title: Diagnostic performance of skeletal maturity for the assessment of midpalatal suture maturation.
abstract: BACKGROUND
  The aim of this study was to analyze the diagnostic performance of the cervical vertebral maturation (CVM) method in estimating accurately the stages of maturation of the midpalatal suture.
  
  
  METHODS
  Cone-beam computed tomography (CBCT) images from 142 subjects (84 female, 58 male; mean age, 14.8 ± 9.7 years) were analyzed by 2 calibrated examiners to define, by visual analysis, the maturational stages of the cervical vertebrae and the midpalatal suture. These CBCT images were required by orthodontists and surgeons for diagnosis and treatment purposes. Positive likelihood ratios (LHRs) were calculated to evaluate the diagnostic performance of the CVM stages in identifying the maturational stages of the midpalatal suture.
  
  
  RESULTS
  Positive LHRs greater than 10 were found for several cervical vertebral stages (CSs), including CS1 and CS2 for the identification of midpalatal suture stages A and B, CS3 for the diagnosis of midpalatal suture stage C, and CS5 for the assessment of midpalatal suture stages D and E. These positive LHRs indicated large and often conclusive increases in the likelihood that the CVM stages were associated with specific stages of midpalatal suture maturation. At CS4, there were a moderate positive LHR for stage C and low positive LHRs for stages D and E.
  
  
  CONCLUSIONS
  Most CVM stages can be used for the diagnosis of the stages of maturation of the midpalatal suture, so that CBCT imaging may not be necessary in these patients. In the postpubertal period, however, an assessment of the midpalatal suture maturation using CBCT images may be indicated in deciding between conventional rapid maxillary expansion and surgically assisted rapid maxillary expansion. On the other hand, if the CVM stage cannot be assessed, chronologic age may be a viable alternative to predict some midpalatal suture stages (particularly the early stages).
authors.affiliation: Associate professor, Department of Orthodontics, São Paulo Methodist University, São Bernardo do Campo, São Paulo, Brazil; visiting scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich. Electronic address: fernandaang@yahoo.com.br.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Angelieri
authors.affiliation: Research associate, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Franchi
authors.affiliation: Assistant professor, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich.
authors.forename: Lucia H S
authors.initials: LH
authors.lastname: Cevidanes
authors.affiliation: Thomas M. and Doris Graber Endowed Professor Emeritus, Department of Orthodontics and Pediatric Dentistry, School of Dentistry; professor emeritus, Cell and Development Biology, School of Medicine; research professor emeritus, Center of Human Growth and Development, University of Michigan, Ann Arbor, Mich.
authors.forename: James A
authors.initials: JA
authors.lastname: McNamara
mesh_terms: D000293:Adolescent; D000328:Adult; D000365:Age Determination by Skeleton / Q000706:statistics & numerical data*; D019412:Anatomy, Cross-Sectional / Q000706:statistics & numerical data; D002508:Cephalometry / Q000706:statistics & numerical data; D002574:Cervical Vertebrae / Q000254:growth & development*; D002648:Child; D002675:Child, Preschool; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003393:Cranial Sutures / Q000254:growth & development*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000254:growth & development*; D011237:Predictive Value of Tests; D011627:Puberty / Q000502:physiology; D012680:Sensitivity and Specificity; D055815:Young Adult