Midpalatal Suture Maturation Research Articles

Prediction of midpalatal suture maturation stage based on transfer learning and enhanced vision transformer

BackgroundMaxillary expansion is an important treatment method for maxillary transverse hypoplasia. Different methods of maxillary expansion should be carried out depending on the midpalatal suture maturation levels, and the diagnosis was validated by palatal plane cone beam computed tomography (CBCT) images by orthodontists, while such a method suffered from low efficiency and strong subjectivity. This study develops and evaluates an enhanced vision transformer (ViT) to automatically classify CBCT images of midpalatal sutures with different maturation stages.MethodsIn recent years, the use of convolutional neural network (CNN) to classify images of midpalatal suture with different maturation stages has brought positive significance to the decision of the clinical maxillary expansion method. However, CNN cannot adequately learn the long-distance dependencies between images and features, which are also required for global recognition of midpalatal suture CBCT images. The Self-Attention of ViT has the function of capturing the relationship between long-distance pixels of the image. However, it lacks the inductive bias of CNN and needs more data training. To solve this problem, a CNN-enhanced ViT model based on transfer learning is proposed to classify midpalatal suture CBCT images. In this study, 2518 CBCT images of the palate plane are collected, and the images are divided into 1259 images as the training set, 506 images as the verification set, and 753 images as the test set. After the training set image preprocessing, the CNN-enhanced ViT model is trained and adjusted, and the generalization ability of the model is tested on the test set.ResultsThe classification accuracy of our proposed ViT model is 95.75%, and its Macro-averaging Area under the receiver operating characteristic Curve (AUC) and Micro-averaging AUC are 97.89% and 98.36% respectively on our data test set. The classification accuracy of the best performing CNN model EfficientnetV2_S was 93.76% on our data test set. The classification accuracy of the clinician is 89.10% on our data test set.ConclusionsThe experimental results show that this method can effectively complete CBCT images classification of midpalatal suture maturation stages, and the performance is better than a clinician. Therefore, the model can provide a valuable reference for orthodontists and assist them in making correct a diagnosis.

Midpalatal Suture Maturation in Relation to Age, Sex, and Facial Skeletal Growth Patterns: A CBCT Study.

The evaluation of midpalatal suture maturation is essential to undertake the most predictable maxillary expansion approach. Several factors, such as age, gender, and facial growth patterns, seem to be involved in midpalatal suture staging and, consequently, in its opening; however, the link between these variables and the stages of midpalatal suture development remains poorly understood. Our study aimed to analyse the midpalatal suture maturation in relation to age, sex, and skeletal growth patterns by CBCT. We enrolled 263 patients (119 males and 144 females) aged from 8 to 20 years. The midpalatal suture maturation was defined according to Angelieri et al.'s classification using a low-dose CBCT. The chi-square test and linear regression were applied to investigate the suture stages by age, sex, and vertical and sagittal growth patterns. Stage A was present in 8- and 9-year-olds with a larger prevalence in boys, while the prevalence of stage E increased progressively with age. Stage D was the most prevalent in our sample. The statistical analysis described that stage A was more likely in the youngest subjects, and stage E in the oldest participants. The males tended to have lower maturation stages. Moreover, the hypodivergent and normodivergent subjects tended to have higher maturation stages, while Class III was more likely in subjects in stages D or E. A total of 127 patients were in stages A, B, and C, showing an unfused suture. In young individuals, the opening of the midpalatal suture leads to a proper facial growth development by correcting the transverse superior hypoplasia. The midpalatal sutural maturation classification was related to age, sex, and divergence.

Feasibility of 3 Tesla MRI for the assessment of mid-palatal suture maturation: a retrospective pilot study.

The maxilla occupies a key position in dentofacial orthopaedics, since its transversal development can be directly influenced by orthodontic therapy. The maturation stages of the mid-palatal suture, which are obtained from cone-beam computed tomography images (CBCT), present an addition to clinical decision-making in transversal discrepancies of the upper jaw. In an endeavour to reduce ionizing radiation in adolescents and young adults, who are particularly susceptible to long term stochastic irradiation effects, we investigated the feasibility of 3 Tesla (3T) MRI in detecting the maturation stages of the mid-palatal suture. A collective of 30 patients aged 24-93years with routine neck MRI at 3T, underwent an additional three-dimensional isotropic T1 weighted study sequence of the midface. Image evaluation was performed on axial, multi-planar formatted reconstructions of the dataset aligned to the midline axis of the palate, and curved reconstructions aligned to the concavity of the palate. Inverted images helped to achieve an image impression similar to the well-known CBCT appearance. All datasets were reviewed by three readers and mid-palatal maturation was scored twice according to Angelieri et al. Intra- and inter-rater agreement were evaluated to measure the robustness of the images for clinical evaluation. 3T MRI deemed reliable for the assessment of mid-palatal suture maturation and hence for the appraisal of the hard palate and its adjacent sutures. The data of this pilot study display the feasibility of non-ionizing cross-sectional MRI for the determination of sutural maturation stages. These findings underline the potential of MRI for orthodontic treatment planning, further contributing to the avoidance of unnecessary radiation doses.

Tooth-Bone-Borne vs Bone-Borne Rapid Maxillary Expanders on Dentoskeletal Changes.

This study compared the insertion and thickness of the cortical bone, the parallelism of the midpalatal suture, and the skeletal transverse dimension using a microimplant-assisted rapid palatal expansion (MARPE) with those produced by bone-anchored maxillary expander (BAME) in adults. The sample comprised 18 patients (mean age, 29.9±9.4 years) selected for the MARPE group and 18 (mean age 24.8±6.8 years) selected for the BAME group. Cone-Beam computed tomography scans taken just before and after the expansion. After treatment, there was a significant palatal depth decrease. In addition, maxillary and mandibular width were increased in both groups. Regarding the cortical bone insertion and cortical bone width, it is shown an increase in both groups but those changes are not significant. However, the anterior suture opening effect occurs more frequently in the BAME than in the MARPE device. There are no differences in the frequency of opening of the midpalatal suture in the cases treated with MARPE and BAME, in both cases the most frequent opening morphology is parallel, independently of midpalatal suture maturation. There are no differences in the use of MARPE or BAME in the parallelism of the middle palatal suture, the cortical bone insertion, and thickness according to the maturation stages of the midpalatal suture but significantly increases the transverse dimensions of the maxillary skeleton.

Performance of dental students, orthodontic residents, and orthodontists for classification of midpalatal suture maturation stages on cone-beam computed tomography scans – a preliminary study

BackgroundAssessment of midpalatal suture maturation on cone-beam computed tomography (CBCT) scans is performed by visual inspection and is therefore subjective. The extent to which the assessment of midpalatal suture maturation is affected by rater experience has not been adequately explored in the existing literature, thus limiting the availability of evidence-based findings. This study compared the outcomes of classification by dental students, orthodontic residents, and orthodontists.MethodsThree different groups of students, orthodontic residents, and orthodontists evaluated 10 randomly chosen CBCT scans regarding midpalatal suture maturation from a pool of 179 patients (98 female and 81 male patients) aged 8 – 40 years which were previously classified by evaluating CBCT scans. The pool was set as benchmark utilizing midpalatal suture maturation classification by one examiner (OsiriX Lite version 11.0; Pixmeo SARL, Bernex, Switzerland). For assessment of intra-rater reliability of the examiners of each group the randomly chosen subjects were reclassified for midpalatal suture maturation after a wash-out period of two weeks by using the same software. Statistical analysis was performed to evaluate intra- and interrater reliability of the three groups with differing experience level.ResultsGroupwise intra-rater reliability assessment between the classification and reclassification was weak for examiners with a low level of experience (k = 0.59). Orthodontists had highest degree of agreement with regard to benchmark classification with an inter-rater reliability to be considered as moderate (k = 0.68).ConclusionsAssessment of midpalatal suture maturation on CBCT scans appears to be a subjective process and is considerably related to the experience level of the examiner. A high level of clinical experience seems to be favorable but does not necessarily ensure accurate results.

A Roentgenographic Comparative Investigation of The Midpalatal Suture Obliteration Evidenced Through Occlusal and Cone Beam CT Radiographs

Background: Assessing the midpalatal suture (MPS) maturation is crucial to successfully predict rapid maxillary expansion. Therefore, radiographic measurement of the suture width is vital for treatment planning. This study compared MPS ossification using cross-sectional maxillary occlusal radiographs and cone-beam computed tomography (CBCT) scans to aid clinicians in making better treatment decisions. Methods: In this study, 33 patients were selected as the study cohort and were categorized into two distinct groups according to their chronological age. Group I included individuals in the growth phase, aged between 8 to 16 years, while Group II encompassed post-adolescent and young adult participants aged between 16 to 25 years. The percentage of MPS ossification was calculated using the suture obliteration index calculated on axial cross-sectional images. Statistical analysis was performed utilizing the student t-test with a significance level set at 0.05. Results: No significant difference was found between occlusal radiographs and CBCT scans in the assessment of MPS ossification in the anterior part (P>0.05). However, significant differences existed in the suture obliteration index in anterior part (P=0.031) and posterior part (P=0.035), with higher mean values obtained by occlusal radiographs. In contrast, significant differences favoring CBCT were found in the anterior part (P<0.001) with higher mean values; no significant difference was found in the posterior part. Lastly, significant difference did not exist in the posterior part between the two imaging modalities (P>0.05). Conclusion: For MPS assessment, both CBCT and occlusal radiography can provide predictable results. However, it is notable that CBCT still has an upper hand in providing better and more accurate results.

The effect of vertical skeletal proportions, skeletal maturation, and age on midpalatal suture maturation: a CBCT-based study

BackgroundMidpalatal suture (MPS) maturation may be influenced by a range of parameters including age, gender, and vertical skeletal pattern. We therefore aimed to evaluate the effect of Frankfurt-mandibular angle (FMA), skeletal maturation, and age on the timing of MPS maturation.MethodsIn this cross-sectional study, cone-beam computed tomography (CBCT) and lateral cephalograms were used to assess the MPS and cervical vertebral maturation (CVM) stage. A proportional odds logistic regression model was used to assess associations between age adjusted for gender and MPS maturation, and a regression analysis was performed to analyze the effect of vertical pattern on these associations.ResultsA total of 201 patients (84 male and 117 female) with a mean age of 13.48 (SD 1.94) were included. With increasing age, the odds of belonging to a higher maturation stage increased (OR: 2.14; 95% CI 1.789; 2.567; P < 0.001); however, no association between FMA and MPS maturation was observed (OR: 1.01; 95% CI 0.964; 1.051; P = 0.76). A strong correlation between MPS maturation and CVM stage was not reported. Males had a higher probability of belonging to a lower MPS maturation stage (OR: 0.24; 95% CI 0.136; 0.415; P < 0.001).ConclusionsBased on this cross-sectional analysis, midpalatal sutural maturation classification is associated with chronological age and occurs later in males. Neither CVM staging nor variation in vertical skeletal proportions were useful predictors of midpalatal maturation stage.

Convolutional neural network-assisted diagnosis of midpalatal suture maturation stage in cone-beam computed tomography

ObjectivesThe selection of treatment for maxillary expansion is closely related to the calcification degree of the midpalatal suture. A classification method for individual assessment of the morphology of midpalatal suture in cone-beam computed tomography (CBCT) is useful for evaluating the calcification degree. Currently, convolutional neural networks (CNNs) have been introduced into the field of oral and maxillofacial imaging diagnosis. This study validated the ability of CNN models in assessing the maturation stage of the midpalatal suture. MethodsThe existing CNN model ResNet50 was trained to locate the CBCT transverse plane which contained a complete midpalatal suture. ResNet18, ResNet50, RessNet101, Inception-v3, and Efficientnetv2-s models were trained to evaluate the midpalatal suture maturation stage. Multi-class classification metrics, accuracy, recall, precision, F1-score, and area under the curve values from the receiver operating characteristic curve were used to evaluate the performance of the models, and gradient-weighted class activation map technology was utilised to visualise five midpalatal suture maturation stages for each model. ResultsResnet50 demonstrated an accuracy of 99.74 % in identifying the transverse plane that contained the complete midpalatal suture. The highest accuracies achieved on the two-stage, three-stage, and five-stage maturation classification tests were 95.15, 88.06, and 75.37 %, all of which exceeded the average accuracy of three experienced orthodontists. ConclusionsThe CNN model can locate the plane of the midpalatal suture in CBCT images and can assist clinicians in assessing the maturation stage of the midpalatal suture to select the means of maxillary expansion. Clinical significanceThe application of artificial intelligence on CBCT midpalatal suture plane localisation and maturation stage evaluation enhances diagnostic and treatment efficiency and accuracy of individual assessment of midpalatal suture calcification degree. Additionally, it assists the clinical palatal expansion technique in achieving ideal results.

Evaluation of the Midpalatal Suture and its Correlation with the Cervical Vertebral Maturation Stages and Second Molar Mineralization Stages: A CBCT Study

Objectives To evaluate and correlate the maturation stage of the midpalatal suture, CVM stages, mandibular left second molar mineralization stages of the subjects by CBCT. Materials and Methods One hundred subjects (55 males and 45 females) with a mean age of 13.56 ± 4.46 years, were divided into five midpalatal suture maturational stage groups (A to E). Cervical vertebral maturational stages on lateral cephalograms and second molar mineralization stages on orthopantograms from the CBCT images obtained from Carestream CS 9300C 3D system were analyzed and correlation among them were calculated by Spearman’s coefficient of correlation and midpalatal suture maturation stage prediction accuracy estimated with sensitivity, specificity, positive predictive value, and likelihood ratio. Results Spearman’s correlation analysis showed a highly significant ( p value &lt; .001) and positive correlation between MPS stage and CVM Stage ( r = 0.930), MPS stage and mandibular left second molar mineralization stage ( r = 0.757), and CVM stage and mandibular left second molar mineralization stage ( r = 0.760). Conclusion Cervical vertebral maturation stages 1,2, and 3 can be used clinically to predict the midpalatal suture maturation stages A, B, and C, respectively, as their likelihood ratios were more than 10. Second molar mineralization stages had less predictive value for MPS stages.

Age-related changes in the midpalatal suture: Comparison between CBCT staging and bone micromorphology

The age-related maturation of the human midpalatal suture is challenging to predict, but critical for successful non-surgical rapid maxillary expansion (RME). While cone-beam computed tomography (CBCT) can be used to categorize the suture into stages, it remains unclear how well the stages predict the actual micromorphology of the palate. To address this clinically relevant question, we used CBCT together with three-dimensional micro-computed tomography (μCT) analysis on 24 human palate specimens from individuals aged 14–34 years. We first classified the specimens into stages (A-E) using CBCT images and then correlated the results with our comprehensive μCT analysis. Our analysis focused on several factors, including bone volume fraction (BV/TV), sutural width, volume, interdigitation, ossification, and their associations with age, CBCT stage, and sex. Our μCT analysis revealed a decrease in sutural width and volume after the age of 20 years, accompanied by sutural closure beginning in the palatal segment. The overall rate of ossification remained low but increased after the age of 20 years. No significant differences were found between males and females. Importantly, we also found no correlation between individual age and CBCT stages. Furthermore, there was no association between CBCT stages and patalal suture volume, ossification and interdigitation.Taken together, our findings cast doubt on the reliability of CBCT stage as a means of predicting skeletal maturity of the palatal suture, as it appears to lack the precision required to accurately assess the true micromorphology of the palatal suture. Future investigations should explore whether alternative CBCT parameters may be more useful in addressing the challenging question of whether RME requires surgical bone weakening.

Investigation of the correlation of midpalatal suture maturation stage with chronological age and cervical vertebral maturation stage

Objectives: The first aim of this study was to investigate the correlation between chronological age, cervical vertebral maturation (CVM) stage, and midpalatal suture (MPS) maturation stage. The second aim was to assess the relationship between the prognosis for rapid maxillary expansion (RME) and age, CVM stage, and MPS maturation stage. Material and Methods: We divided 109 participants into three age groups: &lt;15 years, 15–25 years, and &gt;25 years. The participants had undergone both cone-beam computed tomography (CBCT) and lateral cephalometric X-ray examination. Their MPS maturation stage was classified as A to E and CVM stage as cervical stage 1 (CS1) to CS6, according to a previously proposed method. We used the weighted kappa coefficient to assess intra-examiner agreement and Spearman’s correlation coefficient, to evaluate the correlations of MPS maturation stage with age and CVM stage. Results: The weighted kappa coefficients were 0.849 and 0.923 for the identification of MPS maturation stage and CVM stage, respectively. There were significant, but weak correlations between MPS maturation stage and age (r = 0.313, P = 0.001) and, CVM stage (r = 0.287, P = 0.002). MPS stage C was the most prevalent across all age groups and all CVM stages. Conclusion: Chronological age and CVM stage may not accurately predict MPS maturation stage, especially in older patients. Further, the prognosis for RME may not be strongly related to either CVM or MPS maturation stage. We recommend using CBCT X-rays for individual MPS assessments before selecting the type of maxillary expansion treatment.

Midpalatal suture maturation in 15- to 35-year-olds: morphological assessment in the coronal plane using CBCT-an exploratory study.

Rapid maxillary expansion (RME) is used in patients presenting transverse maxillary deficiency. However, RME may be unpredictable after late adolescence if the midpalatal sutural maturation stage (MPMS) is in late stage. Since MPMS evaluation is influenced by the expertise of the operator and image quality, this classification method could be complemented. Therefore, this study aimed to analyze the morphology of the midpalatal suture (MPS) and its surrounding bone in the coronal plane using cone beam computed tomography (CBCT) images of adolescents and young adults and to correlate the findings with their respective MPMS status. CBCT scans of 200 patients aged 15-35years of both sexes were evaluated. MPS and surrounding bone tissue characteristics in the coronal and axial sections were analyzed, and MPMS was evaluated (A to E). Six categories were identified for the coronal evaluation, analyzing it in 2 standardized locations. Sutural morphology: I, hypodense sutural line limited by 2 hyper-dense para-sutural lines; II, hypodense sutural line; and III, suture not visible. The presence of para-sutural cancellous bone: CB0, compact bone; CB1, dense cancellous tissue; CB2, spaced cancellous bone. Midpalatal bone thickness (MBTh) was also measured. ANOVA-Bonferroni, chi-square, logistic regression and t-tests were used. MPMS increased with age. Sutural morphology I and CB0 bone were the most prevalent. Here we show that sutural morphology, para-sutural bone characteristics, and MPSM were significantly associated. The coronal evaluation of the MPS can complement the information from the MPSM assessment, allowing the identification of patent MPS even in the presence of late MPSM.

Influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors

ObjectivesTo evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors.Materials and methodsPatients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record.ResultsTwenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02).ConclusionsOne and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession.Clinical relevanceClinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.

Correlation Between Third Molar Mineralization and Midpalatal Suture Maturity: A Cone Beam Computed Tomography Study.

BACKGROUND Midpalatal suture ossification varies in patients of different ages, which can lead to making inaccurate presumptions when considering effective treatment timing based on chronological age. Chronological age provides only general information, whereas dental development correlates with skeletal growth, which suggests that tooth mineralization could be considered to be a precise criterion for determining the midpalatal suture's maturity. The present study was conducted to investigate the association between third-molar mineralization and midpalatal suture's maturation stages using cone-beam computed tomography (CBCT) images. MATERIAL AND METHODS The study involved 97 CBCT images of patients aged 8-37 years with normal growth and development. Subjects with cleft lip and palate, caries treatment, or present cavities in the third molars were not included in the study. The stages of midpalatal suture ossification were evaluated according to the protocol suggested by Angelieri et al, and the third-molar mineralization degree was measured by the Demirjian index. Statistical analysis was performed to evaluate correlations between the variables. RESULTS Patients with advanced third-molar mineralization stages were found to have greater midpalatal suture maturity. A statistically significant positive correlation was found between the stages of third-molar mineralization and midpalatal suture maturation (R=0.814, P<0.01). Third-molar development was also found to be associated with chronological age (R=0.883, P<0.01). CONCLUSIONS A measure of third-molar mineralization does not allow for accurate determination of the midpalatal suture maturation stage.

Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status

AbstractThe objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study. Keywords: Cranial Sutures. Hard Palate. Maxilla. Palatine Expansion Technique ResumoO objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico. Palavras-chave: Suturas Cranianas. Palato Duro. Maxila. Técnica de Expansão Palatina

Diagnostic value of cervical vertebral maturation stages for midpalatal suture maturation assessment: a study in the Chinese population

PurposeTo evaluate the correlation between cervical vertebral maturation stages (CVMS) and midpalatal suture maturation stages (MPSMS), and to analyze the diagnostic value of CVMS for the assessment of MPSMS.MethodsCone beam computed tomography (CBCT) images of 233 subjects (8–20 years) were selected. The CVMS was determined using the McNamara and Franchi method, while the MPSMS was evaluated using the Angelieri method. Spearman rank correlation was used to analyze the results, and positive likelihood ratios were calculated to evaluate the diagnostic value of CVMS in identifying MPSMS.ResultsSpearman rank correlation results showed a strong positive correlation (r = 0.867, P < 0.001) between CVMS and MPSMS. The positive likelihood ratios of CS12, CS4, and CS56 for the identification of stages AB, C, and DE were 12.17, 7.64, and 7.79, respectively. The values of the positive likelihood ratios of the other groups were less than five.ConclusionCS12 of the CVMS can be used as a reliable indicator for the assessment of MPSMS stage AB. From CVMS stage 4 forward, midpalatal suture maturation should be evaluated using CBCT.

Can surgically assisted rapid palatal expansion (SARPE) be recommended over orthodontic rapid palatal expansion (ORPE) for girls above the age of14? : Acone-beam CT study on midpalatal suture maturation.

For patients with amaxillary transversal deficiency (MTD), various treatment options are available, partly based on the practitioner's experience. This study aimed to determine acut-off age for decision making between surgically assisted rapid palatal expansion (SARPE) over orthodontic rapid palatal expansion (ORPE) based on skeletal maturation in afemale population. A total of 100 cone beam computed tomography (CBCT) images of young females were analyzed on maturation of the pterygomaxillary (PMS), zygomaticomaxillary (ZMS), transpalatal (TPS), and midpalatal (MPS) sutures. Based on the maturation of these four junctions, four independent observers had to determine whether they would prefer ORPE or SARPE to widen the maxilla. For the PMS, the results show aclosure of 83-100% from 13to 17years. As for the TPS, aclosure of 78-85% was observed from 15years of age. For the 15- to 17-year-old females, aclosed ZMS was present in 32-47%. Regarding MPS, closed sutures presented in 61% (stagesD andE) of the 15-year-old females. The cut-off age at which SARPE was recommended was 15.1years for the orthodontist observers and 14.8years for the maxillofacial surgeon observers. Significant maturation of MPS was reached at the age of15 in afemale population. The PMS, TPS, MPS, and ZMS closed sequentially. Acomprehensive diagnostic approach is necessary for choosing the appropriate treatment. When in doubt, age could assist decision making in afemale population, with acut-off age of 15years in favor of SARPE based on this study.

Applicability of Fractal Analysis for Quantitative Evaluation of Midpalatal Suture Maturation.

The treatment of transversal maxillary deficiency usually aims at skeletal expansion. The treatment option highly depends on the maturation stage of the midpalatal suture (MPS), which may vary between individuals at the same chronological age. Therefore, the individual determination of the MPS maturation is crucial. Our aim was to investigate the applicability of fractal analysis for the quantitative evaluation of MPS maturation. Nine experienced orthodontists were asked to evaluate the MPS maturation on 51 cone beam computed tomography (CBCT) scans according to the Angelieri classification method. Intra- and inter-examiner reliability was measured using Cohen's Kappa coefficient. The stages were agreed upon according to the results of the examiners with the highest strength of agreement. Fractal analysis was then performed on the CBCTs and the correlation between the fractal dimension values and maturation stages was then evaluated. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. The cut-off point was found at 1.073, at which the use of fractal dimension for predicting MPS maturation showed 100% sensitivity, 93.7% specificity, 9.5% false positive, 0% false negative rate. Our results provided further evidence that fractal analysis is a reliable tool to determine MPS maturation stage.

Midpalatal Suture Maturation Stage in 10- to 25-Year-Olds Using Cone-Beam Computed Tomography—A Cross-Sectional Study

In this study, we aimed to evaluate the frequency of midpalatal maturational stages in a Chilean urban sample of adolescents, post-adolescents and young adults, associated with chronological age and sex, by assessing CBCT scan images. Tomographic images in axial sections of the midpalatal sutures from 116 adolescents and young adults (61 females and 55 males, 10-25 years old) were classified according to their morphologic characteristics in five maturational stages (A, B, C, D and E), as proposed by Angelieri et al. The sample was divided into three groups: adolescents, post-adolescents and young adults. Three previously calibrated examiners (radiologist, orthodontist and general dentist) analyzed and classified the images. Stages A, B and C were considered to be an open midpalatal suture, and D and E were considered to be a partially or totally closed midpalatal suture. The most frequent stage of maturation was D (37.9%), followed by C (24%) and E (19.6%). The possibility of finding closed midpalatal sutures in individuals of 10 to 15 years was 58.4%, and in subjects aged 16 to 20 and 21 to 25 years, it was 51.7% and 61.7%, respectively. In males, Stages D and E were present in 45.4%; for females, this prevalence was 68.8%. Individual assessment of the midpalatal suture in each patient is of crucial importance before making the clinical decision of which is the best maxillary expansion method. Due to the extensive calibration and training required, it is advisable to always request a report from a radiologist. Individual evaluation with 3D imaging is recommended because of the great variability observed in the ossification of midpalatal sutures in adolescents, post-adolescents and young adults.

Evaluation of palate-related factors of the effectiveness of microimplant-assisted rapid palatal expansion in late adolescents and adults.

This study investigated the factors of the effectiveness of microimplant-assisted rapid palatal expansion (MARPE) in late adolescents and adults, such as age, midpalatal suture maturation (MPSM) stage, palate length (PL), palatal index (PI), and midpalatal bone thickness (MBT), and at each microimplant position, the palate bone thickness (PBT), the nasal cortical bone thickness (CoTN), the cancellous bone thickness (CaT), and the palate cortical bone thickness (CoTP) were evaluated. Cone-beam computed tomography (CBCT) images of 50 patients (mean, 23.30 ± 7.03years; range, 16-51years) treated with MARPE were evaluated. Maxillary expansion ratio (MER) was used to assess the MARPE effectiveness and grouped patients into low and high MER groups according to the mean of MER. MER was the ratio of maxillary expansion width to MARPE screw expansion measured in CBCT images. Thet-test was used to analyze the differences between the low and high MER groups. The Pearson correlation test was performed to investigate the correlation between MER and age, MPSM stage, PL, PI, MBT, PBT, CoTN, CaT, and CoTP. Age, MPSM stage, and MBT in regions 18mm and 21mm behind the incisor foramen correlated negatively with MER ([Formula: see text], - 0.390, - 0.386, and - 0.335, respectively, all [Formula: see text]), whereas PBT and CoTN of anterior microimplant positions correlated positively with MER ([Formula: see text] and 0.418, respectively, all [Formula: see text]). No correlation was observed between other variables and MER. MARPE effectiveness decreased as age and midpalatal suture maturation stage increased, respectively. Thinner midpalatal suture bone in regions 18mm and 21mm behind the incisor foramen, thicker palate bone, and nasal cortical bone of anterior microimplant positions were related to more effective MARPE. In patients with older chronological age and later MPSM stages, MARPE effectiveness might be unsatisfactory. Clinicians should carefully evaluate the palate bone thickness before MARPE treatment.