A new CBCT evaluation for individual assessment of midpalatal suture maturation: a retrospective analysis

Introduction: The maturation of the midpalatal suture is a critical factor in determining the most appropriate maxillary expansion technique. Angelieri et al. introduced a CBCT-based staging system that shifted the focus from chronological age to individual anatomical assessment. However, inter-examiner variability and challenges in evaluating intermediate stages (C and D) have raised concerns about the diagnostic reliability of axial-only CBCT analysis. This study investigates whether the addition of standardized coronal CBCT sections to traditional axial assessment can improve diagnostic precision - particularly in borderline cases - by revealing morphological variations that may not be evident in axial views alone. Materials and methods: 34 CBCT scans were retrospectively analyzed. Each midpalatal suture was assessed using both the conventional axial plane method proposed by Angelieri and a coronal view evaluation performed on three standardized slices (anterior, middle, posterior). The study focused on evaluating concordance between the two modalities, identifying regional discrepancies and analyzing ossification patterns, particularly in intermediate stages. Results: Full concordance between axial and coronal assessments was observed in 23 out of 34 cases, supporting the overall consistency of the axial view method. However, discrepancies emerged primarily in stage C, where 8 of the 11 discordant cases were concentrated. In most of these cases, at least one coronal slice revealed a more advanced ossification stage than suggested by axial analysis. Additionally, atypical anterior-to-posterior ossification patterns were documented in a minority of cases. Discussion: While our findings do not question the general validity of Angelieri's staging, they suggest that an exclusive reliance on axial views may, in some cases, underestimate the degree of suture maturation. The integration of coronal slices can improve diagnostic resolution in transitional stages, offering a more specific view of the suture's complexity. This multimodal approach may help reduce interpretive subjectivity and potentially limit inter-examiner variability.