title: Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion.
abstract: BACKGROUND
  In this study, we present a novel classification method for individual assessment of midpalatal suture morphology.
  
  
  METHODS
  Cone-beam computed tomography images from 140 subjects (ages, 5.6-58.4 years) were examined to define the radiographic stages of midpalatal suture maturation. Five stages of maturation of the midpalatal suture were identified and defined: stage A, straight high-density sutural line, with no or little interdigitation; stage B, scalloped appearance of the high-density sutural line; stage C, 2 parallel, scalloped, high-density lines that were close to each other, separated in some areas by small low-density spaces; stage D, fusion completed in the palatine bone, with no evidence of a suture; and stage E, fusion anteriorly in the maxilla. Intraexaminer and interexaminer agreements were evaluated by weighted kappa tests.
  
  
  RESULTS
  Stages A and B typically were observed up to 13 years of age, whereas stage C was noted primarily from 11 to 17 years but occasionally in younger and older age groups. Fusion of the palatine (stage D) and maxillary (stage E) regions of the midpalatal suture was completed after 11 years only in girls. From 14 to 17 years, 3 of 13 (23%) boys showed fusion only in the palatine bone (stage D).
  
  
  CONCLUSIONS
  This new classification method has the potential to avoid the side effects of rapid maxillary expansion failure or unnecessary surgically assisted rapid maxillary expansion for late adolescents and young adults.
authors.affiliation: Associate professor, Department of Orthodontics, Methodist University of São Paulo, São Paulo, Brazil. Electronic address: fernandaang@yahoo.com.br.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Angelieri
authors.forename: Lucia H S
authors.initials: LH
authors.lastname: Cevidanes
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Franchi
authors.forename: João R
authors.initials: JR
authors.lastname: Gonçalves
authors.forename: Erika
authors.initials: E
authors.lastname: Benavides
authors.forename: James A
authors.initials: JA
authors.lastname: McNamara
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019412:Anatomy, Cross-Sectional; D015519:Bone Density / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003393:Cranial Sutures / Q000000981:diagnostic imaging / Q000254:growth & development*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008437:Maxilla / Q000254:growth & development; D008875:Middle Aged; D010155:Palatal Expansion Technique; D021362:Palate, Hard / Q000000981:diagnostic imaging / Q000254:growth & development*; D055815:Young Adult