Validity of the Maturation Stage Method in the Individual Assessment of Midpalatal Suture Ossification Before Maxillary Expansion: A Systematic Review

2023 • Volume 17 • Issue 3

Anis Shayani; Marco Andrés Merino-Gerlach; Ivonne Angélica Garay-Carrasco; Pablo Eliseo Navarro-Cáceres & Héctor Paulo Sandoval-Vidal



In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair quality and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman’s correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman’s correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.

KEY WORDS: midpalatal suture maturation method, cranial sutures, maxillary expansion, skeletal maturation, cervical vertebrae; hand-wrist.


How to cite this article

SHAYANI, A.; MERINO-GERLACH, M. A.; GARAY-CARRASCO, I. A.; NAVARRO-CÁCERES, P. E. & SANDOVAL-VIDAL, H. P. Validity of the maturation stage method in the individual assessment of midpalatal suture ossification before maxillary expansion: A systematic review. Int. J. Odontostomat., 17(3):312-326, 2023.


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