Assessing circum-maxillary sutures maturation by CBCT: a diagnostic indicator for skeletal age and treatment timing for class III malocclusion

Objectives Evaluation of skeletal age is essential in determining the timing of maxillary expansion and protraction for adolescent skeletal Class III patients. The aim of this study is to investigate the correlation among the maturation stage of cervical vertebrae (CVMS), midpalatal suture (MPSS) and zygomaticomaxillary suture (ZMSS) and evaluate the possibility of predicting the outcome of maxillary expansion and protraction using circum-maxillary suture maturation stage. Methods Cone beam computed tomography (CBCT) scans and lateral cephalography images of 260 adolescents were analyzed to determine the correlation among different maxillary sutures maturation stages and CVMS. Statistical analysis included the Mann–Whitney, Wilcoxon, and Fisher's exact tests. The level of significance was 5% ( P = 0.05). Results The distribution difference of MPSS and ZMSS is statistically significant between different age groups ( P < 0.05), and two sutures maturation stages both showed a trend of increasing maturation with age. CVMS, MPSS and ZMSS were all significantly correlated ( P < 0.001). Positive likelihood ratio analysis revealed strong diagnostic associations (LHR >10) between specific CVMS stages and corresponding suture maturation levels, particularly for the early and late maturation stages. Conclusion This study verified the efficacy of using the maturational stages of maxillary sutures to assess growth and development. MPSS shows a strong correlation with ZMSS and can serve as a useful reference for estimating ZMSS maturation, supporting a combined assessment approach. The maxillary suture maturational stages can serve as an index to evaluate the intervening time and outcomes of maxillary protraction with palatal expansion in juveniles.