Evaluation of facial suture maturation on CBCTs: a predictor of maxillary orthopedic treatment response?

Maxillary orthopedic treatment outcomes depend in part on the maturational stage of the maxillary sutures. Recently, the evaluation of the maturation of midpalatal suture by way of cone beam computed tomography (CBCT) has been introduced as a response predictor following rapid maxillary expansion (RME). Five maturational stages of the midpalatal suture have been described. 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: complete fusion of the palatine bone where no evidence of a suture is present. Stage E: fusion also has occurred anteriorly in the maxilla. At Stages A and B, more skeletal effects would be expected as there are no bone bridges, as are observed in Stage C. Surgically assisted RME typically is a better choice for patients at Stages D and E. This method for evaluation of midpalatal suture maturation in CBCT images has the potential to be extended to other maxillary sutures, particularly the zygomaticomaxillary sutures, for the prediction of the response from facial mask and bone-anchored maxillary protraction (BAMP) therapies. This diagnostic approach can be used to estimate the prognosis of these maxillary orthopedic treatments and to avoid unnecessary corrective jaw surgery in the future.