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

Abstract

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.

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

“…This is mainly due to the great physiologic variability among patients in relation to the obliteration of palatal suture earlier or at a more advanced age, making it difficult to have a precise diagnostic [ 33 , 34 , 36 , 37 , 44 ]. This is important, because the greater the obliteration of the MPS, the lower the skeletal effects and the greater the dentoalveolar impact of this treatment [ 50 , 52 ].…”

“…Due to the abovementioned issues, the treatment choice of whether an adolescent or a young adult patient is a suitable candidate for maxillary expansion without surgical assistance is a relevant clinical question [ 52 ].…”

Applicability of Fractal Analysis for Quantitative Evaluation of Midpalatal Suture Maturation

“…Furthermore, they recommended the need for an extensive training program for routine clinical application of the method [ 7 ]. Another systematic review that aimed to assess the methodological quality of all the articles about Angelieri’s method also highlighted caution when using Angelieri’s classification routinely [ 28 ].…”

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

“…However, this procedure has to be performed before the midpalatal suture fuses. Once advanced ossification begins, invasive and expensive surgically assisted techniques are required to provide skeletal expansion [ 3 ]. Identifying the midpalatal suture (MPS) maturation stage can play an essential role in preventing treatment complications such as expansion failure, pain, periodontal problems, and undesired buccal tipping with extrusion of the posterior teeth [ 4 – 7 ].…”

“…In this regard, attempts were made to find the relationship between MPS maturation and other commonly used indices in orthodontics. A less invasive method, known as the hand-wrist method (HWM), has been used as the criterion standard for evaluating skeletal maturity [ 3 ]; it involves taking a wrist radiograph and assessing the characteristic features of the selected metaphyseal phalangeal cartilages and the radial bone. The cervical vertebral maturation (CVM) method also eliminates additional patient radiation since it only requires a cephalometric radiograph [ 17 ].…”