometric changes that take place in palatal rugae patterns as a result of orthodontic treatment.
Moreover, the researcher examines whether such changes will compromise our ability to match the
same palatal rugae pattern before and after orthodontic treatment.
The outcome of the study provides more knowledge about the stability of palatal rugae against
orthodontic treatment. It will tell us whether orthodontic treatment will affect the use of palatal
rugae in human identification. It will test the use of palatine rugae patterns as an alternative
fingerprint in the Jordanian population.
This theses is divided in to six chapters, where chapter one is an introduction for the subject,
talking about development of palate and palatal rugae anatomically and histologically, the second
chapter will talk about previous studies were done on this field of study. The third chapter will
contain information about our methodology, materials and sample collection. The fourth chapter
will present the results of the study. Chapter five contains the discussion of the results. The last
chapter, which is chapter six, includes recommendations and suggestions, and conclusion.
1.1 Development of the Palate and Palatal Rugae.
The palate is the structure that separates the oral from nasal structures. It has two key stages of
development during embryonic (primary), and an early fetal (secondary) involving the fusion of
structures and a key epithelial to mesenchymal transition in a process known as Palatogenesis.
The process begins in the sixth week but is not completed until the 12th week. The critical period
of development of the palate is from the end of the sixth week until the beginning of the ninth
week.(Bailey and Miller, 1921).
It is formed by the fusion of both right and left maxillary processes and medial nasal process and
composed of two main parts:
-The Primary Palate
It is formed by two parts formed by the merging of two nasal processes. Early in the sixth
week, it begins to develop from the deep part of the intermaxillary segment of the maxilla.
Initially, this segment is a wedge-shaped mass of mesenchyme between the internal surfaces of the
maxillary prominences of the developing maxillae. It represents only a small part of the adult hard
palate (the part anterior to the incisive fossa) where Bone gradually develops by intramembranous
ossification in the primary palate, forming the premaxillary part of the maxilla, which lodges the
incisor teeth).
- The Secondary Palate
It is divided in two anatomical parts: a-anterior hard palate - ossified (contributions from the
maxilla and palatine bones), b-posterior soft palate - muscular. It is formed by the 7 th to 8th weeks
of development, its form from two mesenchymal projections that extend from the internal aspects
of the maxillary prominences. The growth of maxillary processes from inside gives rise to lateral
palatine processes. It will grow medially and fuse with each other with the inferior border of the
nasal septum, and then it can be classified as hard palate. The medial epithelial seam at the edges
of the palatine shelves breaks down, allowing for the fusion of the palatine shelves. The remaining
part is invaded by muscle and is called the soft palate. The fusion between the nasal septum and
the palatine processes begins anteriorly during the ninth week and is completed posteriorly by the
12th week, superior to the primordium of the hard palate. Concurrently, bone extends from the
maxillae and palatine bones into the lateral palatine processes to form the hard palate. The
median palatine raphe indicates the line of fusion of the lateral palatine processes and terminates
anteriorly at an oval prominence (Paul et al, 1997), the incisive papilla, which is located 2 cm from
the central incisors (Mustafa et al, 2012; Hoggan and Sadowsky, 2001; Morlang,1982).
In human embryos, rugae are relatively prominent and occupy most of the length of the palatal
shelves at the time of their elevation (Bhullar et al, 2011). The palatal rugae appear toward the 3rd
month of intrauterine life (Gandicota et al, 2012; Amaski et al, 2008), distinguished in human
embryos of 32-mm Crown-rump length (CRL) next to the incisive papilla (Gandikota et al,2012).
At the 550 mm stage of embryonic development, there are five to seven rather symmetrically
disposed ridges, with the anterior ones beginning at the raphe, the others more laterally. Towards
the end of intra-uterine life, the pattern of rugae becomes less regular, posterior ones disappearing
and those anterior become considerably more pronounced and compressed (Bhullar et al, 2011).
1.2 Anatomy and Histology of Palate and Palatal Rugae Area
In the hard palate, anteroposteriorly a thin central groove is bordered on each side by a crest,
the palatal raphae. From this crest, laterally three to seven smaller crests emerge on each side.
These crests are called palatal rugae (Indira et al,2012).These rugae are just behind the incisive
papilla and considered to be rigid and tangentially radiating out(Hemanth et al, 2010).
Palate is known as an extremely sensitive region in the oral mucosa and is involved, along with
the tongue, in food ingestion and mastication (Luke ,1988; Sakamoto et al. 1989). In the palatal
mucosa, a variety of mechanoreceptors are distributed site-specifically, such as free nerve endings,
simple corpuscles, Ruffini corpuscles, and Merkel cell–neurite complexes. In particular, Merkel
cell–neurite complexes are known to be densely distributed in the epithelial ridges of the palatal
mucosa (palatine rugae).Merkel cells were found by F. S. Merkel in 1875 as chromophobic cells
which occur together with Langerhans cells and melanocytes in human epithelium; they are
characterized morphologically by polymorphic profiles, cytoplasmic processes, and
intracytoplasmic special granules(Ishizaki et al, 2006).
The anatomical position of the rugae in the mouth remains unchanged in its position throughout
life. Although there is no consensus on this issue.it is relatively stable and resists decomposition
for a few days after death (Indira et al, 2012).
The anatomical position of the palatal rugae inside the oral cavity is surrounded by cheek, lips,
tongue, teeth, and a buccal pad of fat. All these afford some protection in case of fire and high
impact trauma. Rugae are amongst the best protected position in the mouth that remains
unchanged throughout life(Hemanth et al, 2010), morphologically individualizing soft tissue
structures in the body, which are preserved after death and also accessible during life(Indira et al,
2012). Coslet et al. reported the clinical removal of palatal rugae is not permanent and that when
removed, the rugae returned several months later(Patil and Acharya, 2008; Coslet et al,1980).
Histologically, the rugae are covered with stratified squamous (layered scales), mainly
parakeratinized epithelium with small rete ridges and submucosa consisting of fibrous connective
tissue. Similar to the adjacent tissue of the palate, CK20 positive cells were frequently observed in
the cells of the basal cell layer and were particularly aggregated in the tip of the rugae(,Indira et al,
2012,Bhullar et al, 2011; Patil and Acharya, 2008;Ishizaki et al, 2006).
The orientation and forms of palatial rugae are governed by the core fibers running
anteroposteriorly in concentric circles below each rugae. Fibroblasts and collagen fibers, then
accumulate in the connective tissue beneath the thickened epithelium and assume distinct
orientation. The core within the palatal rugae of humans contains elements that are believed to
contribute to the maintenance of its shape. The main structural element of a rugae contains
glycosaminoglycans, which by its hydrophilic nature causes the tissue to swell, and contributes to
the maintenance of the shape of a rugae throughout life. (Rajan et al, 2013; Gandikota et al, 2012;
Indira et al, 2012; Ishizaki et al, 2006; Bharath et al, 2011; Bhuller at al, 2011; Amasaki et al,
2008; Motabagani, 2006; Thomas, 1984).
The palatal rugae at birth are well trainees with a typical orientation pattern and during
adolescence they acquire the final feature shape of each individual. Once formed, they may
experience changes in their size due to growth of the palate, but their shape is
maintained(Gandikota et al, 2012).
Figure 1 : Histology of palatal rugae shows rugae are covered with stratified squamous), mainly parakeratinized
epithelium with small rete ridges. James K, Pauline F, Steele, Nancy Avery.Oral development and histology.2nd edition. Thieme medical publishers.1994 page 253.
1.3 Physiological Function of Palatal Rugae
The anatomic position of these transverse ridges aid the physiological function of palatal rugae
area in oral swallowing, suction in children. In neonates, the rugae which usually corrugate the
hard palate assist gripping of the nipple when suckling. Taste perception by improving the
relationship between food and the taste receptors in the dorsal surface of the tongue. They
participate in speech specially‘s’ and ‘sh’ phonemes and in the medico-legal identification process
(Eboh, 2012; Amasaki et al, 2008; Almeida et al, 1995).
1.4 Significance of Palatal Rugae.
Rugae patterns have been studied for various purposes, with reports being published mainly in
the fields of anthropology, comparative anatomy,genetics, forensic odontology, prosthodontics,
and orthodontics (Hemanth et al,2010).
1.4.1 Significance of Palatal Rugae in Post Mortem Forensic Identification.
There are four legally admissible methodologies used to identify human remains (Thomas and
Kotz, 1984) visual identification, fingerprints or footprint identification, dental identification, and
DNA evidence (Simmons et al;1987). These are the most commonly used techniques in forensic
identification allowing fast and reliable identification.
The palatine rugae possess unique characteristics that can be used in circumstances when it is
difficult to identify a dead person through fingerprints or dental records (Bansode and Kulkarni,
2009). One of the main focuses of the forensic odontologist is identification of an individual.
Dental identification can be used as the sole method of identifying a deceased person. Dental
identification is based on the comparison of antemortem and postmortem records. The records
collected to identify a decedent should be accurate and totally inclusive of objective findings
(Filhoet al, 2009).
It was concluded that palatine rugae don’t undergo pronounced changes under such massive
thermal insults (Winslow,1732). It is suggested that rugae pattern is as unique to a human as are
his or her fingerprints and it retains its shape throughout life (Bhullar,2011). The anatomical
position of the rugae inside the mouth - surrounded by cheeks, lips, tongue, buccal pad of fat,
teeth and bone - keeps them well-protected from trauma and high temperatures. Palatine rugae
can resist postmortem decomposition changes for up to seven days after death (Patil and
Acharya, 2008). Moreover, the stability of palatine rugae have been examined in cases of third
degree burns. Thus, they can be used reliably as a reference landmark during forensic
identification (Buchner, 1985).
Palatal rugae have been considered relevant for human identification due to its stability, which
is equivalent to the fingerprint. In that it is unique for each ruga pattern, palatal rugae appear to
possess the features of an ideal forensic identification parameter, that is, uniqueness, postmortem
resistance, and stability (Hoggans and Sadowsky, 2001).
Muthusubramanian et al (2005) did a study to examine the extent of palatine rugae preservation
for use as an identification tool in burn victims and cadavers. The study results showed that
among the subjects with third-degree panfacial burns, 93 percent of the palatine rugae were
normal. They concluded that the palatine rugae could be used as a reference landmark during
forensic identification of individual.
In forensic identification, , use of dental records, visual identification and fingerprints and
DNA comparisons probably are the most common techniques used allowing fast and secure
reliable identification. When identification cannot be established by fingerprinting or by analysis
of dental arches (dental records data), the palatal rugae can be considered as a source of
comparative material (Limson and Julian,2004).
Many victims of natural disasters such as fires and floods, have also been identified by dental
means. Furthermore, many criminal investigations have included the use of dental evidence
(English et al, 1988).
1.4.2 Palatal Rugae Area Added to Complete Dentures in Prosthodontics .
Restoring patients' speech is an important goal in complete denture fabrication. For those
patients who have difficulty with their speech patterns, accommodating to the introduction of
prosthesis, texture in the palatal region may prove helpful. Such problem might be related to
changed relationship between the tongue and the new topography of the palatine vault. It is
suggested to reproduce the original shape of palate as one of the solutions to relief pain
encountered by patient. This also contributes to reduce speech problems resulted from wearing
these prostheses (Palmer, 1978).
Methods of incorporating palatal rugae in a newly fabricated and existing complete denture
are studied with many researchers (Gitto et al, 1999).
1.4.3 Significance of Palatal Rugae in Orthodontics as Internal Dental Cast Reference Points
for Quantification of Tooth Migration:
Palatal rugae may serve as suitable reference points from which the clinician can derive the
reference planes necessary for longitudinal cast analysis, since dental casts are three dimensional
(3-D) records of malocclusion that have been used successfully during diagnosis and treatment
planning for orthodontic patients (Rajan et al, 2013).
Hoggan and Sadowsky (2001) also investigated the use of the palatine rugae as reference points
for measuring tooth movement in a manner comparable with cephalometric superimpositions. The
results showed no statistical differences between the mean incisor and molar movement measured
cephalometrically. The tooth movement measured relative to the medial and lateral end of the third
palatine ruga. So they concluded that these rugae area can be used successfully to assess
anteroposterior tooth movements.
Christou and Kiliardis (2001) evaluated the vertical changes in the medial aspects of the rugae
and concluded that these changes over time are due to the alterations in the vertical positioning of
maxillary incisors and increase in lower face height.
Positional changes of posterior teeth in the anteroposterior direction are relevant to the
diagnosis and correction of sagittal occlusal abnormalities and arch length discrepancies, which is
another clinical significance of palatal rugae area (Bhuller et al, 2011).
Furthermore, Yang et al (2013) studied rugae area as it is considered a stable reference points
for superimposing 3-dimensional models before and after orthodontic treatment, so they measured
3-dimensional changes for children over 9 years old. Results came up with no significant changes
occurred and then they are considered stable .So used as reference points for superimposing and
evaluating changes during orthodontic treatment.
In the literature, Palatal rugae have been used as reference points for many purposes such as
evaluating tooth movement pre- and post-orthodontic treatment .There are also indications that
various types of orthodontic treatments may have different effects on the rugae, e.g. non extraction
treatment, premolar extraction treatment (different combinations of extraction sequences) and
orthopedics maxillary expansion (Hoggan and Sadowsky, 2001; Ong and Woods, 2001).
Although the use of study model comparisons or the superimposition of images of study
models to evaluate tooth movement has been attempted, results of these studies have been difficult
to interpret because of the lack of available evidence of stable landmarks (Jones, 1991; Rossouw et
al,1991;Van der Linden 1978; Van der Linden 1974).
Recently some researchers have focused on the use of palatal rugae as suitable landmarks, but
the results of these studies are not consistent (Mavropoulos et al,2006;Mavropoulos et al
2004;Miller et al,2003;Hoggan and Sadowsky 2001; Ong and Woods,2001Bailey et al
1996;Almeida et al 1995;Grove and Christensen 1988;Simmons et al 1987; Van der Linden
1978;Peavy and Kendrick 1967).
Although teeth are more durable than other parts of the body, identification via dental records
also may prove to be inaccurate, because dental treatment might have been performed between the
creation of a dental record and the person’s death. Other methods of identification like DNA
profiling are of limited use because of the high costs and the time-consuming nature of the method
which make it particularly unsuitable for large populations.(Venegas et al,2009).
Chapter Two:
2. Literature Review
This literature review discusses four dominant fields regarding studies were done concerning
palatal rugae area. Starting the first part with studies that inspected literature that discussed
individuality of palatal rugae. The second part explored variations of palatal rugae in different
genders and ethnicities. The third part tried to investigate literature of morphometric changes
induced by orthodontic treatment. The fourth part consisted of studies included matching between
pre and post treatment casts, in order to be considered as a method of human identification.
2.1 Individuality of Palatal Rugae.
Palatoscopy or palatal rugoscopy, is the name given to the study of palatal rugae. From a
forensic perspective, this is used primarily to establish a person's identity. Palatal rugae area is
considered to be highly individual and consistent throughout human life (Indira et al, 2012).
The application of palatal rugae patterns for personal identification was first suggested by
Winslow in 1700s then Allen in 1889. But as palatal Rugoscopy, it was first proposed in 1932 by a
Spanish investigator called (Trobo Hermosa) ( Sharma et al,2009; Shriram and Meena,2009). In
the same year, the earliest illustration of palatal rugae was made by Santorins who made a drawing
depicting three continuous wavy lines that crossed the midline of palate (Simmons et al, 1987). So,
Lysell (1955) was unsure if the rugae could be used for identification aspects but Sassoni (1957)
stated that it's possible to device a classification based on symmetry, number and shape of papilla.
When he tested his classification, he was able to identify a person without difficulty (Sassouni et
al, 1957).
Researchers had found difficulty in the task of classification of the rugae patterns due to the
subjective nature of observation and interpretation within and between observers. Since the study
of Lysell (1955) specific anatomical investigations on palatal rugae patterns had been reported by
many researchers. Numerous classifications had been devised by several authors to record the
palatal rugae patterns; among all, the Silva, Carrea and Lysell, classifications are often used in
recording the patterns (Barath et al, 2011).
In 1937 Carrea conducted a detailed study and established a method to classify palatal. In1955
Lysell postulates that palatal rugae patterns have genetic background (Lysell, 1955).This man as
well as Sassouni (1957) who just has said that no two palates are alike in their configuration.
Furthermore, the palatal print does not be changed with time or age, so in general he believes that
these rugae are unchanged throughout human life, but found that this doesn’t apply in every aspect
(Filho,2009; Sassouni,1957; Lysell,1955).
Several studies were done and still being done in the past and nowadays. They have revealed
statistically proved result, in which the rugae patterns are highly individualistic. Although it was
described as being still in infancy in the field of forensic odontology, their uniqueness to
individuals has been recognized clearly as providing a potentially reliable source of identification
(Sharma et al,2009; Kapali et al, 1997; English et al, 1988; Thomas and Kotze, 1983).
The studies done by de Angelis (2011) in Italy, Hermosilla et al (2009), Shukla et al(2011) and
several others were all in agreement that the individuality of palatine rugae were sufficient for
their use as method of identification. This was supported by the fact that the morphology of
palatine rugae is constant throughout life (Bhullar, 2011; Abdel-Aziz and Sabet, 2001; Fahmi et al,
2001; Almeida et al, 1995; Peterkova et al, 1987; Vander Linden, 1978; Lysell,1955).
In a case study, Breault et al (1999) reported on a single case of a 22-year-old white male. A
free gingival graft was placed on the edentulous (toothless) buccal gingival corresponding to tooth
#23. The graft was harvested from the palate and included the palatal rugae. After two months, the
recipient site displayed prominent ridges and a gingivoplasty was performed. After nine years, the
subject returned for treatment and the palatal rugae had reformed in the graft area. This study
showed that the rugae can be transplanted to different parts of the body. If transferred to other
areas of the anterior palate, rugae can easily be confused in identification .Therefore, they are
considered as permanent and unique to each person, and can establish identity through
discrimination (via casts, tracings or digitalized rugae patterns) (Anukool, 2011;Hoggan and
Sadowsky, 2001; English et al, 1988).
Indira et al (2012) studied palatal rugae pattern among five pairs of twins (non identical). They
showed different patterns, although some similar (but not identical) forms are observed on specific
location in two pairs of twins. Such findings were consistent with the study conducted by Ritter
and Chae (cited in English et al, 1988) which strongly suggested that palatal rugae pattern are
unique for each person .I t also questioned the role of genetic influence in determining the rugae
pattern in twins.
The concept about the individuality of palatine rugae was supported by more recent studies
using more technological equipments. It seems to be discussed by Saxena et al (2010). They used
the three dimensional stereoscopy techniques in studying the anatomy of palatine rugae and
mentioned that there were no similarities in the numbers of primary rugae in both sides of each
cast and stressed on the concept of palatine rugae individuality.
2.2 Variations of Palatal Rugae in Different Genders and Ethnicities.
Specific anatomical investigations on palatal rugae patterns had been reported by many
authors. They reported that the number of rugae remains unchangeable during life, the size and
detailed arrangement changes with palatal growth and that there are differences among ethnicities
with or without differences between genders (Eboh, 2012; Filho,2009;Kapali et al, 1997; Dohke
and Osato, 1994; Kashima, 1990).
Thomas and Kotze (1983) in their literature highlighted the difficulties in observing, classifying
and interpreting the limitless and minute variations in palatal rugae and emphasized the necessity
for standardizing the procedures in recording. After a thorough review on all classifications from
the literature, the method of identification used in this study (Thomas et al, 1983) was the most
practical and easy to apply compared with other methods (Bharath et al, 2011).
Thomas and Kotze were able to discern different rugae patterns in southern African populations
implying different genetic origins in their studies in 1983, they found that rugae were unique and
individualistic to each ethnic group and it can be used successfully for genetic research (Bhullar,
2011; Thomas and Kotze, 1983).
While Kepali et al (1997), through several approaches aimed to investigate changes in rugae
patterns with age in Australian aborigines, and compared patterns between aborigines and
Caucasians. They find that the number of primary rugae in Australian aborigines was higher than
in Caucasians. Furthermore, the mean number of rugae in aborigines was higher than reported for
other ethnic groups. However, Caucasians tend to show higher proportions of rugae that are longer
than 10 mm compared with aborigines.
In 1989 Houser et al investigated 117 dental casts of individuals from Swaziland; impressions
were obtained, and then poured in plaster. Prominent rugae were observed on the dental casts, the
palatal rugae area were similar since this population was very homogenous.
Dohke and Osato (1994) indicated that Japanese females had fewer rugae than Japanese males.
In contrast, Saraf et al (2011) compared palatal rugae patterns between Indian males and females.
They reported no significant difference in palatal rugae between both sexes in terms of total
number or various length measurement. But according to shape, the converging type was
statistically greater in number in females whilst the circular type was statistically greater in
number in males which is opposite to earlier studies.
Kepali et al (1997) hadn’t any significant difference in the number of primary rugae among
Australian males and Australian females. On the other hand, Dohke and Osato in 1994 give
opposite results, it might be due to the fact that secondary and fragmentary rugae were not
included in the study of (Saraf et al, 2011; kepali et al, 1997), and it is the secondary rugae that
Dohke and Osato consider in their study, which lead to sex differentiation.
In the study of Preethi et al (2007) that was done on western and south India population,
straight pattern was the more found and circular group was not. Kashima (1990) did a study
involved Indian and Japanese children. It reported that Japanese children had more primary rugae
than Indians.
Sumathi et al (2011) did a study comparing palatal rugae between individuals, where they were
found through the whole work, no identically similar palatal rugae patterns appeared in two
individuals. According to the most predominant pattern, it was the wavy pattern followed by the
straight one, curved, branched, and the least was the circular. There was no significant difference
among males and females in this population.
It had been noted that there is astatically significant association between rugae forms and
ethnicity (Hermosilla et al, 2009; Kepali et al, 1997). Also in 2012, a study was done by Eboh ,
intended to describe the shape and gender distribution of palatal rugae and their prevalence in the
studied population. It was observed that the dominant rugae form among Urhobo ethnic group was
line one, then sinuous patterns, it fails to give any sex significance. Both studies of Kashima
(1990) and Eboh (2012) were met.
According to difference in palatal rugae related to gender, many studied variations in this area
between males and females. Most of them revealed lack of sex variations. However, indicated a
slight difference in number of rugae between both sexes (Saraf et al,2011).
Another study was done by Shetty et al (2011) that attempts to determine the number of
different patterns of rugae, and to see if there is any gender differences present in Mangelore
population. There was no significant difference among sexes; the predominant shape of rugae
among females was curved and straight, while wavy among males. These observations were in
contrast to Swetha et al (2005) who report that Mysorean males and Tibetal females had more
rugae than their respective counterparts (Sharma et al,2009). Furthermore, in this study circular
shaped rugae didn’t show any significant gender differences, while Fahmi and Al-Shamrani (2001)
study among Saudi males and Saudi females shows an increased incidence of circular shaped
rugae in females rather than in males.
Madhankumar et al (2013) make a study with a Cross sectional design in 2009 to evaluate the
gender differences with regard to the shape of the palatal rugae and identify the most predominant
pattern. They collected 135 students aged 17-25yrs to participate in the study. Based on gender
they were divided into two groups comprising of 62 male and 73 female students respectively.
Maxillary impressions were poured in dental stone .These casts were utilized to analyze and study
the variation in rugae pattern based on classification by Thomas and Kotze. The data obtained
were tabulated and analyzed using IBM SPSS 19.0 version. The incidence of specific rugae pattern
and its association with gender were analyzed using Chi-square test. They resulted in noticing that
straight and curve forms were
2.3 Literature of Morphometric Changes Induced by Orthodontic Treatment.
The stability of palatal rugae as a landmark for dental cast analysis is reported by (Patil et al,
2008; Almeida et al, 1995 and Bailey et al, 1996) that form, layout, and characteristics are not
affected by the eruption of the teeth or their loss, but sometimes palatal rugae adjacent to the
alveolar arch slightly change their position after tooth extraction (Hemanth et al, 2012).
On the other hand, other studies showed that some events can contribute to changes in their
patterns such as trauma, extreme finger sucking in infancy, and persistent pressure with
orthodontic treatment (Kapali et al, 1997).
Peavy and Kinderick (1967) demonstrated that the form, layout and characteristics were not
affected by the eruption of teeth or their loss, but there were times that some changes occur to the
position of palatal rugae near to the alveolar ridge after tooth extraction (Eboh,2012; Peavy &
Kendrick,1967) However, Limsoon and Julian (2004) and Baily et al( 1996) said that extractions
can produce a local effect on the directions of palatal rugae.
Shukla et al (2011) and Bansode and Kulkarni (2009) had found that some changes do occur in
the rugae during orthodontic treatment and the morphology of palatal rugae remains stable
throughout life(Hamanth et al,2010 ).
In a study of changes occurring in 15 patients who underwent extraction of four premolars,
Hausser (1989) observed orthodontically treated patients. He concluded that the lateral edges of
the rugae moved forward about one half the distance of the migration of the adjacent teeth, while
the medial rugae were not affected.
On the other hand, Simmons and Colleagues (1987) used the longitudinal database of the Child
Research Council of Denver to examine the anteroposterior stability of the medial rugal region.
Their analysis indicates that the medial rugae region increased significantly in anteroposterior
length, but not uniformly between the sexes. The authors concluded that such changes were
characteristic of general craniofacial growth and suggest that the rugae region is responding to the
differential growth of the underlying bone. Thus, the authors established that the medial rugal
landmarks did not appear to be a stable reference point for tooth migration research.
Peavy and Kendrick (1967) reported that the lateral ends of the rugae that terminated close to
the teeth followed the movement of the teeth in the sagittal plane, but not in the transverse plane as
was said by (Bhuller et al, 2011). Van der Linden (1978) evaluated the changes in the position of
posterior teeth in relation to palatine rugae. He selected 65 normally growing children (aged 6 to
16 years), and six orthodontically treated patients. The maximum mean change in distance
between the rugae in the anteroposterior plane was 0.41 mm. The authors noted larger movements
at both the medial and lateral rugae points in the orthodontically treated patients.
Anukool et al (2011) in his study didn’t observe change in shape of palatal rugae between
pretreatment and post treatment cases.
Bailey et al (1996) presented the results of a double-blind study in 57 adult patients. The
maxillary casts of pre- and post-orthodontic treatment are examined. Two groups of patients, an
orthodontic extraction group (where two maxillary premolars were extracted) and a non-extraction
group, were assessed. Statistically significant changes in rugae were noted only in the extraction
group. Though statistically significant changes occurred, the medial and lateral points of the third
rugae were not considered clinically significant; it can be used for anatomic reference points in
dental cast analysis.
Almeida et al (1995) purported the first rugae as the most stable, whereas Bailey et al (1996)
describes the third rugae as the most stable. These findings presented further contradiction to the
use of rugae in identification due to possible changes over time and after events. Taken together,
these two studies highlighted the discrepancy in the stability of the palatal rugae after orthodontic
treatment and extractions.
2.4 Studies Concerned Matching Pre and Post Treatment Casts as a Method of Human
Identification.
In 1983 Thomas et al gave a classification (which is most applicable in most studies) for the
rugae identification included number, length, shape and unification. So, shapes are classified in to
curved, wavy, straight and circular. Unification is divided in to further converge and diverge
(Anukool et al, 2011; Thomas and Kotze, 1983).
In 2009 Filho and his colleagues, made a study aims to consider palatal rugae as source of
human identification beside other parts related to, in addition to the presence or absence of teeth as
complementary method. Their sample consisted of 100 models and their respective negative.
Three examiners participated of the research. Digital models are examined by means of the
Photoshop 7.0.1® program. The results, led to a percentage of 100% certainty on the
identification, so it made the identification possible foe the whole sample. And this led to conclude
that it is possible to achieve the human identification by means of palatal rugae provided that it has
a previous database. This provides significant advantages in criminal cases (Filho et al, 2009).
In the same year, 2009, Shriram and his colleagues made a study with an objective to compare
rugae patterns in pre and post-orthodontic treatment cases as a way of determining stability of
palatal rugae through orthodontic treatment. So, 30 preoperative and postoperative dental casts
were selected. Thirty casts were randomly selected for the present study. The 30 postoperative
casts were mixed with the 30 randomly selected casts. Thirteen examiners were selected as
evaluators and instructed to match the 30 preoperative dental casts with the 60 dental casts (30
postoperative and 30 randomly selected casts). The case numbers of those that were correctly
matched were noted. The result indicates that during fixed orthodontic treatment, some changes
occur, but not in the rugae pattern. The 13 examiners achieved 90% correct matches. So, it was
concluded that Palatal rugae patterns are unique to an individual. Therefore, used for individual
identification in forensic odontology.
Palihar et al (2010) conducted a study to compare the palatal rugae in pre and post-orthodontic
treated cases in term of their relation to each other, and to median plane for their uniqueness and
stability. The results showed that there is no significant difference between pre and post-
orthodontic cases, so they concluded that palatal rugae area remain stable throughout life.
Consequently, changes that occur in adolescent stage affect length only.
In a double blind study, English et al. (1988) selected 25 orthodontic cases with pretreatment
and post treatment dental casts. The casts came from subjects over 14 years of age. Then the 25
post orthodontic casts were placed within the 100 casts. Seven dentists and 2 dental assistants were
chosen as evaluators. Five of the dentists with varying forensic experience in identification were
assigned as individual evaluators. Two teams were also formed; both teams had no forensic
experience. Each team was asked to compare them to the 125 casts for matches. The time required
for the comparison, coupled with the correct percentage, was recorded. Eight investigators
correctly matched 100% of the casts and one investigator correctly matched 88%. From this study,
it was suggested that palatal rugae can be used for identification purposes. It also demonstrated
that changes that occur from orthodontic movement, extractions, aging, and palatal expansion do
not modify the rugae enough to prevent identification.
Then Anukool et al (2011) conducted a study in India aimed to judge the use of palatal rugae in
pre and post- orthodontic cases and determine their reliability. The classification given by
(Thomas et al, 1983) was used for rugae identification. No statistically significant difference was
found. This proved that rugoscopy identify an individual even after orthodontic treatment also.
Thus, palatal rugae hold potential as a supplementary tool, along with the dentition, to establish the
identity of an individual.
In the same year, Shukla and his colleagues (2011) wrote a research that aimed to determine the
stability of palatal rugae before and after orthodontic treatment. They selected 50 orthodontic cases
with preand post-treatment casts, and 50 casts were randomly selected as variables. In the pre and
post-treatment group, changes in transverse measurements were significantly different for lateral
points of first rugae, in addition, anteroposterior changes were significant for the distances
between first and second rugae. All inter-point measurements of third rugae were stable in post-
treatment casts. Thirty blinded examiners compared 50 trimmed preorthodontic casts to similarly
prepared one hundred casts for possible matches based on pattern of rugae. The percentages of
correct matches for examiners had a median of 90%. The matching ascertained that the
morphology of palatal rugae remains stable throughout life although some changes occur.
Subsequently, points associated with the third palatal ruage were the most immutable over a
person's life and could be used as a reference to evaluate changes in teeth positions happened
during orthodontic treatment (Shukla et al, 2011).
Stavrianos et al (2012) examined 50 orthodontic cases where their treatment lasted from 18
months to four years. Then those 50 were mixed with other 100 casts that were randomly selected.
The whole of 150 casts were given to five researchers to identify similarities between them, four
of the researchers had given 100% match for all 50 casts, and the last one matched 47 of them.
Therefore, they resulted that palatal rugae area is a unique personalized forensic evidence for
recognizing persons.
Shetty et al ( 2013)also conducted a study that aims to investigate palatal rugae patterns in
females and males, and to evaluate the stability of these patterns in pre- and post-operative
orthodontic cases, Fifty patients were selected for this study (25Males and 25 females). From the
above sample, 10 males and 10 females had undergone orthodontic treatment, and their casts were
retrieved for sex determination analysis and stability of rugae patterns pre and post-treatment.
They resulted that some Changes can occur in bony structures during fixed orthodontic treatment,
but rugae patterns remain stable. Kappa statistics and Chi square test were used to analyze
agreement between the two evaluators, and 95% correct matches were achieved. So they
concluded that Palatal rugae are unique to every individual and can be used as an indicator in
forensic odontology. (Madhankumar et al, 2013)
Babu et al (2013) aimed in their study that was done to study, analyze and report the significant
palatal rugae patterns among West Godavari District population. The results then were compared
with those patterns reported in literature to give an extra identification in cases of crime or mass
disasters. They select 100 pre-orthodontic casts. Thomas et al (1983) classification which included
the number, shape and unification patterns of rugae was used. The results represented that wavy
pattern is the significantly predominant pattern of PR. They concluded that Palatal rugae patterns
are definitely associated with regional variation and can aid as an additional tool in forensic
identification procedures.
Several studies have subsequently used palatal rugae as a stable reference points for assessment
of orthodontic tooth movement (Mavropoulos et al, 2005; Ashmore et al, 2002).
During literature review in Middle East countries three studies were done which concerned the
morphometric analysis of palatal rugae in United Kingdom of Saudi Arabia, Egypt, and the third
one was in Jordan, where all of them revealed palatal rugae individuality. For using orthodontic
treated cases to asses and evaluate palatal rugae area as a land mark for individuality, a study was
done in Egypt by Abd el Aziz and Sabet (2001) .They studied 50 pre and post orthodontic casts to
measure the stability of palatal rugae area, there were some changes after orthodontic treatment.
Results were insignificant by comparing pre and post results. It seemed that the lateral third rugae
is the most stable points and can be used for identification (Mustafa et al, 2012; Abdel-Aziz and
Sabet, 2001; Fahmi and Al-Shamrani, 2001; El-Fotoh and El-Sharkawy, 1998).
Chapter Three: Methodology
3.1 Sample Collection
The study was done in the department of anatomy at Jordan University of Science and
Technology, Irbid, Jordan. The study tried to evaluate post orthodontic treatment changes occur in
palatal rugae area of palate. So, the researcher collected 50 pre orthodontics and 50 post
orthodontics dental casts from a private clinic in Irbid, in the north of Jordan. Dental casts of the
upper jaw are used as records of malocclusion. They are of great asset to orthodontists during
diagnosis, treatment planning and monitoring improvements for orthodontic patients. Hence, serve
as replicate for palatal rugae area. Abdel-Aziz and Sabet (2001) mentioned that dental casts used
for analysis of orthodontic treatment changes is an important goal for orthodontic and forensic
researchers.
3.2 Material and Equipment
The study used maxillary dental Casts, they were sent to the lab to be duplicated. Then, using
Hb pencil, rugae area was delineated under adequate light. Every pair of casts (represent pre and
post for every patient) was given a serial number but not shown to the evaluators. A vernier caliper
was used to measure the length of each rugae, (this instrument measures of accuracy .05mm and
easy to be used), it's both edges were put on both end of the rugae. The distance between the two
points was read with its scale to give us the length to measure whether any change occurred.
3.3. Classification Criteria of Palatal Rugae
Palatal rugae were classified by many classifications during literature. Here in this study, the
researcher applied the classification given by Thomas et al, which composed of three parts. The
first part classifies palatal rugae according to their length. Those rugae, which have a length of
more than 5 mm were referred to as primary rugae. Secondary rugae were those that have a length
of 3 to 5mm, whilst fragmentary rugae were those to have less than 3mm. The second part
classifies palatal rugae according to their orientation. The orientation of each rugae is determined
by the relationship between the origin (medial end) and the termination (lateral end) points of each
rugae.
Rugae are considered anterior rugae when the termination point is anterior to the origin point.
Posterior rugae when the termination point is posterior to it. When both points are on the same
level it's considered horizontal. If rugae changes direction for more than one time, it is considered
irregular rugae.The third part classifies palatal rugae according to their shape in to one of six major
types: straight, curved, wavy, circular, diverging and converging. Straight rugae run directly from
their origin to termination. Curved rugae have a simple crescent shape that is curved gently. When
curved rugae have any bend at origin or termination, they are considered wavy rugae. Circular
rugae display a definite continuous ring formation. Rugae that begin from the same origin
medially and split laterally are classified as diverging, whereas, these rugae that begin from more
than one origin, but they unite at their lateral portions, are classified as converging rugae.
This classification was used to know how to give names to the palatal rugae, and to record
changes if occurred in them after orthodontic treatment in the right manner. Furthermore, to make
our next classification that is based on another ten criteria easier to deal with. So, these ten criteria
were considered to be studied and evaluated, followed by comparing between pre orthodontics and
post orthodontics casts as follows:
a. Segmentation; represents one or more rugae in the pre treatment cast that split in to two or
more than that in the post treatment cast.
b. Unification; represents two or more rugae area in the pre treatment cast that become one in
the post treatment cast.So the number of rugae here is decreased.
c. Change in orientation; represents any change in one or more rugae in their direction.
d. Change in shape; it meant that one or more of the rugae changed its way that it looks like
form circular to crescent shape for example.
e. Change in length; is one or more of the rugae could be elongated or shortened.
f. Change in prominence; is one or more of the rugae could be changed to more bulbous or be
thinned or it can be more or less obviously recognized.
g. Displacement of lateral end in mediolateral direction; a movement of lateral end of one or
more rugae in either sides to be nearer or far away of the alveolar ridge.
h. Displacement in medial end in mediolateral direction; a movement of medial end of one or
more rugae in either sides to be nearer or far away of the center line.
i. Displacement in medial end in anterioposterior direction; a movement of medial end of one
or more rugae in either sides to be nearer or far away of the central incisors.
j. Displacement of lateral end in anteroposterior direction; a movement of lateral end of one
or more rugae in either sides to be nearer or far away of the alveolar ridge that they were in
the pre orthodontics–casts .
3.4. Data Analysis
3. 4.1. Palatal Rugae Changes:
The data were then manually transferred to an Excel file on the computer by using every pair of
cast's serial number. Changes occurred were recorded in every post orthodontic cast regarding all
criteria we asked for. Then the researcher gave the number 0 for the criterion that didn’t change in
post treatment cast, and number 1 for the criterion that had changed. The frequencies of how many
casts that did change or got number 1for every criterion were counted. At the end of treatment, the
percentages of casts that had changes were calculated.
Then this excel file will be transformed in to SPSS program to give us frequencies of changes
happened in palatal rugae after orthodontic treatment.
3.4.2. Test of Individuality
Regarding individuality of palatal rugae area, the researcher compared every one of the
pretreatment casts of the fifty casts with the other forty nine casts. Three main categories were
overlooked including both their right, left halves and Medline of the entire palate. This was done
to observe any pairs had the same rugae pattern .So the researcher did 1225 comparison between
the 50 pre treatment casts. Some of them might had the same number of rugae but not the same
shapes and orientations. Similarly, every post treatment cast was also compared with the other post
treatment casts .1225 comparisons were done again in order to assess the individuality of palatal
rugae even after orthodontic treatment.
3.4.3 Matching Test
The researcher blocked out teeth in the pre orthodontics casts, duplicated post treatment casts
and the original post treatment casts (as shown in figure 2) in a standardized manner according to
English et al (1983) technique to be recognized without the help of the occlusion but only based on
the shape of palatal rugae themselves. This was done in a way that involved the teeth and vestibule
and edentulous area to ensure their influence did not exist anymore. The researcher asked ten
evaluators to match between the pre orthodontics and post orthodontics cast related for the same
person to ascertain the uniqueness of this area. So, the evaluators selected the closest match based
on the pattern of rugae. A sample of ten was chosen randomly from the table of random digit
numbers. Every evaluator was asked to match this sample of ten of the pre orthodontics cast with
their similar of the fifty original post orthodontics ones. Then the same evaluator matched ten of
the pre orthodontics casts with their right matches of the duplicated post orthodontics casts. Finally
he/she will match ten of the original post orthodontics casts with their counterparts from all
duplicated post orthodontics casts. All samples were chosen randomly, and every evaluator did his
trials without knowing the right matches, just by looking for palatal rugae area. Furthermore, every
evaluator did his trials without being seen by other evaluators.
Figure (2): Duplicated post orthodontic casts blocked out
3.5 Statistical Analysis
The right matches for all evaluators were recorded for the three trials. The means and standard
deviations for trials were calculated. After that, data were transformed in to SPSS program and
paired t-test was used to detect any significant difference between pre and post treatment data for
all groups we measured.
Chapter Four: Results
Since our study is a descriptive one, we will try to achieve the first aim of our study which is to
calculate frequencies and percentages of morphometric changes occurred in post treatment casts
regarding the criteria we choosed to study. Then regarding the individuality test in the second
section, which is our second aim, was done to verify an accuracy of identification based on rugae
pattern. Finally the matching test which is the second part of the second aim was done to ascertain
the stability of palatal rugae despite of changes that occur throughout person life. In addition, to
assess weather changes occurred in palatal rugae due to orthodontic forces hamper identification.
4.1 Morphologic Changes Induced by Orthodontic Treatment.
4.1.1 Frequencies and Percentage of Palatal Rugae Changes Related to Segmentation
Here in this section we got 11 casts out of 50 that were had segmentation, and this means that
11 casts that had one or more rugae that were divided in to two parts, giving us 22% ,while those
hadn’t changes were 78%, as shown in table1.
4.1.2 Frequencies and Percentage of Palatal Rugae Changes Related to Union
10 casts of the fifty were had this union criteria, that means two or more rugae were unified and
became one. This gives us a percent of 20%, and those without changes were 80%, as shown in
table 1.
4.1.3 Frequencies and Percentage of Palatal Rugae Changes Related to Orientation
Regarding this criteria 3 casts only showed changes in orientation, and this gives us a percent of
6%,while those who didn’t change were 94%.This is very low percent for change which is
considered to be clinically insignificant, as shown in table 1.
4.1.4 Frequencies and Percentage of Palatal Rugae Changes Related to Shape
Regarding this criteria 3 casts only showed changes in orientation, and this gives us a percent
of 6%, while those who didn’t change were 94%.also this criterion resembles low percent of
change therefore, high percent of stability as shown in table 1.
4.1.5 Frequencies and Percentage of Palatal Rugae Changes Related to Length.
I n this criterion 14 casts were changed in length either in increased or decreased pattern.This is
with percent of 28%, while those didn’t change give a percent of 82% as shown in table 1.
The next four criteria are generalized somehow looking for all rugae as one component without
making specifications for every rugae just to give an idea of stability and individuality of palatal
rugae area for clinical significance only not for statistical significance.
4.1.6 Frequencies and Percentage of Palatal Rugae Changes Related to Displacement of
Lateral End in Anteroposterior Direction
30 casts showed anteroposterior changes due to displacements of lateral ends of palatal rugae
and this had a percent of 6o%, while those cast didn’t displaced showed 40% as shown in table 1.
4.1.7 Frequencies and Percentage of Palatal Rugae Changes Related to Displacement of
Lateral End in Mediolateral Direction
For this criterion 28 casts showed displacement, and this gave a percent of 56%, leaving 44%
for those casts didn’t have any displaced rugae as shown in table 1.
4.1.8 Frequencies and Percentage of Palatal Rugae Changes Related to Displacement in
Medial End in Anterioposterior Direction
27 casts out of fifty had displaced medial ends of palatal rugae anteroposteriorly giving a
percent of 54%. Other group with no displacement got 46%as shown in table 1.
4.1.9 Frequencies and Percentage of Palatal Rugae Changes Related to Displacement in
Medial End in Mediolateral Direction
Only 10 casts regarding this criterion had displacement in this direction to give a percent of
20%, casts those with no displaced rugea gave a percent of 80% as shown in table 1.
4.1.10 Frequencies and Percentage of Palatal Rugae Changes Related to Change in
Prominence
Here in this criterion 27 casts showed change in prominence either decreased or increased after
orthodontic treatment. This gave a percent of 54% while other casts which were stable in volume
had a percent of 46% as shown in table 1.
Table 1: Frequencies and Percentage of morphometric Changes of Palatal
Rugae after treatment.
Morph.change frequency percentage%
Segmentation 11 22%
Unification 10 20%
Orientation 03 6%
Shape 03 6%
Length 14 28%
Disp.lat.A-P 30 60%
Disp.lat M-L 28 56%
Disp.med.A-P 27 54%
Diap.med.M-L 10 20%
Prominence 27 54%
In our sample of study 16 cases out of 50 were had extraction for first premolars. This gave a
more extra space needed to be closed which give a more possible changes in palatal rugae area at
the end of treatment .At least three changes occurred in any one of them, although they all shared
the change in palatal rugae area related to displacement of lateral end of palatal rugae both in
anteroposterior and mediolateral directions.
Regarding the non-extraction group four of these 34 post treatment casts had no change in any
of these criteria at all .In both extraction and non-extraction cases no cast involved changes in all
criteria. The casts that contained the highest percent of changes had changed 7 of these criteria but
according to matching test still could be correctly matched, representing those changes as
clinically insignificant.
4.2 Individuality Test
Regarding this test the researcher tried to conduct a qualitative comparison between pairs of
casts. By taking one and compare it with the remaining 49 casts. When pre orthodontics casts were
compared with each other, no two were alike or looks the same of others; even when comparing
the left with the right side for the same cast they were different from each other and can be easily
differentiated. Numbers of trials or comparisons were 1225, and was validated by another
examiner to make this step more accurate .This comparison aimed at detecting any identical
palatine rugae patterns.
Furthermore, post orthodontic casts were compared in the same manner. Another 1225
comparisons were done. No two similar casts existed. The entire palates of each pair of casts were
compared first then each half of the palate was compared to its counterpart in the second cast. The
results showed that we did not have any identical palatine rugae pattern either completely or
partially in our sample. This indicates that palatine rugae patterns among Jordanians are very
individualized. Post treatment casts comparisons revealed that individuality of palatal rugae area
ascertained despite of morphometric changes occurred.
Table (2): Individuality test
Area of comparison Number of comparisons
Pre Post
Number of similarities
Pre post
Entire palate 1225 1225 0 0
Left side rugae 1225 1225 0 0
Right side rugae 1225 1225 0 0
4.3 Matching Test
Talking about the first trial which was between the pre and post treatment casts, the mean for it
for all evaluators was 90% with a standard deviation 1.054, the second trial mean was 94%, and
the standard deviation was 0 .966, and 99% was the mean of the third trials that were matched
correctly by the same evaluators with a standard deviation of 0.316 as shown in table 3.
Regarding this matching test when comparing trials of pre orthodontics casts with the post
orthodontics ones and the trial of post orthodontics with the duplicated post treatment casts (when
p value less than .05) there was a statistical significant difference between them, by using paired t
test ,it was calculated to be 2.46. While by comparing the first trial with that of pretreatment casts
with the duplicated post treatment casts, it was obviously seen that they were not statistically
significant.
Table (3): T-test for the First and the Third Trials.
Type of trial Mean St.D df t P value
Pre and post 90 % 1.054 18 2.46 0.05
Post and copy 99% 0.316
Chapter Five: Discussion
The researcher in this chapter discusses the results of the study in three parts. The first part
discusses the results of the morphometric changes which occurred to palatal rugae after
orthodontics treatment. The second part discusses the results of individuality test, and the third part
discusses the results of matching test, and analyses the results of evaluators matching of pre and
post treatment casts.
This study is the first to be conducted in Jordan for detection of morphometric changes resulted
after orthodontics treatment. Estimation of orthodontics treatment changes is a step forward for
better treatment results, thus stability of palatal rugae is evaluated, and this emphasized the
importance of palatal rugae in accordance to previous literature.
Our aims in this study were to test the uniqueness and individuality of palatal rugae among
Jordanian population. Furthermore, evaluate the reliability palatal rugae as forensic tool for
identification through certain morphological changes resulted post treatment.
5.1 Criteria of Palatal Rugae that Have Changed and its Effect on Palate Morphology
Regarding the first morphologic change which is segmentation, (the splitting of the palatal
rugae in to two parts) just occurred in 22% of casts. This wasn’t studied in the literature, but it can
be seen that although this type of change occurred, still didn’t affect the individuality of palatal
rugae.
Orthodontics treatment strategies involves certain procedures regarding increasing or
decreasing the width of palate by expansion or retraction(ong and wood,2001). These ways can act
on soft tissue by stretching or compressing, this can lead to fragments in these rugae and splitting
of its continuity (Damstra et al,2009). So, its suggested that fragmentation appeared as if this rugae
became two parts very near to each other (Ashmore et al, 2002).
Also regarding the second change, just 20% of casts were unified and united to become one.
This could have the same explanation of the first. Movement of teeth and soft tissues in certain
way that lead to compression of tissues and being unified .They could be very near to each other
after teeth moved and appeared as one rugae .
The previous result didn’t agree with the study of Parihar et al(2010) who concluded that
changes occur in the position of rugae in orthodontics cases are statistically insignificant, and
doesn’t affect their unification. In our study these changes were significantly affected matching
efficiency.
Stavriano et al (2012) stated in their study that number of palatal rugae remains stable
throughout life .Changes that happened as a result of orthodontics therapy may be seen only to
their length. This may not agree with our results regarding the first two morphological changes. In
the literature, consensus of opinion is that the rugae remain fairly stable in number and
morphology except when there is trauma, such as orthodontic tooth movement, which may modify
their alignment. (Paliwal et al, 2010; Houser et al, 1989; Jacob and shalla, 1987).
Regarding changes in orientation and shape, just 6% of casts for each of them showed this
change. It was very limited involving only one terminal part of one rugae.
These results agreed with a study were done by Hopkinz and Harris (2003) suggested that there
are Breadths of the individual rugae changed in different directions after orthodontic treatment.
Consequently, they considered them as movable points. On the contrary to this, Anukool et al
(2012) concluded that no change in shape of palatal rugae was observed when comparing
pretreatment with post treatment cases.
Incidence of change in rugae shape was low when compare pre with post treatment casts as
reported by other studies (kapali ,1997; Robison ,1998)
Stuart et al (2005) concluded that Palatal rugae have been shown to be highly individualistic
and consistent in shape throughout the life. It is highly suggested that palatal rugae pattern is
unique to human being, as his fingerprints. Also changes that resulted from orthodontic
movement, extraction, aging, and palatal expansion did not modify the rugae enough to hamper
identification, which didn’t agree with our study. On the other hand, in another study, post
treatment casts weren’t taken in consideration because of changes in orientation in margins of
lateral rugae has been found. These results might support our findings (Goyal and Goyal, 2013).
Length, the fifth morphological changes were observed in 28% of casts, not necessarily to be
increased after orthodontics treatment, but certain casts their rugae were decreased in length , and
that was depending on the type of treatment carried on, whether it was rapid maxillary expansion
which contribute to increase in length due to stretching, or maxillary constriction and retraction of
anterior segment by either using functional or removable appliances(Peavey and Kendrick,1976).
This agreed with the study of Bansode and Kolkarni (2009), who used in their study arch
expansion technique and gave a result of definite increase in the length of rugae, but these teeth
movements did not significantly alter their pattern.
On contrary, Shetty et al (2011) aimed to evaluate reliability of palatal rugae as forensic tool.
They tried to assess stability of palatal rugae in particular ethnic group. Results showed that palatal
rugae remain unchanged after orthodontic intervention.
Parihar et al (2010) mentioned that median rugal region increased significantly in
anteroposterior length with growth. These measurements were observed as being greater in
orthodontic treated cases. These results evaluated palatal rugae stability and individuality
independent of sex and age.
Percentage of palatal rugae changes related to displacement of lateral end in anteroposterior and
mediolateral and medial end in anterioposterior directions were 60%, 56% and 54% respectively.
It means that more than half of our sample had these changes; in addition, all the extraction group
casts shared the first and the second of them in our sample. That gave an idea about more spaces to
be closed, so, more teeth movement that could be miss identified as rugae displacement.
This agreed with Almeida et al (1995), where he considered extraction of two premolars
creates more space for movement, which changes the lateral and medial rugae nearest to extracted
premolars. In non extraction cases ,stable medial ends of rugae in m-l direction . lateral points
appeared less stable. In addition, they pointed that no significant difference between type of
treatment modality and its effects on changes resulted after orthodontics therapy.
Furthermore, Vanderlanden (1978) said that lateral rugae move with teeth, unlikely, he was
unable to support this due to his small sample.
Peavey and Kinderik (1967) said that the closer the rugae are to teeth, the more prone they are
to stretch in the same direction of associated teeth movement. The influence of orthodontic
treatment was observed on positions of lateral rugae either in anteroposterior or mediolateral
directions.
Moyers et al (1988) reported that the distance between the functional occlusal plane and rugae
increased overtime, which agreed with us, but this change is not easy to be attributed to occlusal
plane or rugae itself.
In the study of Shukla et al (2011), the rugae points were unstable in the transverse direction
with respect to the lateral points of the first rugae. These results concurred with Bailey et al (1996)
who believed that extraction of the first premolars creates a large space for distal retraction of the
maxillary anterior teeth, which affect the positions of the lateral points of the first rugae, thus,
changing the transverse distance between them. In contrary to this, he observed stability of medial
rugae points in transverse direction, which didn’t agree with our results.
In our study 20% of the whole sample showed changes in medial rugae in transverse direction .
But her in Shukla et al study they resulted that None of the medial points of the first rugae were
affected for the transverse values. This finding is in congruence with previous studies by Housser
(1989) who concluded that lateral edges of the rugae move forward with the migration of teeth in
extraction cases but felt that the medial ruga points were unaffected. These results didn’t agree
with our study which showed changes in medial rugae points.
Damstra et al (2009), corresponded with our results ,he suggested adding rapid maxillary
expansion to fixed appliance therapy. This will cause changes in transverse measurements of
medial ends of rugae.
Some investigators have evaluated the stability of the palatal rugae during orthodontic
treatment. In patients treated with a functional appliance or headgear, the medial rugae points
appeared more stable than the lateral rugae points. In the comparison of tooth movement measured
by cephalometric superimposition relative to the rugae points on study models. T he medial points
of the third palatal rugae are suggested to be suitable reference points for the assessment of
anteroposterior tooth movement. Conversely, another study reported that the lateral points of the
third rugae are the most stable. Thus, identification of the most stable area is still controversial
(Abdel-Aziz and Sabet, 2001;Hogan and Sadowsky,2001; Almeida et al, 1995).
Simmons et al. (1987) found that the medial rugae were unstable reference points. (Christov
and Kiliaridis, 2008) investigated medial rugae in both transverse and anterioposterior directions
and observed their change over time. In contrast, Lebret (1962) reported that the distances between
the rugae landmarks were almost constant, especially for rugae points near the median raphe.
Peavy and Kendrick (1967) and Almeida et al. (1995) found that the lateral ends of the rugae were
greatly affected by movement of the teeth, but the medial rugae appeared to be a suitable anatomic
landmark for the construction of stable reference points for longitudinal cast analysis (Devreese et
al, 2007).
Several studies in the literature observed displacements occurred in rugae. Many of them
ascertained their stability. They considered changes due to teeth movement and migration ,or
changing in arch circumference increasing or decreasing. Other studies tried to postpone taking
post treatment casts enough time after completing their treatments. It was based on their theory
that palatal soft tissues are stretched during treatment and changed in dimensions. Relapse will
take place after a while and return back to their normal position as if before starting treatment
(Damstra et al,2009;Cotton,1987).
Changes related to prominence of rugae after treatment, 54% were changed in their size,
whether increased or decreased and this doesn’t agree with Anukool et al (2012) results, where
they observed no change in rugae size after treatment. On the other hand, it agreed with the results
of Hopkinz and Harris (2011) that anterior rugae were narrowed but the distal ones were stretched.
Taking whole criteria in general, Souza lima (1964) assessed pre and post treatment casts, and
concluded that no change in morphology or arrangement of palatal rugae occurred.
5.2 Individuality Test
The results of this test proved individuality of palatal rugae among Jordanian population. It
showed no identical pairs when compared every with each other. Pre treatment and post treatment
casts compared, which gave 1225 comparisons for each. These results were agreed with most
studies that were concerned with the individuality. They ascertained the uniqueness of palatal
rugae area despite of being similar in the same number of rugae. Their shapes and orientations
differed from one person to another.
Most of the literature agreed that the individuality of palatine rugae is sufficient for their use as
a method of identification. This was supported by the fact that the morphology of palatine rugae is
constant throughout life (Hemanth et al, 2010; Almedia et al, 1995).
Patil et al (2011) considered palatal rugae as permanent and stable land marks that could be
used for person discrimination in forensic identification. Having the same results, Shetty et al
(2013), found the palatal rugae are characteristic enough to be used in discrimination.
Furthermore, (Bansode and Kulkarni, 2009; Ernence and Rener 1999; Elfotoh et al, 1998;
English et al, 1988) cohered their results with others where they ascertained the use of palatal
rugae pattern for use in human identification in forensic odontology.
Regarding Jordanian population, one study was done to prove individuality of palatal rugae
and ascertained their use in forensic identification was done by (Mostafa et al, 2012).the results of
their study revealed individuality of palatal rugae area in people without considering any changes
might inflect on them. On the other hand our results proved individuality not only regarding pre
treatment casts. It ascertained the individuality of post treatment casts despite changes induced by
orthodontic treatment.
5.3. Matching Test
In the present study when matching between pretreatment and post treatment casts, the results
showed significant difference between the trials of pre orthodontics with post orthodontics casts.
While matching post treatment casts with those duplicated post treatment casts yielded statistically
insignificant results.
These results showed that changes occurred after treatment decreased matching efficiency
and affected percentage of right matches. On the other hand, the results with duplicated casts
showed higher percent of correct matches attributed to high accuracy level they kept. which
increased levels of correct matching ability.
Our results in this parts declared that morphological changes of palatal rugae during
orthodontic treatment decreased matching efficiency .Therefore, hampered human identification.
In literature, most studies included matching trials between pre and post treatment casts, were
done correctly without difficulties with almost 100%. Parihar et al (2010) noticed that all casts
were matched in ease, thus, he considered them as unique and don't change. Stavirianos et al
(2012) conducted his matching test with four evaluators got 100% of right matches and the fifth
one 94% which is statistically in significant. Bansode and Kulkarni (2009) showed in their study
results close from our study ranged from 76.6% to 96.6% with 13 evaluators participated.they
concluded that despite of changes in rugae area during orthodontic treatment,the morphology of
palatal rugae remains stable throughout life.
Anukool et al (2011). In his study, argued that pretreatment and post treatment casts can be
easily matched with each other quite easily, thus palatal rugae pattern are unique for individual and
do not change. These results suggest the usefulness and easy reproducibility of comparing palatal
rugae patterns for personal identification of cases.
Intra-observer discrepancies might affect the easily of right matching, where the observer
didn’t make an effort to focus on rugae area after slight orthodontic changes, or didn’t look for the
whole pattern, instead of that he just took one part of rugae and looked for it, which can lead to
mismatch and variations in their knowledge regarding oral anatomy and in their experience with
forensic identification, However, some examiners had problems during matching, which may be
due to complex rugae patterns, overlapping of rugae, and poorly demarcated rugae (Bansodeand
Kulkarni, 2009).
Apart from problems of intra-observer discrepancies in reading rugae patterns, there is no doubt
that even greater discrepancies could exist between observers e.g. differences in forensic
experience. The existence of this unreliability brings into question the present usefulness of
descriptive rugoscopy in fields such as forensic science. Although researchers have confirmed the
potential value of rugae in personal identification. It is important that exact reproductions of
patterns (for example, casts or photographs) are available and being updated moreover to depend
on them accurately. Furthermore, classification systems are refined so they are reliable but
relatively simple to apply.
Chapter Six : Conclusion
This chapter aimed at summarizing the important points in this thesis. It is considered an
important study because it's one of the empirical studies, which studied changes occurred due to
orthodontic treatment including different criteria, e.g., segmentation, union as expression for the
change in number, change in orientation, change in shape, change in length, change in volume,
displacement of lateral end (in anteroposterior and mediolateral direction)and displacement in
medial end (in anterioposterior and mediolateral direction)also. Furthermore, it is the first study
concerned all these morphometric changes together.
In addition, the other goal of this study was to further test the individuality of palatal rugae and
their value as a tool in individual identification. This goal was achieved by analyzing the
morphometric changes that take place in palatal rugae patterns as a result of orthodontic treatment.
Moreover, the researcher examined whether such changes will compromise our ability to match
the same palatal rugae pattern before and after orthodontic treatment.
This study dealt with changes that occurred to palatal rugae area through orthodontic
treatments. Orthodontic treatment and tooth movement have a significant effect on the stability of
Palatal rugae as investigated by previous researchers. Many studies in literature have found certain
landmarks on the rugae to be stable reference points for measuring tooth movements during
orthodontic treatment, but still there are controversial about this in literature.
The rugae morphological pattern may be useful in forensic science in case of mutilation when
compared with other parts of the body. Palatal rugae form an intrinsic and integral pattern for
every single individual and can also help in sex determination. The ease of reproducibility
andlower level of variation makes palatal rugae a potential toolin forensic odontology.
Morphometric changes which could occur as a result of orthodontic changes were studied.
These changes affected matching reliability. This justified the need for more updated antimortem
records when identification is needed. However, other methods of recording the rugae pattern are
possible for identification purpose, which might include photographs, palatal prints or impressions,
or computerized tomography of the rugae pattern. In addition, individuality of palatal rugae in
Jordanian population was assessed by comparing all pre orthodontics casts with each other which
gave us 1225 comparisons, which agreed with all studies for different population in literature.
The study reports that orthodontic treatment inflicts changes on palatal rugae. Such changes can
potentially compromise human identification in cases where palatal rugae records are not updated.
The study continues to suggest that palatal rugae patterns are highly individual. Even after
orthodontic treatment induced changes, palatal rugae patterns remain individualized. Thus, they
hold potential as a supplementary tool, along with the dentition, to establish the identity of an
individual, so they considered as a reliable guide in forensic identification when updated records
are available.
Although this study is very important in literature, it is limited by using a small sample which is
50 pre and 50 post casts, in addition, it is limited by the contribution of evaluators with varying
forensic experience. Nevertheless, in the light of previous results the researcher recommends that
larger samples should be examined in detail to further validate the findings of this type of study
and come to definitive conclusions. Likewise, further studies need to be researched on varying
population in different areas.
References:
Abdel-Aziz HM, Sabet NE.(2001). Palatal rugae area: a landmark for analysis of pre- and post-orthodontically treated adult Egyptian patients. East Mediterr Health J;7:60-6.
Anukool H. Pateria, Krushna. (2011). Thakkar Palatal rugae a stable landmark -A comparison between pre and post orthodontic patients:International Journal Of Dental Clinics:3(4):9-12
Almeida MA, Phillips C, Kula K, Tulloch C. (1995).Stability of the palatal rugae as landmarks for analysis of dental casts. Angle Orthod;65: 43-8.
Amasaki H, Ogawa M, Nagasao J, Mutoh K, Ichihara N, Asari M, et al. (2003).Distributional changes of BrdU, PCNA, E2F1 and PAL31 molecules in developing murine palatal rugae.Ann Anat185(6):517–23.
Ashmore, J.L., Kurland, B.F., King, G.J., Wheeler, T.T., Ghafari, J.,Ramasy, D.S., (2002). A 3-dimensional analysis of molar movement duringheadgear treatment.American Journal of Orthodontics and DentofacialOrthopedics, 121, 18-30.
Bailey, F.R. and Miller, A.M. (1921).Text-Book of Embryology. New York: William Wood and Co.
Bailey LT, Esmailnejad A, Almeida MA.(1996).Stability of the palatal rugae as landmarks for analysis of dental casts in extraction and non-extraction cases.Angle Orthod;66: 73-8
Bharath ST, Kumar GR, et al. (2011).Sex determination by discriminant function analysis of palatal rugae from a population of coastal Andhra.J Forensic Dent Sci 3 (2): 58-62.
Bhullar A, Kaur RP, Kamat MS (2011) Palatal Rugea – an Aid in Clinical Dentistry.J Forensic Res 2:124.
Breault LG, Fowler EB, Billman MA. (1999). Retained free gingival graft rugae: a 9-year case report. J Periodontol70:438-440.
Buchner A. The identification of human remains. Int Dent J1985; 35:307-11.
Carrea JU (1955) Gaumenfalten-Fotostenogramme, ein neues identfizierungsverfahren [Fotostenograms of palate folds, a new identification technic]. Dtsch Zahnarztl Z 10: 11-17.
Chatterjee, S and Khanna, M. (2011) . Dimensional analysis of various rugae patterns in north Indian population subset. J Forensic Dent Sci. Jul-Dec; 3(2): 86–881.
Chritou P, Kiliardis S. (2008). Vertical growth related changes in the positions of the palatal rugae and maxillary incisors. Am J Orthod Dentofacial Orthop.;133:81–6.
Coslet JG, Rosenberg ES, Tisat R. (1980).The free autogenously gingival graft. Dent Clin North Am; 24:651-682.
Cotton LA. (1978) .Slow maxillary expansion: skeletal versus dental response to low magnitude force in Macaca mulatta. American Journal of Orthodontics; 73:1-23.
Damstra J, Mistry D, Cruz C, Ren Y. (2009).Antero-posterior and transverse changes in the positions of palatal rugae after rapid maxillary expansion.Eur J Orthod.; 31:327–32.
D. De anglis , F.Riboli, D. Gibelli, A. Cappella, C.Cattaneo. (2011).Palatal rugae as an individualizing marker: reliability for forensic odontology and personal identification. J.science and justice article in press.
Dohke M, Osato S. (1994).Morphological study of the palatal rugae in Japanese 1.Bilateral differences in the regressive evaluation of the palatal rugae. Jap J Oral Biol;36:125-40.
D. Shukla,a A. Chowdhry,a D. Bablani,a P. Jain,b R. Thapar.c . (2011) Establishing the reliability of palatal rugae pattern in individual identification (following orthodontic treatment) .J Forensic Odontostomatol;29:1:20-29.
Eboh, D. E. O. (2012). Palatal rugae patterns of Urhobos in Abraka, South-Southern Nigeria. Int. J. Morphol., 30(2):709-713,.
El-Fotoh MM, El-Sharkawy GZH.(1998).A study of palatal rugae pattern (rugoscopy) in an Egyptian population.Egypt Dent J;44:3177-84.
English WR, Robison SF, Summitt JB, Oesterle LJ, Brannon RB, Morlang WM. (1988).Individuality of human palatal rugae. J Forensic Sci;33:718-26
Fahmi FM, Al-Shamrani SM, Talic YF.(2001). Rugae pattern in a Saudi population sample of males and females.Saudi Dental Journal;13:92-5
Filho,M I E ; Sales Peres, SHC ; Sales Peres, A. ; Carvalho, S P M . (2009). Palatal rugae patterns as bioindicators of identification in Forensic Dentistry. Revista da Faculdade dodontologia.: v. 14, p. 227-233.
Gandikota C, Venkata YP, et al. (2012). Comparative study of palatal rugae pattern in class II div 1 and class I individuals. J Pharm Bioallied Sci 4 (Suppl 2): S358-63.
Gitto CA, Esposito SJ, Draper JM. A simple method of adding palatal rugae to a complete denture. J Prosthet Dent. 1999;81(2): 237-239.
Goyal S, Goyal S. (2013) .Study of palatal rugae pattern of rwandan patients attending The dental department at king faisal hospital, kigali, rwanda: A preliminary study. Rwanda Med J;70:19-25.
Grove, H. F. and Christinsen, L. V. (1988).Relationship of first primary palatine rugae to the maxillary canines in man. Journal of Oral Rehabilitation, 15: 133–139.
Hauser G, Daponte A, et al. (1989). Palatal rugae.J. Anat. 165: 237-49.
Hemanth M, Vidya M, et al. (2010). Identification of individuals using palatal rugae: Computerized method. J Forensic Dent Sci 2 (2): 86-90.
Hermosilla, V. V.; San Pedro, V. J.; Cantin, M. & Suazo, G. I. C. (2009). Palatal rugae: Systemic analysis of its shape and dimensionsfor use in human identification. Int. J. Morphol., 27(3):819- 25.
Hoggan BR, Sadowsky C. (2001).The use of palatal rugae for the assess-ment of anteroposterior tooth movements.Am J Orthod DentofacialOrthop;119(5):482-488.
Indira AP, Manish Gupta, David MP. (2011).Rugoscopy for establishing individuality.Indian J Dent Adv;3:427-32.
Indira AP, Gupta M, David MP.( 2012).Palatal rugae patterns for establishing individuality.J Forensic Dent Sci.; 4(1): 25.
Ishizaki K, Sakurai K, et al. (2006). Response of Merkel cells in the palatal rugae to the continuous mechanical stimulation by palatal plate. Somatosens Mot Res 23 (1-2): 63-72.
Kapali S, Townsend G, Richards L, Parish T. (1997).Palatal rugae patterns in Australian Aborigines and Caucasians. Aust Dent J;42:129-33.
Kashima K. (1990). Comparative study of the paltal rugae & shape in Japanese & Indian children.Aichi Gaukin Daigaku Shigakkai Shi ; 28(1-2): 295-320.
Keith L. Moore, T.V.N. Persaud, Mark G. Torchia. Philadelphia, PA: Saunders. (2011). The Developing Human: clinically oriented embryology 9th ed .pp 333-400.
Limson, K. S. & Julian, R. (2004).Computerized recording of the palatal rugae pattern and an evaluation of its application in forensic identification.J. Forensic Odontostomatol., 22(1):1-4.
Luke DA (1988) Development and growth of palatal rugae in the mouse. Acta Anat 133: 41-44
Lund O. Histologische beitrage zur anatomie des munddachs undparadentiums. (1924).Vrtlzschr F Zahnh; 40:1-20
Lysell L. (1955). Plica palatinae transversae and papilla incisive in man: a morphological and genetic study. Acta Odontol Scand;13:5-137.
Manashvini S. Patil, Sanjayagouda B. Patil and Ashith B. Acharya. (2008). Palatine Rugae and Their Significance in Clinical Dentistry: A Review of the Literature. J Am Dent Assoc;139;1471-1478.
Mavropoulos, A., Karamouzos, A., Kiliaridis, S.,Papadopoulos, M.A., (2004). Efficiency of noncompliance simultaneous firstand second upper molar distalization: a three-dimensional tooth movementanalysis. Angle Orthodontist, 75, 532-539.
Mavropoulos,A., Sayinsu,K., Allaf,F., Kiliaridis, S., Papadopoulos,M,A., Keles, A.O. (2006). Noncompliance unilateralmaxillary molar distalization: a three-dimensional tooth movement analysis. AngleOrthodontist, 76, 382-387.
Miller, R.J., Kuo, E., Choi, W., (2003). Validation of Align Technology’sTreat lll digital model superimposition tool and its case application.OrthodCraniofacial Research, 6 (Suppl 1), 143-149.
Motabagani MA, (2006).A histological study on the prenatal development of the palatal rugae in the white rat. Ital J Anat Embryol. Apr-Jun;111(2):97-104.
Moyers, R.E., 1988. Handbook of Orthodontics.4th ed. Chicago: MedicalYearbook Publishers Inc., 236-239.
Mustafa, A, Allouh, M,Tarawneh ,I,Alrabata, R,(2013). Morphometric analysis of palatal rugae among Jordanians: further evidence of worldwide palatal rugae individuality.Australian Journal of Forensic Sciences;46:1 53-63.
Muthusubramanian M, Limson KS, Julian RJ. Analysis of rugae in burn victims and cadavers to simulate rugae identification in cases of incineration and decomposition. Forensic Odontostomatol 2005; 23: 26-29.
Nayak P, Acharya AB, Padmini AT, Kaveri H. (2007). Differences in palatal rugae shape in two population of India. Arch Oral Biol;52:977-82.
Ong, H.B., Woods, M.G.( 2001). An occlusal and cephalometric analysis of maxillary first and second premolar extraction effects.The Angle Orthodontist, 71,90-102.
Palmer JM. Structural changes for speech improvement in complete upper denture fabrication. J Prosthet Dent. 1979;41(5):507-510.
Patil M. S. , Patil S. B. , Acharya A. B. (2008). Palatine Rugae and Their Significance in Clinical Dentistry: A Review of the Literature. J Am Dent Assoc.;139: 1471-1478
Peavy, D. C. Jr. & Kendrick, G. S. (1967).The effects of tooth movement on the palatine rugae.J. Prosthet. Dent., 18(6):536-42.
Peterkova R, Klepacek I, Peterka M. (1987).Prenatal development of rugae palatinae in mice: scanning electron microscopic and histologic studies.J Craniofac Genet Dev Biol, 7:169-89.
Preethi, N.; Ashith, B.; Padmini, A. T. & Kaveri, H.( 2007). Differences in the palatal rugae shape in two populations of India. Arch. Oral Biol., 52:977-82.
Ratnakar.P, Singaraju. (2010).Methods of Identification in Forensic Dentistry G.S:.2.1.26-28.
Rossouw, P.E., Preston, C.B., Lombard, C. (1995). A longitudinal evaluation of extraction versus nonextraction treatment with special reference to the post treatment irregularity of the lower incisors.Seminars in Orthodontics, 5; 160-170.
Sakamoto, MK, Nakamura, K, Handa, J, Kihrat, T, Tanimura,T( 1989).Morphogenesis of the secondary palate in mouse embryos with special reference to the development of rugae. Anat Rec 223 : 299-310.
Saraf A, Bedia S, Indurkar A, Degwekar S, Bhowate R.(2011).Rugae patterns as an adjunct to sex differentiation in forensic identification,J Forensic Odontostomatol. Jul 1;29(1):14-9.
Sassouni, V. (1957).Palatoprint and Roentgenographic cephalometry as new method in human identification.J. Forensic Sci., 2:428- 42.
Schoenwolf .GC, Bleyl .SB, Brauer.PR. and PH.(2009) .Larsen’s Human Embryology. Francis-West - Chapter 12 Development of the Head, the Neck, the Eyes, and the Ears pp349 - 418.
Saxena S, Sharma P, Gupta N. Experimental studies of forensic odontology to aid in the identification process. Journal of forensic dental sciences. 2010;2(2):69-76.
Sharma P, Saxena S, Rathod V. (2009) Comparative reliability ofcheiloscopy and palatoscopy in human identification. Indian JDent Res;20(4):453-57.
Shetty SK, Mahabalesh, Premalatha K.(2011). Study of Palatal Rugae Pattern among the Student Population in Mangalore.Journal of Indian Academy of Forensic Medicine 33 (2). pp. 112-115. ISSN 0971-0973
Shetty SK, Kalia S, Patil K, Mahima VG.(2005) Palatal rugae pattern inMysorean and Tibetan populations. Indian J Dent Res;16(2):33-37.
Shriram C B, Meena M. (2009). Importance of palatal rugae in individual identification.Journal of forensic dental sciences:1(2):77-80.
Simmons JD, Moore RN, Erickson LC. (1987) . A longitudinal study of anteroposterior growth changes in the palatine rugae. J Dent Res;66:1512-15.
Sumathi MK,Balaji N,Vezhavendhan N,Sathish Kumar G,Shanthi V. (2012).Palatoscopy among Pondicherry Population: Journal of Scientific Dentistry. 1(1), pp 15- 24
Standring, S.Palate. In: Gray’s Anatomy. (2008). The Anatomical basis of clinical practice .40th ed. London, Elsevier, pp.547-59, 598-614.
Swetha SK, Kalia S, Patil K, Mahima VG.(2005). Palatal rugae pattern in Mysorean and Tibetan populations.Indian J Dent Res;16:51–5.
Thomas CJ, Kotze TJ. (1983).The palatal ruga pattern: A new classification.J Dent Assoc S Afr;38:153-76.
Thomas CJ, Kotze TJ. (1983)The palatal ruga pattern in six Southern African human population. Part-I.A description of population and a method for its investigation.J Dent Assoc S Afr;38:547-53.
Thomas CJ, Kotze TJ. (1983).The palatal ruga pattern in six Southern African human population. Part-II.Inter-racial differences.J Dent Assoc S Afr;38:166-72.
Thomas CJ, Van Wyk CW.( 1987) . Elastic fibre and hyaluronic acid inthe core of human palatal rugae. J Biol Buccale;15(3):171-174.
Van der Linden FP. (1978).Changes in the position of posterior teeth in relation to ruga points.Am JOrthod;74:142-61.
Venegas et al. (2009).Palatal Rugae: Systematic Analysis of its Shape and Dimensions for Use in Human Identification, Int. J. Morphol.:7(3):819-825.
Winslow JB.(1955) Exposition Anatomique de la structure du corpshumain. 1732. Cited by: Lysell L. Plicae palatinae transversae andpapilla incisiva in man. Acta Odontol Scand;13:(suppl 18):5-137.
Yang ST, Kim HK, et al. (2013). A three dimensional observation of palatal vault growth in children using mixed effect analysis: a 9 year longitudinal study. Eur J Orthod.35 (6):832-840.
التقويمية خالل الحنكي للغضون تحدثالتي المظهرية التغييرات صلتها المعالجة االستعرافب و الفردي
الشهاب: محمد روان اعداد
الملخص
حساب و التقويمية المعالجة بعد الحنكي الغضون منطقة معينةعلى مظهرية تغييرات بدراسة قمنا لقد \ \ . التغيرات ه ه كانت ا ا فيما باستكشاف قمنا البحث من الثاني الجزء في و لحصولها المئوية النسبةالعملية بعد و قبل الحنكي الغضون منطقة مطابقة على القدرة على القدرة من تقلل المظهرية
التقويمية.
العلوي , للفك طبعة بمائة االستعانة تمت الدراسة و 50لتحقيق العالج قبل الحصول 50ما تم العالج بعدالمعالجة . بعد حدثت التي المظهرية التغييرات وسجلت األسنان لتقويم عيادة من عشوائي بشكل عليها
من . طلب المئوية 10التقويمية النسب حساب وتم بينها المطابقة الصحيحة مقيمين للمطابقةاختبار. تقرن استخدم وقد . tوتسجيلها
.
التي و العالج بعد و قبل ما بين الغضون نمط في الحاصلة التغيرات بعض هناك أن الدراسة كشفت . هذه أن إلى نخلص أن ويمكن المقيمين بين الصحيحة المطابقة على القدرة المقابل في خفضتعلى القدرة على أثرت الذي العالج بعد و قبل ما بين تغييرات أحدثت دراستها تمت التي المعايير
الغضون . فردية من التأكد تم معينة درجة الى الصحيحة الدراسات .المطابقة من مزيد إلى حاجة هناكالشرعية . العلوم في الهوية لتحديد إضافية كطريقة استخدامها يمكن بحيث النتائج هذه لتأكيد
Appendix A
Changes occurred post orthodontic treatment: Segmentation
Pre treatment cast without segmentation.
Post treatment cast with segmentation in one of the rugae .
Appendix B
Changes in post orthodontics treatment: Union
Pre treatment cast with rugae that is separated from each other.
Post treatment casts with these rugae are united together and become one rugae.
Appendix C
Changes in post orthodontic treatment: Shape
Pre treatment cast with straight shape rugae.
Post treatment cast with the same rugae that is being curved.
Appendix D
Changes in post orthodontic treatment: Orientation
Pretreatment cast posteriorly oriented rugae.
Post treatment cast with anteriorly oriented rugae.
Appendix E
Changes in post orthodontic treatment: Length
Pre treatment cast with this length. Post treatment cast with
decreased length of rugae.
Appendix F
Change in post orthodontic treatment: Displacement of lateral rugae A-P
Pretreatment cast with lateral rugae placed.
Post treatment cast with more anteriorly placed lateral rugae
Appendix G
Changes in post orthodontic treatment: Displacement of lateral rugae M-L
Pretreatment cast with lateral rugae placed .
Post treatment cast with lateral rugae are more medially displaced.
Appendix H
Change in post orthodontic treatment: Displacement of medial rugae A-P
Pre treatment cast with these dimensions of palatal rugae
Post treatment cast with medial rugae are more anteriorly displaced
Appendix I
Change in post orthodontic treatment: Displacement of medial rugae M-L
Pretreatment cast of palatal rugae. Post treatment cast with medial rugae are more laterally displaced.
Appendix J
Changes in post orthodontic treatment: Prominence
Pretreatment cast with a good prominent rugae .
Post treatment cast with decreased prominence of rugae.