Diagnostic performance of skeletal maturity for the assessment of midpalatal suture maturation

Correlations of spheno-occipital synchondrosis, cervical vertebrae, midpalatal suture, and third molar maturation stages

OBJECTIVES

To estimate the joint correlations among cervical vertebrae maturation (CVM), spheno-occipital synchondrosis (SOS), midpalatal suture maturation (MPS), and third molar mineralization (TMM) and to assess the predictive potential of SOS on CVM and MPS.

MATERIALS AND METHODS

570 pretreatment cone-beam computed tomogram (CBCT) scans from three private practices were analyzed, and MPS, CVM, SOS, and TMM stages were categorized and recorded by two independent investigators. Intra- and inter-rater reliability tests were evaluated with weighted Cohen's kappa tests. Spearman correlation coefficients for ordinal data were used to estimate the pairwise correlations among SOS, CVM, MPS, and TMM. To evaluate if SOS could predict CVM and MPS, ordinal regression models were estimated and cross-validated.

RESULTS

The analysis demonstrated a robust positive correlation between SOS and CVM (r = 0.845) and between SOS and MPS (r = 0.742). A significant correlation was also observed between CVM and MPS (r = 0.659). Further correlations were identified between TMM and SOS (r = 0.444), TMM and MPS (r = 0.392), and TMM and CVM (r = 0.358). Ordinal regression models indicated the potential of using SOS as a predictive marker for CVM and MPS stages.

CONCLUSIONS

With a comprehensive analysis, SOS is strongly correlated with CVM and MPS, and SOS stage can be used to predict CVM and MPS using ordinal regression. Since MPS stages are challenging to categorize due to their anatomy, this finding suggests a diagnostic tool using SOS stages or when more information on skeletal maturity of the patient is desired.

Morphological characteristics of the palate according to mid-palatal suture maturational stage on cone-beam computed tomography images: A cross-sectional study

INTRODUCTION

Besides the mid-palatal suture maturation stage, the morphology of the palate might also play a role in the effectiveness of miniscrew insertion planning or effectiveness of palatal expansion.

OBJECTIVES

The aim was to assess the mid-palate length, height and surface area according to the mid-palatal suture maturation stage and its correlation to the maturity of the transverse palatine suture on cone-beam computed tomography (CBCT) maxillary images in a consequently selected group of subjects.

MATERIAL AND METHODS

High-resolution CBCT images of 100 subjects (56 females, 44 males), aged 33.9±22.7 years, were selected. The images were clustered according to the mid-palatal suture maturation stage (stages B, C, D, and E) and 25 images per stage group were retrieved. The length, heights (at 2mm intervals) and surface area of the mid-palate were measured from the posterior border of the incisal foramen to the posterior nasal spine, and the maturity of the transverse palatine suture was recorded.

RESULTS

No between-stage-group differences were seen for mid-palate length, while heights and surface areas were significantly different between maturational stages. The mid-palate height was significantly smaller in maturational stages D and E groups (5.65±1.55mm and 5.77±1.70mm, respectively) than in groups B and C (6.97±1.82mm and 7.00±1.53mm, respectively). However, differences were significant only distally to the sixth mm measurement point. The surface area was significantly different among groups, denoting higher values for stage B and C (1.82±0.55cm2 and 1.86±0.41cm2, respectively), compared to stage D and E groups (1.53±0.38cm2 and 1.57±0.54cm2, respectively). A significant negative but poor correlation was seen between mid-palate total average height, surface area and mid-palatal suture stage (rho=-0.278, P=0.005 and rho=-0.222, P=0.027, respectively). Moreover, a very strong to moderate positive correlation (rho=0.847, P<0.001, rho=0.739, P<0.001) was seen between age and the maturational stage of the mid-palatal and transverse palatine sutures, respectively. Both the mid-palatal and transverse palatine sutures maturity stages were positively and very strongly correlated (rho=0.839, P<0.001).

CONCLUSIONS

The height and surface area of the mid-palate were significantly different among the maturational stage groups, while no differences were observed regarding the mid-palate length. Less mature sutures exhibit greater height and surface area values than more mature sutures. Although further research is needed in this regard, the mid-palatal suture maturational stage C showed greater distribution variability in terms of the transverse palatal maturation stages, which might be a discriminating factor between successful and unsuccessful skeletal palatal expansion, even with the use of skeletal anchorage devices.

Evaluation of midpalatal suture maturation stage in 5- to 20-year-olds using cone-beam computed tomography

INTRODUCTION

This study aimed to evaluate the midpalatal suture (MPS) maturation stages using the cone-beam computed tomography classification method in Chinese children aged 5-10 years, adolescents aged 11-15 years, and postadolescents aged 16-20 years and identify a correlation between maturation stage and age and sex.

METHODS

Axial sections of tomographic images from 717 participants (369 female and 348 male participants) aged 5-20 years were used to classify the maturation stage of the MPS (stages A, B, C, D, and E). Kappa statistics were used to evaluate the measurement error. The chi-square test was applied to analyze the differences in the distribution of MPS stages by age group and by sex among all participants, as well as the adolescent group. The Fisher exact test was employed to assess the differences in MPS stage distribution by sex among children aged 5-10 years and among the postadolescent group. The Mann-Whitney U test was used to assess the potential variance in age distribution between stages C and D.

RESULTS

The most prevalent maturation stage was stage C (40.3%). Of the total population, 69.4% had MPS in stages A, B, or C. A significant difference in age distribution was observed between stage C and stage D (P <0.001). The distribution of the MPS maturation stage significantly varied by age group (P <0.001) and sex (P <0.001).

CONCLUSIONS

The distribution of participants in advanced maturation stages increases with age. Female patients generally experience earlier MPS maturation than male patients, particularly between the ages of 11-20 years.

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

BACKGROUND

Midpalatal 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.

METHODS

In 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.

RESULTS

A 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).

CONCLUSIONS

Based 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.

Skeletal and Dentoalveolar Changes in Growing Patients Treated with Rapid Maxillary Expansion Measured in 3D Cone-Beam Computed Tomography

The skeletal and dental effects of rapid maxillary expansion (RME) have been extensively studied, but high-quality research is still needed to determine the three-dimensional (3D) effects of RME. The aim of this study was to compare skeletal and dentoalveolar parameters through cone-beam computed tomography (CBCT) pre- (T1) and post-treatment (T2) with respect to RME. Twenty growing patients (mean age 10.7 years) were treated with a Hyrax-type expander. A 3D CBCT was performed at T1 and T2, measuring nasal width, maxillary width, palatal height, maxillary arch perimeter, angulation of the upper first molar, and intermolar width. The mean palatal suture opening was 2.85 ± 0.62 mm (p < 0.0001). Nasal width increased 1.28 ± 0.64 mm and maxillary width 2.79 ± 1.48 mm (p < 0.0001). In contrast, palatal height was reduced 0.65 ± 0.64 mm (p < 0.0001). Regarding arch perimeter, the radicular perimeter increased 2.89 ± 1.80 mm, while the coronal perimeter increased 3.42 ± 2.09 mm (p < 0.0001). Molar angulation increased 5.62 ± 3.20° for the right molar and 4.74 ± 2.22° for the left molar (p < 0.0001). Intermolar width increased 5.21 ± 1.55 mm (p < 0.0001). Treatment with Hyrax produced a significant opening in the mean palatal suture. Also, a significant increase in nasal width, maxillary width, arch perimeter, molar angulation, and intermolar width, and a decrease in palatal height, were observed.

Long-term efficacy and stability of miniscrew-assisted rapid palatal expansion in mid to late adolescents and adults: a systematic review and meta-analysis

BACKGROUND

The purpose of this study is to investigate the long-term efficacy and stability of Miniscrew-assisted Rapid Palatal Expansion (MARPE), including its primary outcomes, namely the nasomaxillary complex transverse skeletal and dental expansion, and related secondary outcomes.

METHODS

Electronic databases and manual literature searches, up to October 31, 2022, were performed. The eligibility criteria were the following: studies on patients with transverse maxillary deficiency treated with MARPE in adults and adolescents over 13.5 years of age.

RESULTS

Ultimately, twelve articles were included in the analysis, one prospective and eleven retrospective observational studies. Five studies showed a moderate risk of bias, while the remaining seven studies were at a serious risk of bias. The GRADE quality of evidence was very low. MARPE is an effective treatment modality for transverse maxillary deficiency (mean success rate: 93.87%). Patients showed increased mean in the skeletal and dental transverse expansion. The basal bone composition, mean alveolar bone and mean dental expansion accounted for 48.85, 7.52, and 43.63% of the total expansion, respectively. There was a certain degree of skeletal and dental relapse over time. MARPE could also cause dental, alveolar, and periodontal side effects, and have an impact on other craniofacial bones, upper airway, and facial soft tissue.

CONCLUSIONS

MARPE is an effective treatment for transverse maxillary deficiency, with a high success rate and a certain degree of skeletal and dental relapse over time.

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

PURPOSE

To 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.

METHODS

Cone 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.

RESULTS

Spearman 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.

CONCLUSION

CS12 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.

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.

Analysis of factors associated with the success of microimplant-assisted rapid palatal expansion

INTRODUCTION

Success-related factors of microimplant-assisted rapid palatal expansion (MARPE) were evaluated, including age, palatal depth, suture, and parassutural bone thickness, suture density and maturation, and the relation to corticopuncture (CP) technique, as well as skeletal and dental effects.

METHODS

Sixty-six cone-beam computed tomography scans were analyzed before and after rapid maxillary expansion procedures in 33 patients aged 18-52 years for both sexes. The scans were generated in digital imaging and communications in medicine file format and analyzed in the multiplanar reconstruction of the regions of interest. Palatal depth, suture thickness, density and maturation, age, and CP were assessed. To evaluate dental and skeletal effects, the sample was divided into 4 groups: successful MARPE (SM), SM + CP technique (SMCP), failure MARPE (FM), and FM + CP (FMCP).

RESULTS

Successful groups presented more skeletal expansion and dental tipping than failure groups (P <0.05). The mean age of the FMCP group was significantly higher than the SM groups; suture and parassutural thickness significantly related to the success, and patients who received CP showed a success rate of 81.2% compared with 33.3% in the no CP group (P <0.05). Suture density and palatal depth did not show a difference between the success and failure groups. Suture maturation was higher in SMCP and FM groups (P <0.05).

CONCLUSIONS

Older age, thin palatal bone, and higher stage of maturation can influence the success of MARPE. CP technique in these patients appears to have a positive impact, increasing the chance of treatment success.

Factors related to microimplant-assisted rapid palatal expansion in teenagers and young adults: A cone-beam computed tomography study

INTRODUCTION

For patients with maxillary transverse deficiency, selecting an appropriate therapeutic method is important for the treatment effect and prognosis. Our study aimed to explore factors related to microimplant-assisted rapid palatal expansion (MARPE) in teenagers and young adults using cone-beam computed tomography.

METHODS

Twenty-five patients who underwent MARPE were included in this retrospective study from February 2014 to June 2019. Midpalatal suture density (MPSD) ratio, midpalatal suture maturation (MPSM), bone effect, dentoalveolar effect, and dental effect in maxillary first molar were evaluated using cone-beam computed tomography. Spearman correlation analysis was used to analyze the correlation between the MPSD ratio, MPSM, age, and the expansion amount generated by MARPE.

RESULTS

Twenty-five patients (mean age, 19.84 ± 3.96 years; range, 15-29 years) with maxillary transverse deficiency were analyzed. Age was negatively correlated with bone expansion, alveolar expansion, and alveolar change (all P <0.05). There was a negative correlation between MPSM and nasal cavity variation, bone expansion, and alveolar change (all P <0.05). The bone expansion was negatively correlated with MPSD ratio 3 (r = -0.417; P <0.05) and MPSD ratio 4 (all P <0.05).

CONCLUSIONS

Age, MPSM, and MPSD ratio were significantly related to the MARPE effect. Age, MPSM, and MPSD ratio should be considered when choosing MARPE.

Midpalatal Suture Maturation Method for the Assessment of Maturation before Maxillary Expansion: A Systematic Review

Assessment of midpalatal suture maturation is crucial before deciding which type of maxillary expansion technique will be performed to treat transverse discrepancies. In 2013, Angelieri et al. proposed a new method to evaluate midpalatal maturation using cone-beam computed tomography. The aim of this study was to systematically identify, evaluate, and provide a synthesis of the existing literature about this new method and to rigorously assess the methodological quality of these articles. A bibliographic search was carried out using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus using the terms midpalatal suture, cranial sutures, palate, maturation, interdigitation, ossification, maxillary expansion, evaluation, assessment, and assess. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Hence, 56 articles were obtained, of which only 10 met the selection criteria. We could not include any of the data into an analysis because of the large variation of the data collected and high methodological heterogeneity found among studies. Of all the studies included, 10% had poor quality, 70% fair, and 20% good quality, respectively. Even though age and sex play a role in midpalatal suture obliteration, there is a poor correlation between these variables. Thus, every patient should be assessed individually before choosing the best protocol for maxillary expansion. The midpalatal suture maturation method has the potential to be used for diagnostic purposes, but clinicians should be cautious of routinely using it because an extensive training and calibration program should be performed prior.

Does MARPE therapy have effects on intracranial pressure? a clinical study

Background

We aimed to evaluate possible intracranial pressure (ICP) changes caused by screw activations during active microimplant-assisted rapid palatal expansion (MARPE) therapy of post-pubertal individuals by measuring the optic nerve sheath diameter (ONSD) under ultrasonography (US) guidance.

Methods

This study’s participants comprised 15 patients (7 males, 8 females) with posterior crossbite and a mean age of 16.7 years (14.25–20.08 years). The Maxillary Skeletal Expander (MSE) appliance was used to perform MARPE in all patients. Their vital signs (heart rate, mean arterial pressure (MAP), and peripheral oxygen saturation (SpO₂)) were recorded. The ONSD was measured by US immediately before the first screw activation (T0), and the measurements were repeated 1 min (T1) and 10 min (T2) after the first activation. In the last session of active MARPE therapy, the same measurement protocol was performed as in the first activation session (T3, T4, and T5). The patients’ perceptions of pain during the screw activation were also noted at T1 and T4 using a four-category verbal rating scale (VRS-4). The significant differences among different time intervals performed with the Friedman test (for all tested variables; SpO2, MAP, Heart Rate, VRS-4 and ONSD). Spearman correlation test was used for VRS-4 and ONSD comparisons. The statistical significance level was accepted as p < 0.05.

Results

The ONSD values ​​(T1 and T4) relatively increased within 1 min after screw activation but did not reach a statistically significant level (p > 0.05). There was also no significant difference between the initial (T0) and the final (T5) ONSD values ​​during the active MARPE therapy (p > 0.05).

Conclusion

There is no changes or alterations in intracranial pressure in late adolescents during active MARPE therapy.

Supplementary information

The online version contains supplementary material available at 10.1186/s12903-022-02482-x.

Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.

Rapid Maxillary Expansion on the Adolescent Patient: Systematic Review and Case Report

Aim: In the literature, many studies and articles are investigating new devices and approaches to achieve rapid palate expansion through the opening of the palatal suture, and evaluating the skeletal, dental, and soft tissue effects. The purpose of this review was to assess how palatal expansion is performed in adolescent patients with permanent dentition. Furthermore, it was reported as an example of successful orthodontic treatment of an 11-year-old female patient affected by maxillary skeletal transverse deficiency, in permanent dentition. Methods: A search of the literature was conducted on PubMed, Cochrane, Scopus, Embase, and Web of Science databases. Inclusion criteria were the year of publication between 2017 and 2022, patients aged 10 to 16 years in permanent dentition, with transversal discrepancy, treated with tooth-borne, bone-borne, hybrid palatal expanders. Results: A total of 619 articles were identified by the electronic search, and finally, a total of 16 papers were included in the qualitative analysis. Conclusions: From this study, it was assessed that MARPE is more predictable, and it determines a more significant expansion of the suture than the Hyrax expander, with fewer side effects.

Fully automated determination of the cervical vertebrae maturation stages using deep learning with directional filters

INTRODUCTION

We aim to apply deep learning to achieve fully automated detection and classification of the Cervical Vertebrae Maturation (CVM) stages. We propose an innovative custom-designed deep Convolutional Neural Network (CNN) with a built-in set of novel directional filters that highlight the edges of the Cervical Vertebrae in X-ray images.

METHODS

A total of 1018 Cephalometric radiographs were labeled and classified according to the Cervical Vertebrae Maturation (CVM) stages. The images were cropped to extract the cervical vertebrae using an Aggregate Channel Features (ACF) object detector. The resulting images were used to train four different Deep Learning (DL) models: our proposed CNN, MobileNetV2, ResNet101, and Xception, together with a set of tunable directional edge enhancers. When using MobileNetV2, ResNet101 and Xception, data augmentation is adopted to allow adequate network complexity while avoiding overfitting. The performance of our CNN model was compared with that of MobileNetV2, ResNet101 and Xception with and without the use of directional filters. For validation and performance assessment, k-fold cross-validation, ROC curves, and p-values were used.

RESULTS

The proposed innovative model that uses a CNN preceded with a layer of tunable directional filters achieved a validation accuracy of 84.63%84.63% in CVM stage classification into five classes, exceeding the accuracy achieved with the other DL models investigated. MobileNetV2, ResNet101 and Xception used with directional filters attained accuracies of 78.54%, 74.10%, and 80.86%, respectively. The custom-designed CNN method also achieves 75.11% in six-class CVM stage classification. The effectiveness of the directional filters is reflected in the improved performance attained in the results. If the custom-designed CNN is used without the directional filters, the test accuracy decreases to 80.75%. In the Xception model without the directional filters, the testing accuracy drops slightly to 79.42% in the five-class CVM stage classification.

CONCLUSION

The proposed model of a custom-designed CNN together with the tunable Directional Filters (CNNDF) is observed to provide higher accuracy than the commonly used pre-trained network models that we investigated in the fully automated determination of the CVM stages.

Short-term skeletal and dentoalveolar effects of overexpansion

OBJECTIVES

To evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur.

MATERIALS AND METHODS

This randomized controlled trial included 23 patients who had rapid maxillary expansion (RME). Subjects were randomly assigned to a conventional expansion control group (n = 12) or an overexpansion group (n = 11), who started treatment at 13.2 ± 1.5 and 13.8 ± 1 years of age, respectively. Cone beam computed tomography scans (11 cm) were obtained prior to rapid maxillary expander (RME) delivery and approximately 3.7 months later. Initial hand-wrist radiographs were used to determine the participants' skeletal maturity.

RESULTS

The RME screws were activated 5.6 ± 1.2 mm and 10.1 ± 0.6 mm in the conventional and overexpansion groups, respectively. Overexpansion produced significantly greater expansion of the nasal cavity (2.1X-2.5X), maxillary base (2.3X), buccal alveolar crest (1.4X), and greater palatine foramina (1.9X). Significantly greater intermolar width increases (1.8X) and molar inclination (2.8X) changes were also produced. The nasal cavity and maxillary base expanded 23%-32% as much as the screws were activated. Skeletal expansion was positively correlated with RME screw activation (R = 0.61 to 0.70) and negatively correlated (R = -0.56 to -0.64) with the patients' skeletal maturation indicators (SMIs). Together, screw activation and the patients' SMI scores explained 48%-66% of the variation in skeletal expansion.

CONCLUSIONS

This pilot study shows that overexpansion produces greater changes than conventional expansion, with greater skeletal effects among less mature patients.

A CBCT Evaluation of Midpalatal Bone Density in Various Skeletal Patterns

The purpose of this study was to evaluate midpalatal bone density (BD) by using cone-beam computed tomography (CBCT) according to gender, age, and vertical and horizontal skeletal patterns. CBCT images from 126 subjects (64 females and 62 males) were reoriented and analyzed in order to attain BD values at the midpalatal suture. Four age groups were used for classification (adolescence, 10 ≤ early < 14 years, 14 ≤ middle ≤ 17 years, and 17 < late ≤ 21 years; adult > 21 years). Vertical skeletal pattern categories were differentiated by the Frankfort horizontal line to mandibular plane angle (hypodivergent < 22°, 22° ≤ normovergent ≤ 28°, and 28° < hyperdivergent). Horizontal skeletal pattern differentiation was defined by ANB angle (Class III < 0°, 0° ≤ Class I ≤ 4°, and 4° < Class II). Females showed significantly higher BD than males (p < 0.001). As age increased, BD increased significantly (p < 0.001). There were no significant differences between vertical skeletal patterns. Class II showed significantly less BD than Class III (p < 0.05). With this information, clinicians can better understand BD trends of the midpalatal suture and, thus, better understand our patient’s anatomy and potential hurdles in successful treatment.

Midpalatal suture density ratio after rapid maxillary expansion evaluated by cone-beam computed tomography

INTRODUCTION

Identifying the stage of midpalatal suture (MPS) fusion is essential for rapid maxillary expansion (RME). The objective of this study was to evaluate the relationship between MPS density ratio and the skeletal response after RME using cone-beam computed tomography (CBCT).

METHODS

CBCT scans of 64 patients (age, 13.81 ± 1.68 years; 42 females and 22 males) who underwent RME as part of comprehensive orthodontic treatment were used for this study. Two CBCT records were made at T1 (pre-RME) and T2 (post-RME). MPS density was assessed by gray scale and the skeletal effects through linear measurements: greater palatine foramina, the width of the nasal cavity (NW), infraorbital foramina. The data were collected at 4 different times: baseline, 24 hours, 48 hours, and 4 weeks.

RESULTS

There was no statistically significant correlation between MPS density ratio and greater palatine foramina or infraorbital foramina. Negative correlations with MPS density ratio are presented with the difference of age post-RME and pre-RME (r = -0.46, P = 0.033) in males, and NW (r = -0.41, P = 0.007) in females. A significant association between gender and the MPS density ratio was found (P = 0.015) in females.

CONCLUSIONS

There is a weak negative correlation between the MPS density ratio and the difference of age post-RME and pre-RME in males and the NW in females. Females presented greater density ratios than males. MPS density ratio through CBCT does not appear to be an adequate parameter to predict the skeletal effect in adolescent patients and young adults.

Maturity evaluation of orthodontically important anatomic structures with computed tomography

BACKGROUND/OBJECTIVES

The success of the orthopaedic treatment is closely related to the patient's skeletal maturation. This study aimed to evaluate the midpalatal suture (MPS), the zygomaticomaxillary suture (ZMS) maturation, and the closure degree of the spheno-occipital synchondrosis (SOS) in patients of different age groups. The presence of a correlation between these parameters and the palatal dimensions was also verified.

SUBJECTS/METHODS

The study was based on computed tomography images of 314 patients between 7 and 30 years of age with no orthodontic treatment history. The images were retrieved from the archive of the Radiology Department of Bezmialem Vakif University Hospital and divided into six groups according to the patient's age: 7-10, 11-13, 14-16, 17-20, 21-25, and 26-30 years. The maturation scores of ZMS, SOS, and MPS were determined, and palatal thickness and length were recorded. The data were analysed by using Statistical Package for Social Sciences for Windows 22.0.

RESULTS

A positive relationship was found between SOS closure degree and MPS/ZMS maturation (MPS-ZMS: r = 0.816, MPS-SOS: r = 0.736, ZMS-SOS: r = 0.868, P = 0.000). The degrees of ZMS and MPS maturation were significantly increased as the SOS closure degree increased. The MPS maturation score was significantly lower in patients with a short and thick palate (MPS-palatal thickness: r = 0.405, MPS-palatal length: r = 0.387, P = 0.000).

CONCLUSIONS

A positive correlation indicated the simultaneous progress in the maturation of the SOS, MPS, and ZMS. Moreover, the ANS-PNS length increase was found to be correlated with the increase of the MPS, ZMS, and SOS maturation scores. In contrast, a negative correlation was observed between the palatal thickness and the maturation stage of these structures.

Maturation stages of the sutures in the median palatine evaluated with cone-beam computed tomography

INTRODUCTION

This study aimed to evaluate the influence of age, sex, and facial growth patterns on the maturation stage of midpalatal sutures.

METHODS

We selected 90 total skull cone-beam computed tomography scans and divided them into the following 3 groups: brachyfacial (n = 30), mesofacial (n = 30), and dolichofacial (n = 30). These groups were determined using Ricketts VERT 3-dimensional cephalometric analysis. All patients were aged ≥18 years and were divided into those aged ≥30 years and >30 years. The maturational stage of the median palatine sutures was determined by evaluating the central transverse axial dimension in the maxillary-mandibular palate. Maturational stages were classified as A, B, C, D, and E.

RESULTS

Of the 90 images reviewed, 55 (61.1%) were female patients, and 35 were male patients (38.9%). The age of patients ranged from 18 to 59 years, with 55 patients aged <30 years (61.1%) and 35 aged ≥30 years (38.9%). Regarding the maturational stages, 3.3% of brachyfacial, 6.7% of mesiofacial, and 16.7% of dolichofacial subjects (P = 0.032) were classified as stages B and C.

CONCLUSIONS

The patients' facial patterns were found to be a significant signal for the maturation stage of midpalatal sutures. Adult dolichofacial patients are the most likely to have stage B and C.

Tomographic analysis of midpalatal suture prior to rapid maxillary expansion

INTRODUCTION

In Orthodontics and Facial Orthopedics, the timing of treatment onset may be critical and individual analysis should be applied to promote a favorable treatment planning. In this study, individual analysis of midpalatal suture (MS) and palatal measurements were performed in teenagers and young adult patients treated with rapid maxillary expansion (RME).

DESCRIPTION

Twenty-six patients submitted to RME with a tooth-supported appliance (Hyrax) were evaluated. The inclusion criteria were: minimum age of 14 years, presenting all posterior teeth, diagnosed with transverse maxillary discrepancy, and with a clinical indication for maxillary expansion. The pretreatment CBCT scans of these patients were assessed to obtain the stages of MS maturation (MSM); density ratio (MSD); and palatal length, thickness (anterior, intermediate and posterior) and sagittal area.

RESULTS

The maturation stages present were C, D or E; the density ranged from 0.6 to 1, and lower density (MSD < 0.75) and higher density (MSD ≥ 0.75) groups were determined. Individuals with higher MSD presented smaller sagittal area, compared to the lower density group. Individuals in D and E MSM stages presented smaller sagittal area and intermediate thickness, compared to stage C.

CONCLUSIONS

Smaller palatal sagittal area was observed in the high MSD groups and in the stages D and E of MSM.

Skeletal and dental changes after maxillary expansion with a bone-borne appliance in young and late adolescent patients

INTRODUCTION

Rapid palatal expansion is a common therapy during orthodontic treatment and could be a preliminary step for correcting different malocclusions; furthermore, this treatment could be necessary at any age. Different anchorage approaches have been proposed to obtain an effective skeletal result, although every device produces both dental and skeletal effects. This study aimed to compare the dentoskeletal effects of a bone-borne palatal expander considering 2 groups of patients of different ages.

METHODS

Twenty-four patients consecutively treated were included in the study; patients were divided into 2 groups according to their age: group 1 with age ≤16 years and group 2 patients >16 years. All patients had a preexpansion cone-beam computed tomography scan; a second scan was required at the end of activations. All patients received a bone-borne appliance anchored on 4 miniscrews.

RESULTS

Significant intragroup differences were found for maxillary width and dental diameters. No significant differences were found between groups with regard to longitudinal changes, except for the maxillary right plane.

CONCLUSIONS

The use of bone-borne maxillary expansion was effective in generating palatal widening both in growing and young adult patients. No significant skeletal or dental differences were found between groups.

Evaluation of the suture ossification level according to age and sex in children, adolescents, and adults. A cross-sectional and observational 3D study

OBJECTIVE

To determine the ossification level of the midpalatal suture (MPS) in children, adolescents and adults from a Peruvian sample; according to the method proposed by Angelieri et al. with cone-beam computed tomographies (CBCTs).

MATERIAL AND METHODS

The sample consisted of 315 CBCTs of 168 females and 147 males. The total sample was divided into 3 groups according to age and sex: children (n=77), adolescents (n=113) and adults (n=125). The images were mainly assessed in the axial plane using the Real Scan 2.0 software. The different periods of ossification of the MPS at the level of the vertical half of the palate was defined according to the five stages of Angieleri method (from A to E). The Student t-Test, Chi-square test, Kruskal-Wallis test and Spearman's Rho test were applied.

RESULTS

Chi² test results showed that the stages of MPS ossification depended on the age of the patient by age ranges (P<0.005). Multiple comparison tests affirmed that male and female subjects in the children group had fewer ossification stages than the adolescent and adult groups (P<0.001). Meanwhile, there were no statistically significant differences between the two older age groups. Finally, there was a moderate positive correlation between the stages of ossification of the MPS and the age in the male group (Rho=0.511).

CONCLUSIONS

The onset of MPS ossification was significantly related to subjects up to 12 years of age and more frequently in stages B and C in both sexes. There was no difference in MPS ossification in adolescents and adult subjects.

Midpalatal suture density ratio: Assessing the predictive power of a novel predictor of skeletal response to maxillary expansion

INTRODUCTION

Rapid maxillary expansion (RME) is a common orthodontic treatment to correct maxillary transverse deficiency; however, the inability to determine the precise timing of fusion of the midpalatal suture creates difficulty for clinicians to prescribe the appropriate treatment, surgical or nonsurgical expansion. The purpose of this study was to assess the predictive power of the midpalatal suture density ratio (MPSD) for a skeletal response to RME.

METHODS

Pre- and posttreatment cone-beam computed tomography scans were obtained from 78 orthodontic patients aged from 8 to 18 years treated with RME. MPSDs were calculated from pretreatment scans, and a prediction was made for the amount of skeletal expansion obtained at the level of the palate after comprehensive orthodontic treatment. Predicted values were compared with actual outcomes as assessed from posttreatment scans, followed by regression analyses to investigate correlations between MPSD and skeletal expansion and equivalence testing to analyze the performance of the predicted measurements.

RESULTS

The MPSDs were not statistically significantly (P >0.05) correlated with the amount of skeletal expansion achieved. In addition, the predicted skeletal expansion using MPSD was not statistically equivalent to the skeletal expansion achieved using an equivalence margin of ±0.05.

CONCLUSIONS

The results suggest that the MPSD obtained from pretreatment cone-beam computed tomography scans were not correlated well enough with the amount of skeletal expansion achieved to be an effective predictor of the amount of long-term skeletal expansion after RME.

Timing of Spheno-Occipital Synchondrosis Ossification in Children and Adolescents with Cleft Lip and Palate: A Retrospective Case-Control Study

Background: Cleft lip and palate (CLP) can affect the development of the maxilla; which may create a midfacial deficiency as well as an interference of the facial growth pattern and dentofacial esthetics. Objective: This study aimed to estimate the chronological age of complete fusion of the spheno-occipital synchondrosis (SOS) in cleft lip and palate patients and a control group; using cone beam computed tomography (CBCT) images. Methods: In this retrospective study; 125 patients were enrolled (cleft lip and palate group (n = 91); control group (n = 34)). Age comparison was made with a chi-square test; and a Kaplan–Meier analysis determined the median time to reach complete fusion of the spheno-occipital synchondrosis (p < 0.05). Results: The experimental group showed statistically significant differences in the median time for complete ossification between males and females (p = 0.019). The median time for complete ossification of the spheno-occipital synchondrosis was; for males; 15.0 years in both groups; for females; it was 14.0 years and 13.0 years in the experimental group and in the control group; respectively. Both for males and females; there were no statistically significant differences between experimental and control groups (p = 0.104). Conclusions: The present study showed no differences in the ossification of the spheno-occipital synchondrosis between individuals with and without cleft lip and/or palate.

Correlation assessment of cervical vertebrae maturation stage and mid-palatal suture maturation in an Iranian population

AIM

The aim of the current study was to evaluate the correlation of skeletal age based on cervical vertebrae maturation (CVM) stage and mid-palatal suture (MPS) maturation in an Iranian population.

MATERIAL AND METHODS

This was a cross-sectional analytic study. A total number of 93 samples were included. Samples were taken from patients who were in CS3 to CS6 stages of CVM who had cone-beam computed tomography and lateral cephalometry based on inclusion criteria. The maturation of MPS was assessed based on the cone-beam computed tomography images. In the classification of maturation of MPS, there are five stages (A-E) and the suture fusion occurs in stage D. In stage E, the suture is fused completely. The CVM stage (CS1-6) was also assessed based on the lateral cephalograms. Data were analyzed using Spearman correlation with a significance level of 0.05.

RESULTS

A total of 51 female individuals with a mean age of 14.98 ± 4.806 and 42 male individuals with a mean age of 15.79 ± 5.135 participated in this study. The correlation coefficient between the CVM stage and MPS maturation was 0.691 in female and 0.754 in male individuals (P < 0.001). Stage D was correlated with CS4.

CONCLUSION

The results demonstrated that CVM stages had a significant but moderate positive correlation with the maturation of MPS. Until CS3, the MPS has not been fused and in CS6 the MPS is fused definitely.

Reliability of cephalograms derived of cone beam computed tomography versus lateral cephalograms to estimate cervical vertebrae maturity in a Peruvian population: A retrospective study

OBJECTIVE

Cone beam computed tomography (CBCT) images can be useful for estimating cervical vertebrae maturity (CVM). The aim of this study was to evaluate the reliability of cephalograms derived from CBCT versus lateral cephalograms (LC) to estimate the CVM in a Peruvian population.

MATERIAL AND METHODS

The sample evaluated consisted of 40 cephalograms derived from CBCT and 40 LC images from individuals aged 10-19 years. One trained and calibrated observer (Kappa scores≥0.90) interpreted the CBCT and LC images twice. Intra-observer reliability of each maturation stage on CBCT sagittal slices and LC images were analysed using the weighted kappa statistics (α=0.05). Comparison of CVM stages between CBCT slices and LC images were analysed by the Spearman rank correlation coefficient, p<0.05.

RESULTS

The weighted kappa test showed almost perfect intra-observer agreement for the CVM stages using the CBCT sagittal slices (0.873). Considering the LC images, the weighted kappa test showed almost perfect intra-observer agreement too (0.937). In both intra-observer agreement, the difference was limited to one maturation stage of the CVM method. The first and second intra-observer agreement for the CVM stages between the CBCT sagittal slices and LC images were almost perfect (0.937 and 0.874). High correlation values at the first (0.975) and second (0.976) intra-observer agreement for the CVM stages between CBCT sagittal slices and LC images were also found.

CONCLUSION

CBCT is a reliable method for CVM assessment and can be used as an alternative method for this purpose. The orthodontists might use the CBCT scans as a valuable tool for CVM method estimation.

Rapid maxillary expansion outcomes according to midpalatal suture maturation levels

BACKGROUND

This study aims to compare the relationship between skeletal and dental outcomes of rapid maxillary expansion (RME) treatment on cone beam computed tomography (CBCT) images between pre-pubertal peak (pre-peak) and post-pubertal peak (post-peak) patients. The null hypothesis was that there was no difference in the outcomes of RME treatment between the groups.

METHODS

Thirty-two patients who underwent RME treatment were classified according to midpalatal suture maturation levels and then divided into two groups as pre-peak and post-peak. Skeletal and dental measurements were performed on the CBCT images at T0 (pre-treatment stage) and at T1 (post-treatment stage). Paired sample t test was used to evaluate normally distributed data and P < 0.05 was taken as the significance level.

RESULTS

There were significant differences between T0 and T1 within the groups, but the changes between the pre-peak and post-peak patient groups were not statistically significant.

CONCLUSION

Non-significant changes were found between the two groups, and the null hypothesis was excepted.

Transverse Skeletal Effects of Rapid Maxillary Expansion in Pre and Post Pubertal Subjects: A Systematic Review

OBJECTIVE

The aim of this systematic review was to assess the transverse skeletal effects of rapid maxillary expansion (RME) in pre and post-pubertal subjects.

MATERIAL AND METHODS

Five databases were searched till May 2018; Pubmed, Cochrane, Scopus, Lilacs and Web of science in addition to the manual search of other sources. There were no language restrictions. Methodological Index for Non-Randomized Studies MINORS was used to assess the quality and risk of bias of the trials included.

RESULTS

Six studies were finally included in the qualitative analysis. A meta-analysis wasn't performed due to the heterogeneity of methodologies and outcomes. All of the included studies showed drawbacks in their structure yielding weak evidence. On the short term, RME caused an increase in the maxillary and lateral-nasal widths in pre-pubertal subjects by 3.4 mm and 3.3 mm, and by 2.8 and 2.2 mm respectively in post-pubertal subjects. Although statistically insignificant, the maxillary width increase was more than that of the post-pubertal subjects by 0.6 mm. Over the long term, expansion produced permanent increases in the transverse dimensions of both the dento-alveolar and skeletal components of the maxilla and circum-maxillary structures in pre-pubertal subjects. The post-pubertal subjects presented with a statistically significant increase only in the later-nasal width by 1.3 mm than the untreated controls with no permanent increase in the skeletal maxillary width.

CONCLUSION

The literature is very deficient regarding the use of skeletal age as a reference in the treatment of skeletal crossbites using RME. Only weak evidence exists supporting the increased maxillary and lateral-nasal widths after tooth-tissue borne RME in pre-pubertal subjects, with these effects being less in the post-pubertal ones.

Reliability and reproducibility of the method of assessment of midpalatal suture maturation: A tomographic study

OBJECTIVES

To assess reliability and reproducibility of the individual assessment of midpalatal suture maturation in computed tomography among orthodontists and radiologists for potential diagnosis application.

MATERIALS AND METHODS

Sixty axial slices from cone-beam computed tomography and multi-slice CT scans of patients aged between 11 and 21 years old (33 females and 27 males) were selected. For the investigation of reliability and reproducibility of the method, two groups of examiners were established. The first group consisted of 11 orthodontists and the second consisted of 10 radiologists. Each group examined the images and performed individual assessment of the midpalatal suture maturation method twice within an interval of 21 days. During the first and second analyses, the sequence of images was randomized to reduce potential bias. Weighted Cohen's kappa was performed to assess inter- and intra-examiners' agreement. The percentage of perfect agreement and the number of stages apart for each disagreement were calculated. The significance level was P < .05.

RESULTS

The overall inter-examiner agreement was satisfactory in the first (kappa_w: 0.37) and the second (kappa_w: 0.34) analyses. Intra-examiner agreement outcomes were similar between orthodontists (kappa_w: 0.44) and radiologists (kappa_w: 0.41). The percentage of perfect agreement was 43.2%.

CONCLUSIONS

The method for individual assessment of midpalatal suture maturation revealed potential reliability and reproducibility. However, the agreement rate observed in the present study was not high enough for a method designed for routine clinical applications.

Midpalatal suture: evaluation of the morphological maturation stages via bone density

Background

To investigate the relationship between the morphological maturation stages of the midpalatal suture and its bone densities.

Methods

The sample consisted of 91 subjects aged 8–18 years who underwent cone beam computed tomography. All images were examined to classify morphological maturation of the midpalatal suture to five groups according to Angelieri et al. Bone density of the midpalatal suture was measured at the maxillary and palatal regions. Kruskal-Wallis and Mann-Whitney U tests were used to analyze the difference between groups.

Results

Bone density of the midpalatal suture was significantly higher in the palatal region in E stage and in the maxillary region in D and E stages.

Conclusions

It is concluded that the change in bone density of the midpalatal suture between the morphological maturation stages supports their reliability in clinical application.

Skeletal, Dentoalveolar, and Periodontal Changes of Skeletally Matured Patients with Maxillary Deficiency Treated with Microimplant-assisted Rapid Palatal Expansion Appliances: A Pilot Study

Introduction

Microimplant-assisted rapid palatal expansion (MARPE) has recently been offered to adult patients for correcting maxillary transverse deficiency. However, there is limited information in the literature on the success of this appliance and its skeletal and dental effects on skeletally matured patients. The purpose of this study was to investigate the immediate skeletal, dentoalveolar, and periodontal response to MARPE appliance using cone-beam computed tomography in a skeletally matured patient as assessed by the cervical vertebral maturation method.

Materials and Methods

Eight consecutively treated patients (2 females, 6 males; mean age of 21.9 ± 1.5 years) treated with a maxillary skeletal expander were included in the study. Measurements were taken before and after expansion to determine the amount of midpalatal suture opening, upper facial bony expansion, alveolar bone bending, dental tipping, and buccal bone thickness (BBT). Data were analyzed using a one-way ANOVA and matched-pair t-test (α = 0.05).

Results

Midpalatal suture separation was found in 100% of the patients with no dislodged microimplants. Total maxillary expansion was attributed to 41% skeletal, 12% alveolar bone bending, and 48% dental tipping. Pattern of midpalatal suture opening was found to be parallel in both the coronal and axial planes. On average, the absolute dental tipping ranged from 4.17° to 4.96° and the BBT was reduced by an average of 39% measured at the premolars and molars.

Conclusions

The MARPE appliance can be a clinically acceptable, nonsurgical treatment option for correcting mild to moderate maxillary transverse discrepancies for skeletally matured adult patients with a healthy periodontium.

The cervical vertebral maturation method: A user's guide

The cervical vertebral maturation (CVM) method is used to determine the craniofacial skeletal maturational stage of an individual at a specific time point during the growth process. This diagnostic approach uses data derived from the second (C2), third (C3), and fourth (C4) cervical vertebrae, as visualized in a two-dimensional lateral cephalogram. Six maturational stages of those three cervical vertebrae can be determined, based on the morphology of their bodies. The first step is to evaluate the inferior border of these vertebral bodies, determining whether they are flat or concave (ie, presence of a visible notch). The second step in the analysis is to evaluate the shape of C3 and C4. These vertebral bodies change in shape in a typical sequence, progressing from trapezoidal to rectangular horizontal, to square, and to rectangular vertical. Typically, cervical stages (CSs) 1 and CS 2 are considered prepubertal, CS 3 and CS 4 circumpubertal, and CS 5 and CS 6 postpubertal. Criticism has been rendered as to the reproducibility of the CVM method. Diminished reliability may be observed at least in part due to the lack of a definitive description of the staging procedure in the literature. Based on the now nearly 20 years of experience in staging cervical vertebrae, this article was prepared as a "user's guide" that describes the CVM stages in detail in attempt to help the reader use this approach in everyday clinical practice.

Assessment of midpalatal suture ossification using cone-beam computed tomography

BACKGROUND AND OBJECTIVE

The degree of ossification of the midpalatal suture is an important factor in the selection of treatment procedure, especially in young individuals. Considering the discrepancies in the results of studies on the exact time of the closure of this suture, the present study was undertaken to evaluate ossification and morphology of the suture with the use of CBCT.

METHODS

In the present cross-sectional study, the CBCT images of the maxilla in 144 Iranian subjects (72 males, 72 females) with an age range of 10 to 70 years, referring to a private radiology center in Sari, Iran, were evaluated. The CBCT images were evaluated in the axial cross-sectional slice at 1 mm intervals to determine morphology and the maturation stage of the suture and its degree of ossification. The six developmental stages that were observed were as follows: stage A, a direct line without disturbances; stage B, a scalloped appearance in the suture; stage C, two parallel lines with a scalloped appearance that were connected at some points; stage CD, the anterior portion was similar to stage C, and the posterior region was similar to stage D; stage D, ossification only in the palatine bone; stage E, complete ossification of the suture. The degree of ossification of the suture was calculated with the use of the ratio of the length of the ossified segment to the entire length of the suture. Data were analyzed with Spearman's correlation test, Chi-squared test, t-test, ANOVA, Mann-Whitney U, and Kruskal-Wallis test. Intra-observer agreement was calculated with the use of weighted kappa coefficient. Data were analyzed with SPSS 17.

RESULTS

There was a strong correlation between the age groups and the developmental stages of the midpalatal suture in both genders (r=0.681, p<0.001). The ossification process occurred in the posterior to anterior direction in 98% of the cases. There was a significant relationship between aging and the degree of ossification (p<0.001); however, the difference was not significant between the two genders (p=0.193).

CONCLUSION

Although the rate of suture closure increased with aging, age was not a reliable factor alone to determine the developmental stage of the suture. Use of CBCT is necessary in all the patients to determine the degree of ossification and morphology of the midpalatal suture.

Prediction of rapid maxillary expansion by assessing the maturation of the midpalatal suture on cone beam CT

Rapid maxillary expansion (RME) primarily involves the mechanical opening of the midpalatal suture of the maxillary and palatine bones. The fusion of the midpalatal suture determines the failure of RME, a common event in late adolescents and young adults. Recently, the assessment of the maturation of midpalatal suture as viewed using cone beam computed tomography (CBCT) has been introduced. Five maturational stages of the midpalatal suture have been presented: Stage A = straight high-density sutural line, with no or little interdigitation; Stage B = scalloped appearance of the high-density sutural line; Stage C = two parallel, scalloped, high-density lines that lie close to each other, separated in some areas by small low-density spaces; Stage D = fusion of the palatine bone where no evidence of a suture is present; and Stage E = complete fusion that extends also anteriorly in the maxilla. At Stage C, less skeletal response would be expected than at Stages A and B, as there are many bony bridges along the suture. For patients at Stages D and E, surgically assisted RME would be necessary, as the fusion of the midpalatal suture already has occurred either partially or totally. This diagnostic method can be used to estimate the prognosis of the RME, mainly for late adolescents and young adults for whom this procedure is unpredictable clinically.

Spheno-Occipital Synchondrosis Fusion Correlates with Cervical Vertebrae Maturation

The aim of this study was to determine the relationship between the closure stage of the spheno-occipital synchondrosis and the maturational stage of the cervical vertebrae (CVM) in growing and young adult subjects using cone beam computed tomography (CBCT). CBCT images with an extended field of view obtained from 315 participants (148 females and 167 males; mean age 15.6 ±7.3 years; range 6 to 23 years) were analyzed. The fusion status of the synchondrosis was determined using a five-stage scoring system; the vertebral maturational status was evaluated using a six-stage stratification (CVM method). Ordinal regression was used to study the ability of the synchondrosis stage to predict the vertebral maturation stage. Vertebrae and synchondrosis had a strong significant correlation (r = 0.89) that essential was similar for females (r = 0.88) and males (r = 0.89). CVM stage could be accurately predicted from synchondrosis stage by ordinal regression models. Prediction equations of the vertebral stage using synchondrosis stage, sex and biological age as predictors were developed. Thus this investigation demonstrated that the stage of spheno-occipital synchondrosis, as determined in CBCT images, is a reasonable indicator of growth maturation.