Midpalatal suture maturation stage assessment in adolescents and young adults using cone-beam computed tomography

Can surgically assisted rapid palatal expansion (SARPE) be recommended over orthodontic rapid palatal expansion (ORPE) for girls above the age of 14? : A cone-beam CT study on midpalatal suture maturation

BACKGROUND

For patients with a maxillary transversal deficiency (MTD), various treatment options are available, partly based on the practitioner's experience. This study aimed to determine a cut-off age for decision making between surgically assisted rapid palatal expansion (SARPE) over orthodontic rapid palatal expansion (ORPE) based on skeletal maturation in a female population.

METHODS

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.

RESULTS

For the PMS, the results show a closure of 83-100% from 13 to 17 years. As for the TPS, a closure of 78-85% was observed from 15 years of age. For the 15- to 17-year-old females, a closed ZMS was present in 32-47%. Regarding MPS, closed sutures presented in 61% (stages D and E) of the 15-year-old females. The cut-off age at which SARPE was recommended was 15.1 years for the orthodontist observers and 14.8 years for the maxillofacial surgeon observers.

CONCLUSIONS

Significant maturation of MPS was reached at the age of 15 in a female population. The PMS, TPS, MPS, and ZMS closed sequentially. A comprehensive diagnostic approach is necessary for choosing the appropriate treatment. When in doubt, age could assist decision making in a female population, with a cut-off age of 15 years in favor of SARPE based on this study.

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.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

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 15-35 years 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.

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.

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

OBJECTIVES

The 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.

METHODS

The 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.

RESULTS

Resnet50 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.

CONCLUSIONS

The 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 SIGNIFICANCE

The 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.

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.

Assessment of Skeletal Maturation in Nonsyndromic Cleft and Non-cleft Children-A Comparative Study

The study aims to determine the difference in the skeletal maturation of unilateral cleft lip and palate (UCLP) and non-cleft children. This study also attempts to determine sexual dimorphism in attaining skeletal maturation between UCLP and non-cleft children. This was a retrospective, cross-sectional study. The total sample consisted of the lateral cephalogram of 131 UCLP (62 female and 71 male) children and 500 (274 female and 226 male) non-cleft children. The reviewer used the Baccetti method (2005) to review all the cephalograms for the cervical vertebrae maturation (CVM) stages. T -test was used to compare the mean chronological age and skeletal maturation of cleft and non-cleft children at each CVM stage. There was no significant difference in the mean chronological age and skeletal maturation status of UCLP and non-cleft children. There was no significant difference in skeletal maturation based on sex. The intraobserver assessment showed 80% and 85% kappa agreement, signifying absolute agreement. The correlation coefficient between chronological age and CVMIs was 0.86 ( P <0.001) in cleft children and 0.76 ( P <0.001) in non-cleft children, which was highly significant. The study indicates no significant difference in the skeletal maturation of UCLP and non-cleft children and no sex-related difference.

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.

[Skeletal maturation of the hand and wrist and ossification of the mid palate suture in adolescents: a literature review]

Introduction

The evaluation of skeletal age is an important factor in orthodontic planning to anticipate changes in growth, with the analysis of hand and wrist radiographs showing the degree of bone and facial growth potential. The objective was to evaluate the relationship between skeletal maturation of the hand and wrist and ossification of the midpalatal suture (MPS) in adolescents.

Materials and methods

A search was carried out in four databases such as Pubmed, Scopus, Science Direct and Embase were reviewed until December 13, 2022. The included studies were descriptive and comparative articles on the skeletal maturation of the hand and wrist and ossification of the midpalatal suture of patients aged 7 to 18 years. Two researchers carefully selected the articles evaluated and analyzed the different key topics related to the topic.

Results

Four articles were included in this study; According to the studies, it was found that the greater the degree of bone maturation there is an increase in the approximation of the SMP, especially in late stages, with high and positive correlations; Furthermore, there were greater evaluation results with the Fishman analysis method as opposed to the Hagg and Taranger and Björk methods. The critical limit stages in SMI7-9, a greater approach to the closure of SMP compatible with stage D-E was found. The completion of maturation in women occurs up to 2 years earlier than in men.

Conclusions

Diagnostic evaluation methods using carpal analysis can be used for predictive evaluations of the maturation stage of SMP; However, the results were not absolute in all cases so they cannot be generalized.

Applicability of Fractal Analysis for Quantitative Evaluation of Midpalatal Suture Maturation

BACKGROUND

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.

AIMS

Our aim was to investigate the applicability of fractal analysis for the quantitative evaluation of MPS maturation.

METHODS

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.

RESULTS

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.

CONCLUSION

Our results provided further evidence that fractal analysis is a reliable tool to determine MPS maturation stage.

Age-dependent effects on palate volume and morphology during orthodontic RME treatment

OBJECTIVES

Rapid maxillary expansion (RME) shows different age-dependent effects. It has been shown that RME leads to a parallel expansion prior to the age of 10, while later and especially from the age of 12, a V-shaped expansion happens (transverse, anterior > posterior; horizontal, inferior > superior). However, it is not clear to what extent these effects influence palatal volume and morphology and eventually maxillary functional space. The aim of the present study was to examine possible age-related effects of treatment with a dental anchored RME appliance upon volume and width/height ratio of the anterior and posterior palate.

MATERIALS AND METHODS

Sixty children and adolescents with documented treatment histories after RME were divided into three equal groups according to age at treatment begin (PG 1, < 10 years, n=20; PG 2, 10 ≤ 12 years, n=20; PG 3, > 12 years, n=20). Maxillary dental casts before and after therapy were digitised. Changes in palatal volume were determined using 3D analyses.

RESULTS

In all patients, the palatal volume increases significantly after RME. Older patients experienced smaller increases in total and posterior volume in absolute and percentage terms. The anterior palate volume increases are almost equal in all patients. Since palatal width increases more markedly than palatal height, the width/height ratio always increases. Except for the posterior region in PG 3, its increase is significant in all groups, both anteriorly and posteriorly. After successful RME, the palatal morphology appears normal anteriorly in PG 1, PG 2 and PG 3 and rather steep posteriorly in PG 3.

CONCLUSIONS

RME treatment with identical force application causes different, age-dependent effects upon palate volume and morphology. Width changes have a greater influence on palate volume than height changes.

CLINICAL RELEVANCE

It is preferable to use an RME prior to the age of 10 if homogeneous changes of the anterior and posterior palate regarding maxillary symmetry and functional space are desired.

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 the Frequency and Correlated Factors of Midpalatal Suture Maturation Stages in Young Adults, Based on Cone Beam Computed Tomography Imaging

BACKGROUND

The choice of whether to perform a palatal disjunction in constricted maxilla has traditionally been decided based on the age of the patients, although there are gradually increasing references to the fact that this is not a determining factor. The main goal of this study was to evaluate the frequency of the different stages of midpalatal suture maturation in a sample of young adults between 15 and 30 years of age. Other objectives also included analyzing the possible correlation the maturation stages could maintain with sex and age groups.

METHODS

142 Cone Beam Computed Tomography (CBCT) scans of young adults were performed. The images were divided into four age groups based on age ranges of 15-18, 19-22, 23-26, and 27-30 years. Each group consisted of 26, 41, 39, and 36 patients, respectively, which were classified using Angelieri's method. In addition, sex and age groups were considered as variables, and the possible correlation of the prevalence of each one, according to age and sex, was studied.

RESULTS

the sample was classified into 4.9% stage B; 52.1% stage C; 27.5% stage D; and 15.5% stage E. In addition, no statistically significant correlation between sex and the maturation stages was found, but more advanced stages did appear to be related to the chronological age of the subjects.

CONCLUSIONS

The frequency of maturational stages where the suture is shown to be consolidated did not appear to be as high as expected; therefore, the idea of rejecting transverse plane treatment in a conventional manner in an out-of-growth patient should be discarded.

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.

Age, Sex, and Maxillary Position Are Associated with Successful Microimplant-Assisted Rapid Palatal Expansion in Adults

The purpose of this study was to investigate the possible predictors of success of microimplant-assisted rapid palatal expansion (MARPE) in skeletally mature patients. Additionally, factors associated with the amount of maxillary expansion were analyzed. Factors associated with MARPE success were analyzed in 53 adult patients (27 males, 26 females, mean age 25.8 ± 8.9 years, and range 18.0 to 56.6 years) who had a maxillary transverse deficiency greater than 2 mm and a cervical vertebral maturation stage of 6. Age at pretreatment (T1), sex, sutural bone density at T1, type of appliance, mode of microimplant fixation, and lateral cephalometric variables at T1 were considered for inclusion as predictors for MARPE success. In patients who showed successful maxillary skeletal expansion, the linear distances of maxillary widths were measured on cone-beam-computed-tomography images at T1 and after MARPE (T2), and factors associated with the amount of expansion were analyzed. In total, 41 of the 53 patients showed successful maxillary expansion. Age (p = 0.019), sex (p = 0.002), and A-N perp (p = 0.015) were significantly associated with the success of MARPE. The factors associated with the amount of maxillary skeletal expansion were SN-MP and midpalatal-suture density at T1. In conclusion, there is a greater chance of failure in male patients who are older and have maxillary retrusion. A greater amount of maxillary expansion can be expected in patients with a higher mandibular-plane angle and with lower midpalatal-suture density.

Effectiveness of miniscrew assisted rapid palatal expansion using cone beam computed tomography: A systematic review and meta-analysis

Objective

This study aims to examine the effectiveness of miniscrew assisted rapid palatal expansion (MARPE) treatment in late adolescents and adult patients using cone-beam computed tomography (CBCT).

Methods

Literature search was conducted in five electronic databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) based on the PICOS keyword design focusing on MARPE. Out of the 18 CBCT screened outcomes, only nine parameters were sufficient for the quantitative meta-analysis. The parameters were classified into three main groups 1) skeletal changes, 2) alveolar change, and 3) dental changes. Heterogeneity test, estimation of pooled means, publication bias, sensitivity analysis and risk of bias assessment were also performed.

Results

Upon database searching, only 14 full-text articles were qualified from the 364 obtained results. Heterogeneity test indicated the use of the random-effects model. The pooled mean estimate were as follows 1) Skeletal expansion zygomatic width, 2.39 mm; nasal width, 2.68 mm; jugular width, 3.12 mm; and midpalatal suture at the posterior nasal spine and anterior nasal spine, 3.34 mm and 4.56 mm, respectively; 2) Alveolar molar width expansion, 4.80 mm; and 3) Dental expansion inter-canine width, 3.96 mm; inter-premolar width, 4.99 mm and inter-molar width, 5.99 mm. The percentage of expansion demonstrated a skeletal expansion (PNS) of 55.76%, alveolar molar width expansion of 24.37% and dental expansion of 19.87%.

Conclusions

In the coronal view, the skeletal and dental expansion created by MARPE was of the pyramidal pattern. MARPE could successfully expand the constricted maxilla in late adolescents and adult patients.

A Simplified Digital Approach to the Treatment of a Postpuberty Patient with a Class III Malocclusion and Bilateral Crossbite

Monolateral and bilateral crossbites are amongst the most frequent forms of malocclusion in the world population. The lack of early correction of this type of malocclusion leads to the partial or total ossification of the sutures which then require surgical treatment in adult patients. In recent years, devices on minipalatal screws have noticeably increased the time window in which it is possible to correct these types of alterations. In this case report, we show how it is possible to correct a third-class skeletal malocclusion associated with a posterior bilateral crossbite in a young woman using a rapid expander on miniscrews and fixed orthodontic device to finalise the process. The procedure for the insertion of the palatal screws was aided by the use of a digitally printed surgical guide, and the appliance was applied in the same sitting thanks to the use of a digital flow software and a systematic easy driver. The CBCT scans show how the orthopaedic expansion of the upper maxilla was obtained without any important alterations that damaged the permanent teeth. This case report wishes to demonstrate how easy and predictable it can be to resolve cases of this type with optimal aesthetic and functional results even when body growth has ended.

Association of the mid-palatal suture morphology to the age and to its density: A CBCT retrospective comparative observational study

OBJECTIVE

The twofold aim of the present investigation was to: 1. evaluate the degree of mid-palatal suture (MPS) maturation via CBCT in relation to patient age, and 2. to determine whether there was a correlation between quantitative (i.e., suture density) and qualitative (i.e., suture morphology) analysis.

MATERIALS AND METHODS

The stage of mid-palatal suture maturation and suture density ratio were assessed for 160 subjects on CBCTs using five qualitative stages proposed by Angelieri with the addition of three additional stages (i.e., B/C, C/D and D/E) and quantitative grey density scores of Grünheid MPS1,2,3,4 with the addition of parasutural bone and soft palate. The repeatability of both methods was evaluated using Cohen's K.The relationship between midpalatal suture maturation and age was assessed using ANOVA and Classification and Regression Trees (CART) analysis and tabulation and a χ² test for quantitative and qualitative analysis respectively. Statistical significance was assessed using a 5% threshold.

RESULTS

The final sample included 160 CBCTs (80 male,80 female; mean age 23.2±13.5). Both methods were found to be correlated and highly repeatable. In addiction they showed an age-related correlation in MPS morphology.

CONCLUSION

The mid-palatal suture density ratio and the stage of mid-palatal suture maturation has the potential to become useful in clinical practice. In fact, despite the correlation between MPS maturation stage and age, the latter parameter cannot be used as a clinical discriminator due to the great variability between subjects. It is therefore advisable to assess each patient individually on CBCT scans in order to determine treatment choices.

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.

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.