Search

Objectives: The aim of our study is to determine the relationship between MPS maturation and CVM stage determined from CBCTs. Materials and methods: CBCT images of 130 individuals (75 females, 55 males) with a mean age of 15.04 ± 3.11 (9.56–25.05 years) were analyzed. Images were analyzed using the i-CAT Vision software program. The cephalometric images to be examined were also obtained from the same CBCT images with the ImageJ program. The correlation between MPS and CVM stages was evaluated using the Spearman correlation test. The relationship between the skeletal developmental stage and MPS maturation, as assessed by the CVM method, was evaluated with the positive likelihood ratio. Results: Significant correlations were found between CVM and MPS maturation stages. Positive LHR values of cervical vertebral stages were obtained to define the maturation stages of the midpalatal suture. LHR values greater than ten were found between CS2, CS5, and CS6 and maturation stages B, D, and E, respectively. A 15–30% correlation was observed between CS3 and CS4 maturation stages B and C, respectively. A positive correlation of 15% was found between CS3 and stage C. Conclusion: MPS fusion is more likely to occur after CS4. The correlation between the CVM and MPS maturation stages is significant (r = 0.858). CVM stages CS2, CS4, and CS6 can be a preliminary indicator for MPS stages B, D, and E, respectively. CS5 shows that MPS fusion has occurred partially or completely. Clinical relevance: A significant relationship exists between skeletal developmental stages and suture maturation. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of our study is to determine the relationship between MPS maturation and CVM stage determined from CBCTs. Materials and methods CBCT images of 130 individuals (75 females, 55 males) with a mean age of 15.04 ± 3.11 (9.56–25.05 years) were analyzed. Images were analyzed using the i-CAT Vision software program. The cephalometric images to be examined were also obtained from the same CBCT images with the ImageJ program. The correlation between MPS and CVM stages was evaluated using the Spearman correlation test. The relationship between the skeletal developmental stage and MPS maturation, as assessed by the CVM method, was evaluated with the positive likelihood ratio. Results Significant correlations were found between CVM and MPS maturation stages. Positive LHR values of cervical vertebral stages were obtained to define the maturation stages of the midpalatal suture. LHR values greater than ten were found between CS2, CS5, and CS6 and maturation stages B, D, and E, respectively. A 15–30% correlation was observed between CS3 and CS4 maturation stages B and C, respectively. A positive correlation of 15% was found between CS3 and stage C. Conclusion MPS fusion is more likely to occur after CS4. The correlation between the CVM and MPS maturation stages is significant (r = 0.858). CVM stages CS2, CS4, and CS6 can be a preliminary indicator for MPS stages B, D, and E, respectively. CS5 shows that MPS fusion has occurred partially or completely. Clinical relevance A significant relationship exists between skeletal developmental stages and suture maturation.

Simple Summary: The treatment of a transverse maxillary constriction is a challenge for orthodontists, as the expansion approach depends on the midpalatal suture maturation. A conventional palatal expander provides skeletal effects in an unfused suture, while surgically or miniscrew-assisted expansions are suggested in a closed suture. The midpalatal suture development is affected by multiple variables, such as age, sex, and facial growth patterns. Consequently, we conducted a CBCT study among 263 patients aged from 8 to 20 in order to evaluate the relation between midpalatal suture maturation and age, sex, and vertical and sagittal growth patterns. The midpalatal suture was classified into five stages from A to E according to the progressively increasing maturation stage. The youngest individuals, the male participants, and the hyperdivergent subjects tended to show lower stages. Therefore, our study provided a further analysis of the potential predictors involved in midpalatal suture maturation that are useful to the clinician to choose the most effective expansion approach. Background. The evaluation of midpalatal suture maturation is essential to undertake the most predictable maxillary expansion approach. Several factors, such as age, gender, and facial growth patterns, seem to be involved in midpalatal suture staging and, consequently, in its opening; however, the link between these variables and the stages of midpalatal suture development remains poorly understood. Our study aimed to analyse the midpalatal suture maturation in relation to age, sex, and skeletal growth patterns by CBCT. Methods. We enrolled 263 patients (119 males and 144 females) aged from 8 to 20 years. The midpalatal suture maturation was defined according to Angelieri et al.'s classification using a low-dose CBCT. The chi-square test and linear regression were applied to investigate the suture stages by age, sex, and vertical and sagittal growth patterns. Results. Stage A was present in 8- and 9-year-olds with a larger prevalence in boys, while the prevalence of stage E increased progressively with age. Stage D was the most prevalent in our sample. The statistical analysis described that stage A was more likely in the youngest subjects, and stage E in the oldest participants. The males tended to have lower maturation stages. Moreover, the hypodivergent and normodivergent subjects tended to have higher maturation stages, while Class III was more likely in subjects in stages D or E. Conclusions. A total of 127 patients were in stages A, B, and C, showing an unfused suture. In young individuals, the opening of the midpalatal suture leads to a proper facial growth development by correcting the transverse superior hypoplasia. The midpalatal sutural maturation classification was related to age, sex, and divergence. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate and correlate the maturation stage of the midpalatal suture, CVM stages, mandibular left second molar mineralization stages of the subjects by CBCT. Materials and Methods: One hundred subjects (55 males and 45 females) with a mean age of 13.56 ± 4.46 years, were divided into five midpalatal suture maturational stage groups (A to E). Cervical vertebral maturational stages on lateral cephalograms and second molar mineralization stages on orthopantograms from the CBCT images obtained from Carestream CS 9300C 3D system were analyzed and correlation among them were calculated by Spearman's coefficient of correlation and midpalatal suture maturation stage prediction accuracy estimated with sensitivity, specificity, positive predictive value, and likelihood ratio. Results: Spearman's correlation analysis showed a highly significant (p value < .001) and positive correlation between MPS stage and CVM Stage (r = 0.930), MPS stage and mandibular left second molar mineralization stage (r = 0.757), and CVM stage and mandibular left second molar mineralization stage (r = 0.760). Conclusion: Cervical vertebral maturation stages 1,2, and 3 can be used clinically to predict the midpalatal suture maturation stages A, B, and C, respectively, as their likelihood ratios were more than 10. Second molar mineralization stages had less predictive value for MPS stages. [ABSTRACT FROM AUTHOR]

Abstract Background Midpalatal suture (MPS) maturation may be influenced by a range of parameters including age, gender, and vertical skeletal pattern. We therefore aimed to evaluate the effect of Frankfurt-mandibular angle (FMA), skeletal maturation, and age on the timing of MPS maturation. Methods In this cross-sectional study, cone-beam computed tomography (CBCT) and lateral cephalograms were used to assess the MPS and cervical vertebral maturation (CVM) stage. A proportional odds logistic regression model was used to assess associations between age adjusted for gender and MPS maturation, and a regression analysis was performed to analyze the effect of vertical pattern on these associations. Results A total of 201 patients (84 male and 117 female) with a mean age of 13.48 (SD 1.94) were included. With increasing age, the odds of belonging to a higher maturation stage increased (OR: 2.14; 95% CI 1.789; 2.567; P

Background: Midpalatal suture (MPS) maturation may be influenced by a range of parameters including age, gender, and vertical skeletal pattern. We therefore aimed to evaluate the effect of Frankfurt-mandibular angle (FMA), skeletal maturation, and age on the timing of MPS maturation. Methods: In this cross-sectional study, cone-beam computed tomography (CBCT) and lateral cephalograms were used to assess the MPS and cervical vertebral maturation (CVM) stage. A proportional odds logistic regression model was used to assess associations between age adjusted for gender and MPS maturation, and a regression analysis was performed to analyze the effect of vertical pattern on these associations. Results: A total of 201 patients (84 male and 117 female) with a mean age of 13.48 (SD 1.94) were included. With increasing age, the odds of belonging to a higher maturation stage increased (OR: 2.14; 95% CI 1.789; 2.567; P < 0.001); however, no association between FMA and MPS maturation was observed (OR: 1.01; 95% CI 0.964; 1.051; P = 0.76). A strong correlation between MPS maturation and CVM stage was not reported. Males had a higher probability of belonging to a lower MPS maturation stage (OR: 0.24; 95% CI 0.136; 0.415; P < 0.001). Conclusions: Based on this cross-sectional analysis, midpalatal sutural maturation classification is associated with chronological age and occurs later in males. Neither CVM staging nor variation in vertical skeletal proportions were useful predictors of midpalatal maturation stage. [ABSTRACT FROM AUTHOR]

Abstract Background Midpalatal suture (MPS) expansion can be affected by many factors, and researchers have attempted to regulate the initial inflammatory stage of expansion to optimize clinical outcomes and their underlying mechanisms. This study aimed to investigate the potential effects and mechanisms of M1 macrophage small extracellular vesicles during rat MPS expansion. Materials and methods RAW264.7 cells were induced to M1 or M2 polarization and, small extracellular vesicles were isolated from the polarized macrophages. Male Sprague–Dawley rats (6–7 weeks) were administered 70 ± 5 g expansion force devices for 7 days. Rats with expanders without force served as controls. M1/M2 small extracellular vesicles were injected into the MPS region (50 µg/day) in the M1 and M2 small extracellular vesicle-assisted groups, while 0.9% saline was injected into the expansion-only group. Suture width, bone mass, and morphological changes in the region of interest (ROI) were examined. Results The M1 small extracellular vesicle-assisted group showed a significantly increased MPS suture width in vivo (P

Background. The evaluation of midpalatal suture maturation is essential to undertake the most predictable maxillary expansion approach. Several factors, such as age, gender, and facial growth patterns, seem to be involved in midpalatal suture staging and, consequently, in its opening; however, the link between these variables and the stages of midpalatal suture development remains poorly understood. Our study aimed to analyse the midpalatal suture maturation in relation to age, sex, and skeletal growth patterns by CBCT. Methods. We enrolled 263 patients (119 males and 144 females) aged from 8 to 20 years. The midpalatal suture maturation was defined according to Angelieri et al.’s classification using a low-dose CBCT. The chi-square test and linear regression were applied to investigate the suture stages by age, sex, and vertical and sagittal growth patterns. Results. Stage A was present in 8- and 9-year-olds with a larger prevalence in boys, while the prevalence of stage E increased progressively with age. Stage D was the most prevalent in our sample. The statistical analysis described that stage A was more likely in the youngest subjects, and stage E in the oldest participants. The males tended to have lower maturation stages. Moreover, the hypodivergent and normodivergent subjects tended to have higher maturation stages, while Class III was more likely in subjects in stages D or E. Conclusions. A total of 127 patients were in stages A, B, and C, showing an unfused suture. In young individuals, the opening of the midpalatal suture leads to a proper facial growth development by correcting the transverse superior hypoplasia. The midpalatal sutural maturation classification was related to age, sex, and divergence.

Abstract Purpose To evaluate the correlation between cervical vertebral maturation stages (CVMS) and midpalatal suture maturation stages (MPSMS), and to analyze the diagnostic value of CVMS for the assessment of MPSMS. Methods Cone beam computed tomography (CBCT) images of 233 subjects (8–20 years) were selected. The CVMS was determined using the McNamara and Franchi method, while the MPSMS was evaluated using the Angelieri method. Spearman rank correlation was used to analyze the results, and positive likelihood ratios were calculated to evaluate the diagnostic value of CVMS in identifying MPSMS. Results Spearman rank correlation results showed a strong positive correlation (r = 0.867, P

Background: Midpalatal suture (MPS) expansion can be affected by many factors, and researchers have attempted to regulate the initial inflammatory stage of expansion to optimize clinical outcomes and their underlying mechanisms. This study aimed to investigate the potential effects and mechanisms of M1 macrophage small extracellular vesicles during rat MPS expansion. Materials and methods: RAW264.7 cells were induced to M1 or M2 polarization and, small extracellular vesicles were isolated from the polarized macrophages. Male Sprague–Dawley rats (6–7 weeks) were administered 70 ± 5 g expansion force devices for 7 days. Rats with expanders without force served as controls. M1/M2 small extracellular vesicles were injected into the MPS region (50 µg/day) in the M1 and M2 small extracellular vesicle-assisted groups, while 0.9% saline was injected into the expansion-only group. Suture width, bone mass, and morphological changes in the region of interest (ROI) were examined. Results: The M1 small extracellular vesicle-assisted group showed a significantly increased MPS suture width in vivo (P < 0.001), and less bone mass was observed in the ROI (P < 0.05). Histological examination showed that the M1 small extracellular vesicle-assisted group exhibited a wider palatal area and obvious fibrous tissue rearrangement. The expression of RANKL and the number of osteoclasts were increased (P < 0.01) in the bony edges, and the p65 protein expression was significantly higher (P < 0.001). Conclusions: M1 macrophage-derived small extracellular vesicles have a positive effect in MPS expansion and increase p65 protein content and RANKL expression, thus promoting bone turnover. This study may contribute to the clinical application of small extracellular vesicles in the expansion of the palatal suture. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the correlation between cervical vertebral maturation stages (CVMS) and midpalatal suture maturation stages (MPSMS), and to analyze the diagnostic value of CVMS for the assessment of MPSMS. Methods: Cone beam computed tomography (CBCT) images of 233 subjects (8–20 years) were selected. The CVMS was determined using the McNamara and Franchi method, while the MPSMS was evaluated using the Angelieri method. Spearman rank correlation was used to analyze the results, and positive likelihood ratios were calculated to evaluate the diagnostic value of CVMS in identifying MPSMS. Results: Spearman rank correlation results showed a strong positive correlation (r = 0.867, P < 0.001) between CVMS and MPSMS. The positive likelihood ratios of CS12, CS4, and CS56 for the identification of stages AB, C, and DE were 12.17, 7.64, and 7.79, respectively. The values of the positive likelihood ratios of the other groups were less than five. Conclusion: CS12 of the CVMS can be used as a reliable indicator for the assessment of MPSMS stage AB. From CVMS stage 4 forward, midpalatal suture maturation should be evaluated using CBCT. [ABSTRACT FROM AUTHOR]

In this study, we aimed to evaluate the frequency of midpalatal maturational stages in a Chilean urban sample of adolescents, post-adolescents and young adults, associated with chronological age and sex, by assessing CBCT scan images. Tomographic images in axial sections of the midpalatal sutures from 116 adolescents and young adults (61 females and 55 males, 10–25 years old) were classified according to their morphologic characteristics in five maturational stages (A, B, C, D and E), as proposed by Angelieri et al. The sample was divided into three groups: adolescents, post-adolescents and young adults. Three previously calibrated examiners (radiologist, orthodontist and general dentist) analyzed and classified the images. Stages A, B and C were considered to be an open midpalatal suture, and D and E were considered to be a partially or totally closed midpalatal suture. The most frequent stage of maturation was D (37.9%), followed by C (24%) and E (19.6%). The possibility of finding closed midpalatal sutures in individuals of 10 to 15 years was 58.4%, and in subjects aged 16 to 20 and 21 to 25 years, it was 51.7% and 61.7%, respectively. In males, Stages D and E were present in 45.4%; for females, this prevalence was 68.8%. Individual assessment of the midpalatal suture in each patient is of crucial importance before making the clinical decision of which is the best maxillary expansion method. Due to the extensive calibration and training required, it is advisable to always request a report from a radiologist. Individual evaluation with 3D imaging is recommended because of the great variability observed in the ossification of midpalatal sutures in adolescents, post-adolescents and young adults. [ABSTRACT FROM AUTHOR]

The midpalatal suture is mainly responsible for the growth and development of the maxillary and resistance to rapid maxillary expansion (RME). It is essential for clinical researchers to explore the intramembrane ossification and to elucidate the underlying mechanism of the maturation and ossification process of the midpalatal suture to help identify the optimum time and force of RME. However, mechanistic studies associated with the midpalatal suture are rare. The aim of this present study is to create an intramembrane osteogenesis model for the midpalatal suture region of mice. Interestingly, we discovered a type of chondrogenic mesenchymal cell expressing Piezo2, which might be related to the detection of mechanical and external stimuli. This result provides a potential molecular and cellular mechanism that explains why the midpalatal suture is not closed until adulthood. We depict a landscape of mesenchymal cells that might play an important role in the intramembrane osteogenesis of the midpalatal suture and provide new perspectives on midpalate suture maturation and ossification, which might lead to further possibilities for clinical operations. [ABSTRACT FROM AUTHOR]

BackgroundMini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture.MethodsFifteen subjects (mean age of 17.2 years; range, 13.9-26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher's exact test was used.ResultsRegarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping. [ABSTRACT FROM AUTHOR]

In this study, we aimed to evaluate the frequency of midpalatal maturational stages in a Chilean urban sample of adolescents, post-adolescents and young adults, associated with chronological age and sex, by assessing CBCT scan images. Tomographic images in axial sections of the midpalatal sutures from 116 adolescents and young adults (61 females and 55 males, 10–25 years old) were classified according to their morphologic characteristics in five maturational stages (A, B, C, D and E), as proposed by Angelieri et al. The sample was divided into three groups: adolescents, post-adolescents and young adults. Three previously calibrated examiners (radiologist, orthodontist and general dentist) analyzed and classified the images. Stages A, B and C were considered to be an open midpalatal suture, and D and E were considered to be a partially or totally closed midpalatal suture. The most frequent stage of maturation was D (37.9%), followed by C (24%) and E (19.6%). The possibility of finding closed midpalatal sutures in individuals of 10 to 15 years was 58.4%, and in subjects aged 16 to 20 and 21 to 25 years, it was 51.7% and 61.7%, respectively. In males, Stages D and E were present in 45.4%; for females, this prevalence was 68.8%. Individual assessment of the midpalatal suture in each patient is of crucial importance before making the clinical decision of which is the best maxillary expansion method. Due to the extensive calibration and training required, it is advisable to always request a report from a radiologist. Individual evaluation with 3D imaging is recommended because of the great variability observed in the ossification of midpalatal sutures in adolescents, post-adolescents and young adults.

Background and objectives. This paper aimed to evaluate the changes in mean bone density values of the midpalatal suture (MPS) in 392 young patients treated with a rapid palatal expander (RPE) appliance, depending on sex and vertical and sagittal skeletal patterns. Materials and Methods. Evaluations were performed using a low-dose protocol for cone beam computed tomography scans at T0 (preoperative) and T1 (1 year after the beginning of the therapy). The region of interest was used to calculate bone density in Hounsfield units (HU) for the area between the maxillary incisors. Results. CBCT scan data of 196 females and 196 males (mean age of 11.7 years) showed homogeneous and similar density values of the MPS at T0 (550.17–563.70 HU) and T1 (541.92–553.85 HU). Class III skeletal individuals showed significantly higher BD than the Class II group at T0, but not at T1. Females showed significant and substantially higher BD than males at T0 and T1. No significant differences were found between the other groups and between the two time points in terms of the bone density values of the MPS. Conclusions. Females and the Class III group showed significantly higher bone density values than males and Class II, respectively. No statistically significant differences were found from T0 to T1 in any groups, suggesting that a similar rate of suture reorganization occurs after the use of an RPE, causing reorganization and bone deposition along the MPS. [ABSTRACT FROM AUTHOR]

Objective To investigate the manufacturing procedures of personalized miniscrew-assisted rapid palatal expanders (pMARPE) using digital technologies and to evaluate the effect of the expanders when expanding the midpalatal suture of an adult. Methods Digital technologies were used to make pMARPE, which was used to treat a 21-year-old woman with maxillary transverse deficiency (MTD). The relevant literature on MARPE was reviewed. Results PMARPE could be manufactured using intraoral digital scanning, computer-aided design and computer-aided manufacturing(CAD/CAM ), and 3D printing technologies. After expansion, the width of the anterior midpalatal suture, posterior midpalatal suture and maxillary skeletal width increased by 3.9 mm, 3.2 mm and 4.7 mm, respectively. There was no significant change in the inclination of maxillary first molars, and the height of alveolar ridge decreased slightly. It could be seen that using digital technologies to manufacture personalized expanders was possible for MARPE , and the initial stability of miniscrews played an important role in the expansion success rate, the increase of molar inclination is composed of many parts, and the decrease of alveolar ridge height may be overestimated due to the measurement method, as shown by a literature review. Conclusion The midpalatal suture of an adult patient with MTD could be expanded by pMARPE. However, the effect of this expander on the inclination of the first molar and alveolar bone height needs to be further studied with a larger sample size.

Abstract Objective The purpose of this study was to assess the palatal suture opening and the pterygopalatine suture disarticulation pattern in the tomographic axial plane after treatment with midfacial skeletal expander (MSE). Materials and methods Pre- and post-expansion CBCT records of 50 subjects (20 males, 30 females, mean age 18 ± 3 years) who were treated with MSE (Biomaterials Korea, Seoul, Korea) appliance were superimposed and compared using OnDemand software. Reference planes were identified and the angulation of the midpalatal suture opening after expansion was calculated as well as the frequency of the pterygopalatine suture split. Results After MSE treatment, the mean palatal suture opening angle (SOA) was 0.57°. (− 0.8° to 1.3°). There was no significant difference between males and females in terms of the palatal suture opening pattern (P > 0.05). Only 3 out of 50 (6%) subjects presented SOA above 1 degree. Also, 3 out of 50 (6%) patients presented a negative SOA value. With regard to the pterygopalatine suture split, 84 sutures out of 100 (84%) presented openings between the medial and lateral pterygoid plates on both right and left sides. Partial split was detected with 8 patients (5 females, 3 males). Five patients had split only in the medial pterygoid plates of both pterygomaxillary sutures, and 3 patients exhibited disarticulation on the right side only. No significant differences were found in the frequency of suture opening between males and females (P = 1.000). Conclusions MSE appliance performed almost parallel expansion in the axial view. Remarkably, this study shows that pterygopalatine suture can be split by MSE appliance without the surgical intervention; the disarticulation of pterygopalatine suture was visible in most of the patients.

Background: Cone beam computed tomography (CBCT) imaging techniques are the recent rage in the field of oral diagnostic imaging modality. It is noninvasive, faster and lacks anatomic superimposition. Earlier maxillary occlusal radiographs were used to assess and evaluate the mid palatal suture, but being a two dimensional imaging modality it could not assess the ossification process which takes place in multiple planes mostly due to curved nature of the palate. In this study we assessed the mid palatal suture morphology and classify them according to the variants using CBCT images. Materials and methods: A total of 200 CBCT scans (95 males and 105 females) were evaluated in the present study from the archives of an imaging center. As per Angelieri classification the midpalatal suture was classified into five categories (A–E) depending on the degree of ossification that had taken place. Statistical analysis was done by Chi Square test using SPSS version 23.0. Results: There is statistically significant difference present in the stages of maturity of mid palatal suture in various age groups with Stage B is most common in Group 1 (50%), Stage C most common in Group 2 (60%) and Group 3 (40%) and Stage E more common in Group 4 (50%). Conclusion: The results of the present study showed a wide variation in the initiation time and the degree of ossification and morphology of the midpalatal suture in different age groups. Although there was an increase in the closure of the suture with aging, age is not a reliable criterion for determining the open or closed nature of the suture. This finding is important in providing an idea as to how diverse is the ossification of maxillary sutures.

The midpalatal suture is mainly responsible for the growth and development of the maxillary and resistance to rapid maxillary expansion (RME). It is essential for clinical researchers to explore the intramembrane ossification and to elucidate the underlying mechanism of the maturation and ossification process of the midpalatal suture to help identify the optimum time and force of RME. However, mechanistic studies associated with the midpalatal suture are rare. The aim of this present study is to create an intramembrane osteogenesis model for the midpalatal suture region of mice. Interestingly, we discovered a type of chondrogenic mesenchymal cell expressing Piezo2, which might be related to the detection of mechanical and external stimuli. This result provides a potential molecular and cellular mechanism that explains why the midpalatal suture is not closed until adulthood. We depict a landscape of mesenchymal cells that might play an important role in the intramembrane osteogenesis of the midpalatal suture and provide new perspectives on midpalate suture maturation and ossification, which might lead to further possibilities for clinical operations.

Abstract A safe and suitable approach in the treatment of unusual malformed anterior maxillary teeth would be to accept a birooted fused incisor as two central teeth by moving it across the midpalatal suture and improve the frontal esthetics.

A safe and suitable approach in the treatment of unusual malformed anterior maxillary teeth would be to accept a birooted fused incisor as two central teeth by moving it across the midpalatal suture and improve the frontal esthetics. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to compare the relationship between skeletal and dental outcomes of rapid maxillary expansion (RME) treatment on cone beam computed tomography (CBCT) images between pre-pubertal peak (pre-peak) and post-pubertal peak (post-peak) patients. The null hypothesis was that there was no difference in the outcomes of RME treatment between the groups. Methods Thirty-two patients who underwent RME treatment were classified according to midpalatal suture maturation levels and then divided into two groups as pre-peak and post-peak. Skeletal and dental measurements were performed on the CBCT images at T0 (pre-treatment stage) and at T1 (post-treatment stage). Paired sample t test was used to evaluate normally distributed data and P

This study presents the development and validation of a fibre Bragg gratings (FBGs)‐based sensor system for the assessment of strain in the midpalatal suture in subjects using rapid palatal expanders (RPEs). The ex‐vivo experiments were made by means of positioning two RPEs in a porcine palatal region. The RPEs used were the Hyrax, a tooth‐borne expander and MARPE (microimplant‐assisted rapid palatal expansion), a bone‐borne expander. In order to define the regions in the palatal region for the sensors positioning, a finite‐element analysis was performed in a porcine head subjected to the loadings caused by an RPE. In addition, a strain transfer model was used to obtain a correction coefficient that approximates the strain estimated by the FBG to the actual strain in the structure under shear and normal stress. Results show high linearity in the sensors characterisation tests with the advantages of compactness, intrinsic safe operation and multiplexing capabilities of FBGs. In the RPE analysis, a higher strain was estimated in the anterior region, which is in accordance with the simulation and previously reported results, where MARPE showed a higher strain (with an exponential pattern) than Hyrax as the number of activations increase. [ABSTRACT FROM AUTHOR]

Background and objectives. This paper aimed to evaluate the changes in mean bone density values of the midpalatal suture (MPS) in 392 young patients treated with a rapid palatal expander (RPE) appliance, depending on sex and vertical and sagittal skeletal patterns. Materials and Methods. Evaluations were performed using a low-dose protocol for cone beam computed tomography scans at T0 (preoperative) and T1 (1 year after the beginning of the therapy). The region of interest was used to calculate bone density in Hounsfield units (HU) for the area between the maxillary incisors. Results. CBCT scan data of 196 females and 196 males (mean age of 11.7 years) showed homogeneous and similar density values of the MPS at T0 (550.17–563.70 HU) and T1 (541.92–553.85 HU). Class III skeletal individuals showed significantly higher BD than the Class II group at T0, but not at T1. Females showed significant and substantially higher BD than males at T0 and T1. No significant differences were found between the other groups and between the two time points in terms of the bone density values of the MPS. Conclusions. Females and the Class III group showed significantly higher bone density values than males and Class II, respectively. No statistically significant differences were found from T0 to T1 in any groups, suggesting that a similar rate of suture reorganization occurs after the use of an RPE, causing reorganization and bone deposition along the MPS.

Abstract Background To investigate the relationship between the morphological maturation stages of the midpalatal suture and its bone densities. Methods The sample consisted of 91 subjects aged 8–18 years who underwent cone beam computed tomography. All images were examined to classify morphological maturation of the midpalatal suture to five groups according to Angelieri et al. Bone density of the midpalatal suture was measured at the maxillary and palatal regions. Kruskal-Wallis and Mann-Whitney U tests were used to analyze the difference between groups. Results Bone density of the midpalatal suture was significantly higher in the palatal region in E stage and in the maxillary region in D and E stages. Conclusions It is concluded that the change in bone density of the midpalatal suture between the morphological maturation stages supports their reliability in clinical application.

Abstract Background Personalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME. Methods Three patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy. Results In agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture’s long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae. Conclusions The microCT imaging revealed, for the first time to the authors’ knowledge, the 3D bone regeneration in children submitted to RME.

Objective: The purpose of this study was to assess the palatal suture opening and the pterygopalatine suture disarticulation pattern in the tomographic axial plane after treatment with midfacial skeletal expander (MSE). Materials and methods: Pre- and post-expansion CBCT records of 50 subjects (20 males, 30 females, mean age 18 ± 3 years) who were treated with MSE (Biomaterials Korea, Seoul, Korea) appliance were superimposed and compared using OnDemand software. Reference planes were identified and the angulation of the midpalatal suture opening after expansion was calculated as well as the frequency of the pterygopalatine suture split. Results: After MSE treatment, the mean palatal suture opening angle (SOA) was 0.57°. (− 0.8° to 1.3°). There was no significant difference between males and females in terms of the palatal suture opening pattern (P > 0.05). Only 3 out of 50 (6%) subjects presented SOA above 1 degree. Also, 3 out of 50 (6%) patients presented a negative SOA value. With regard to the pterygopalatine suture split, 84 sutures out of 100 (84%) presented openings between the medial and lateral pterygoid plates on both right and left sides. Partial split was detected with 8 patients (5 females, 3 males). Five patients had split only in the medial pterygoid plates of both pterygomaxillary sutures, and 3 patients exhibited disarticulation on the right side only. No significant differences were found in the frequency of suture opening between males and females (P = 1.000). Conclusions: MSE appliance performed almost parallel expansion in the axial view. Remarkably, this study shows that pterygopalatine suture can be split by MSE appliance without the surgical intervention; the disarticulation of pterygopalatine suture was visible in most of the patients. [ABSTRACT FROM AUTHOR]

This study used finite element (FE) analysis to investigate the stability of miniscrews (screws) placed at the median palate. FE models with variable suture maturity and screw-suture distances were used to examine the relationship with screw stability. Four groups were classified by extent of maturation of the midpalatal suture (0%, 60%, 75%, and 100%). The placement position was set at the center of the suture (0.0 mm), or 0.5, 1.0, and 1.5 mm to the side of the suture, and von Mises stress values in bone and screw displacement were compared among models. The stress value for the unsutured model, in which the screw was placed at the center of the suture, was greater than 30 MPa. Stress values for models in which screws were placed to the side (0.5-1.5 mm) were less than 28 MPa. Maximum screw displacement was greater in the 0.0-mm incomplete suture model than at other placement positions. Because bone conditions vary among patients, placement position and suture maturation should be examined on cone beam-computed tomography images, to ensure screw stability. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate midpalatal bone density (BD) by using cone-beam computed tomography (CBCT) according to gender, age, and vertical and horizontal skeletal patterns. CBCT images from 126 subjects (64 females and 62 males) were reoriented and analyzed in order to attain BD values at the midpalatal suture. Four age groups were used for classification (adolescence, 10 ≤ early < 14 years, 14 ≤ middle ≤ 17 years, and 17 < late ≤ 21 years; adult > 21 years). Vertical skeletal pattern categories were differentiated by the Frankfort horizontal line to mandibular plane angle (hypodivergent < 22°, 22° ≤ normovergent ≤ 28°, and 28° < hyperdivergent). Horizontal skeletal pattern differentiation was defined by ANB angle (Class III < 0°, 0° ≤ Class I ≤ 4°, and 4° < Class II). Females showed significantly higher BD than males (p < 0.001). As age increased, BD increased significantly (p < 0.001). There were no significant differences between vertical skeletal patterns. Class II showed significantly less BD than Class III (p < 0.05). With this information, clinicians can better understand BD trends of the midpalatal suture and, thus, better understand our patient’s anatomy and potential hurdles in successful treatment.

Abstract Background Mini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture. Methods Fifteen subjects (mean age of 17.2 years; range, 13.9–26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher’s exact test was used. Results Regarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P

To evaluate the effects of the Indium Gallium Arsenide Phosphoride (InGaAsP) diode laser at different energy levels on orthopedically expanded midpalatal sutures of rats. Eighty Wistar rats were randomly divided into four groups: a control group and low-, moderate-, and high-level laser groups with amounts of energy irradiated at 0 J, 18 J, 42 J, and 60 J, respectively. Each group was divided into two subgroups (n = 10) according to the schedule of sacrifice (7 and 21 days). Laser application (940 ± 10 nm, 0.1 W) was completed twice weekly until sacrifice. The number of osteoblasts (OB), osteocytes (OC), and vessels (V); area of connective tissue (CT); inflammation (IN); and newly formed bone (NB); as well as the ratio of newly formed bone to the total bone area (N/T) were evaluated statistically at a significance level of P <.05. For the low-level laser group, OB, NB, and N/T were significantly higher, and CT was lower, on both the 7th and 21st days. The amount of OC was significantly higher in the low-level laser group compared with the control group on the 7th day and the control and high-level laser groups on the 21st day. The IN was significantly higher for the high-level group on the 21st day compared with other groups. Both the moderate-level and high-level laser groups possessed fewer vessels than the low-level laser group on the 21st day. The InGaAsP laser at the low dosage induced a favorable effect on bone formation in the orthopedically expanded midpalatal suture of rats. [ABSTRACT FROM AUTHOR]

Introduction: The evaluation of skeletal age is an important factor in orthodontic planning to anticipate changes in growth, with the analysis of hand and wrist radiographs showing the degree of bone and facial growth potential. The objective was to evaluate the relationship between skeletal maturation of the hand and wrist and ossification of the midpalatal suture (MPS) in adolescents ., Materials and Methods: A search was carried out in four databases such as Pubmed, Scopus, Science Direct and Embase were reviewed until December 13, 2022. The included studies were descriptive and comparative articles on the skeletal maturation of the hand and wrist and ossification of the midpalatal suture of patients aged 7 to 18 years. Two researchers carefully selected the articles evaluated and analyzed the different key topics related to the topic., Results: Four articles were included in this study; According to the studies, it was found that the greater the degree of bone maturation there is an increase in the approximation of the SMP, especially in late stages, with high and positive correlations; Furthermore, there were greater evaluation results with the Fishman analysis method as opposed to the Hagg and Taranger and Björk methods. The critical limit stages in SMI7-9, a greater approach to the closure of SMP compatible with stage D-E was found. The completion of maturation in women occurs up to 2 years earlier than in men., Conclusions: Diagnostic evaluation methods using carpal analysis can be used for predictive evaluations of the maturation stage of SMP; However, the results were not absolute in all cases so they cannot be generalized., Competing Interests: Conflictos de intereses: Ninguno