# Assessing circum-maxillary sutures maturation by CBCT: a diagnostic indicator for skeletal age and treatment timing for class III malocclusion

## TL;DR

This study shows that the maturity of certain facial sutures can help determine the right time for orthodontic treatment in adolescents with Class III malocclusion.

## Contribution

The study introduces a new diagnostic method using maxillary suture maturation stages for skeletal age assessment in Class III malocclusion treatment planning.

## Key findings

- MPSS and ZMSS maturation stages increase with age and are significantly correlated.
- CVMS, MPSS, and ZMSS are strongly correlated, with high diagnostic likelihood ratios.
- Maxillary suture maturation stages can predict treatment timing and outcomes for maxillary protraction.

## Abstract

Evaluation of skeletal age is essential in determining the timing of maxillary expansion and protraction for adolescent skeletal Class III patients. The aim of this study is to investigate the correlation among the maturation stage of cervical vertebrae (CVMS), midpalatal suture (MPSS) and zygomaticomaxillary suture (ZMSS) and evaluate the possibility of predicting the outcome of maxillary expansion and protraction using circum-maxillary suture maturation stage.

Cone beam computed tomography (CBCT) scans and lateral cephalography images of 260 adolescents were analyzed to determine the correlation among different maxillary sutures maturation stages and CVMS. Statistical analysis included the Mann–Whitney, Wilcoxon, and Fisher's exact tests. The level of significance was 5% (P = 0.05).

The distribution difference of MPSS and ZMSS is statistically significant between different age groups (P < 0.05), and two sutures maturation stages both showed a trend of increasing maturation with age. CVMS, MPSS and ZMSS were all significantly correlated (P < 0.001). Positive likelihood ratio analysis revealed strong diagnostic associations (LHR >10) between specific CVMS stages and corresponding suture maturation levels, particularly for the early and late maturation stages.

This study verified the efficacy of using the maturational stages of maxillary sutures to assess growth and development. MPSS shows a strong correlation with ZMSS and can serve as a useful reference for estimating ZMSS maturation, supporting a combined assessment approach. The maxillary suture maturational stages can serve as an index to evaluate the intervening time and outcomes of maxillary protraction with palatal expansion in juveniles.