Evaluation of a novel palatal suture maturation classification as assessed by cone-beam computed tomography imaging of a pre- and postexpansion treatment cohort.

OBJECTIVES: To test the reliability and usefulness of the midpalatal suture maturation classification and methodology proposed in 2013 by Angelieri et al. for successful prediction of rapid maxillary expansion (RME) treatment results.
MATERIALS AND METHODS: Reliability testing focused on 16 patients aged 9.5-17 years with early mixed to full permanent dentition, representing all proposed palatal maturation stages, from available preexpansion cone-beam computed tomography (CBCT). A retrospective observational longitudinal (cohort) study evaluated 63 preadolescent and adolescent patients aged 11-17 years with full permanent dentition treated with tooth-borne RME appliances who had CBCT records taken at pre- (T1) and postexpansion (T2). CBCT three-dimensional landmarking produced skeletal and dental widths and dental angulations used to evaluate the extent of skeletal and/or dental expansion. A regression model was used to assess the prediction capability of the T1 palatal suture classification of each subject for dental and skeletal changes.
RESULTS: There was almost perfect intraexaminer agreement and slight to poor interexaminer agreement, differing from previously reported reliability, affected by necessary operator calibration and the degree of postacquisition image sharpness and clarity. Further exploration of its scientific basis suggested that the proposed classification was ill-founded. Results from the cohort study were also wholly unsupportive of efficacy of the proposed palatal suture maturation classification in predicting the magnitude of portrayed changes.
CONCLUSIONS: Clinicians should be cautious in applying this classification. Although it has merits, the palatal classification still needs much more research and validation.