Midpalatal Suture Maturation in Young Individuals: Cone-Beam Computed Tomography Evidence Challenging Age-Based Treatment Decisions

Abstract

Background: Assessment of midpalatal suture (MPS) maturation is essential for determining whether rapid maxillary expansion (RME) or surgically assisted rapid maxillary expansion (SARME) is indicated. Although MPS maturation is associated with age and sex, considerable individual variability exists. Objective: The aim of this study was to investigate the relationship between MPS maturation stages, age, and sex using cone-beam computed tomography (CBCT). Methods: A retrospective analysis of 488 CBCT scans was performed. MPS maturation was assessed using the 5-stage classification system proposed by Angelieri et al 2 observers independently evaluated the images, and interobserver reliability was calculated. Results: Interobserver agreement was excellent (κ=0.919). The distribution of MPS maturation stages was as follows: stage A (0.2%), stage B (16.6%), stage C (34.8%), stage D (39.5%), and stage E (8.8%). Among individuals aged 18 to 20 years, 1.8% were classified as stage C, 64.2% as stage D, and 34% as stage E. Conclusion: A high proportion of the study population (91.2%) exhibited immature MPS stages, suggesting a favorable response to nonsurgical maxillary expansion. Notably, only 34% of individuals aged 18 to 20 years demonstrated complete suture maturation (stage E), indicating that chronological age alone is an unreliable determinant for treatment planning. Female participants exhibited earlier suture maturation compared with males.