Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study

Yasemin Tunca; Sema Kaya

doi:10.7126/cumudj.1809697

EN TR

Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study

Abstract

Objectives: This study aimed to evaluate the relationship between the maturation stages of the midpalatal (MPS), pterygomaxillary (PMS), and circummaxillary sutures using cone-beam computed tomography (CBCT) in the Turkish population. Materials and Methods: This retrospective study included 300 individuals (150 males, 150 females; 12–17 years) with skeletal Class I and normodivergent growth patterns. CBCT scans were assessed for the maturation stages of six sutures: MPS, transpalatal (TPS), PMS, zygomaticomaxillary (ZMS), frontomaxillary (FMS), and zygomaticotemporal (ZTS). The MPS maturation was classified according to Angelieri’s five-stage system (A–E), while other sutures were recorded as open or closed. Intra-observer reliability was tested using the intraclass correlation coefficient (ICC). Statistical analyses included Chi-square, Spearman correlation, and post hoc standardized residuals (p < 0.05). Results: The maturation of the midpalatal suture (MPS) increased significantly with age (ρ = 0.93, p < 0.001). A significant sex-related difference was also observed, with females showing a higher prevalence of advanced stages (C–E) compared to males (p < 0.001). The transpalatal suture (TPS) demonstrated a significant difference between sexes (p = 0.048). A strong positive correlation was found between the MPS and the pterygomaxillary suture (PMS) (right: ρ = 0.71, p = 0.032; left: ρ = 0.68, p = 0.041), and a moderate positive relationship was noted between the MPS and the frontomaxillary suture (FMS) (p ≈ 0.06). No significant correlations were observed between the MPS and the zygomaticomaxillary or zygomaticotemporal sutures (p > 0.05). Conclusion: MPS maturation showed a linear age-related increase and a strong correlation with PMS, indicating that circummaxillary sutures mature in coordination rather than independently. Therefore, simultaneous evaluation of MPS and PMS via CBCT can provide a reliable reference for selecting between MARPE and SARME in individualized maxillary expansion planning.

Keywords

Türk Popülasyonunda Pterigomaksiller, Midpalatal ve Sirkummaksiller Sütürlerin Olgunlaşma Evreleri Arasındaki İlişkinin Değerlendirilmesi: CBCT Çalışması

Abstract

Amaç: Bu çalışmanın amacı, Türk popülasyonunda konik ışınlı bilgisayarlı tomografi (CBCT) kullanılarak midpalatal suüür (MPS), pterigomaksiller (PMS) ve çevresel maksiller sütürlerin olgunlaşma evreleri arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif çalışmaya iskeletsel Sınıf I ve normodiverjan büyüme paternine sahip 12–17 yaş arası 300 birey (150 erkek, 150 kadın) dahil edilmiştir. CBCT görüntüleri kullanılarak altı sütürün olgunlaşma durumu değerlendirilmiştir: MPS, transpalatal (TPS), PMS, zigomatikomaksiller (ZMS), frontomaksiller (FMS) ve zigomatikotemporal (ZTS) sütürler. MPS olgunlaşması Angelieri’nin beş aşamalı sınıflamasına (A–E) göre değerlendirilirken, diğer sütürler açık veya kapalı olarak kaydedilmiştir. Gözlemciler arası güvenirlik intraclass korelasyon katsayısı (ICC) ile test edilmiştir. İstatistiksel analizlerde Ki-kare testi, Spearman korelasyonu ve post hoc analiz kullanılmıştır (p < 0.05). Bulgular: Midpalatal sütür (MPS) olgunlaşması yaşla birlikte anlamlı şekilde artmıştır (ρ = 0.93, p < 0.001). Cinsiyetler arasında da anlamlı bir fark gözlenmiş olup, kadınlarda ileri evrelerin (C–E) erkeklere göre daha yüksek oranda görüldüğü saptanmıştır (p < 0.001). Transpalatal sütürde (TPS) de cinsiyetler arasında anlamlı bir fark belirlenmiştir (p = 0.048). Orta damak sütürü (MPS) ile pterigomaksiller sütür (PMS) arasında güçlü pozitif bir korelasyon bulunmuştur (sağ: ρ = 0.71, p = 0.032; sol: ρ = 0.68, p = 0.041). Ayrıca MPS ile frontomaksiller sütür (FMS) arasında orta düzeyde pozitif bir ilişki gözlenmiştir (p ≈ 0.06). Buna karşılık, MPS ile zigomatikomaksiller ve zigomatikotemporal sütürler arasında anlamlı bir ilişki saptanmamıştır (p > 0.05). Sonuçlar: Midpalatal sütürünün (MPS) olgunlaşması yaşla doğrusal bir artış göstermiş ve pterigomaksiller sütür (PMS) ile güçlü bir korelasyon sergilemiştir. Bu durum, çevresel maksiller sütürlerin birbirinden bağımsız değil, eşgüdümlü olarak olgunlaştığını göstermektedir. Bu nedenle, CBCT ile MPS ve PMS’nin eş zamanlı değerlendirilmesi, bireyselleştirilmiş maksiller genişletme planlamasında MARPE ve SARME arasında seçim yapılmasında güvenilir bir biyolojik referans sağlayabilir.

Keywords

References

1. McNamaraa JA. Maxillary transverse deficiency. Am J Orthod Dentofacial Orthop 2000;117(5):567–570.
2. Sato FRL, Mannarino FS, Asprino L, de Moraes M. Prevalence and treatment of dentofacial deformities on a multiethnic population: a retrospective study. Oral Maxillofac Surg 2014;18(2):173–179.
3. Southard TE, Marshall SD, Allareddy V, Shin K. Adult transverse diagnosis and treatment: A case-based review. Semin in Orthod 2019;25(1):69–108.
4. Jesus AS de, Oliveira CB de, Murata WH, Suzuki SS, Santos-Pinto AD. Would midpalatal suture characteristics help to predict the success rate of miniscrew-assisted rapid palatal expansion? Am J Orthod Dentofacial Orthop 2021;160(3):363–373.
5. Kaya N, Seker ED, Yücesoy T. Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study. Prog Orthod 2023;24(1):7.
6. Cho A-R, Park JH, Moon W, Chae J-M, Kang K-H. Short-term effects of microimplant-assisted rapid palatal expansion on the circummaxillary sutures in skeletally mature patients: a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2022;161(2):e187–e197.
7. Lines PA. Adult rapid maxillary expansion with corticotomy. Am J Orthod 1975;67(1):44–56.
8. Bell WH., Jacobs JD. Surgical-orthodontic correction of horizontal maxillary deficiency. J Oral Surg 1979;37(12):897–902.

9. Jeon JY, Choi S-H, Chung CJ, Lee K-J. The success and effectiveness of miniscrew-assisted rapid palatal expansion are age- and sex-dependent. Clin Oral Investig 2022;26(3):2993–3003.
10. Bonjour JP, Theintz G, Buchs B, Slosman D, Rizzoli R. Critical years and stages of puberty for spinal and femoral bone mass accumulation during adolescence. J Clin Endocrinol Metab 1991;73(3):555–563.
11. Knaup B, Yildizhan F, Wehrbein H. Age-related changes in the midpalatal suture. A histomorphometric study. J Orofac Orthop 2004;65(6):467–474.
12. Korbmacher H, Schilling A, Püschel K, Amling M, Kahl-Nieke B. Age-dependent three-dimensional microcomputed tomography analysis of the human midpalatal suture. J Orofac Orthop 2007;68(5):364–376.
13. Govaerts D, Da Costa O, Garip M, Combes F, Jacobs R, Politis C. Can surgically assisted rapid palatal expansion (SARPE) be recommended over orthodontic rapid palatal expansion (ORPE) for girls above the age of 14?: A cone-beam CT study on midpalatal suture maturation. J Orofac Orthop 2025:86;38-48.
14. Persson M, Thilander B. Palatal suture closure in man from 15 to 35 years of age. Am J Orthod 1977;72(1):42–52.
15. Ok G, Sen Yilmaz B, Aksoy DO, Kucukkeles N. Maturity evaluation of orthodontically important anatomic structures with computed tomography. Eur J Orthod 2021;43(1):8–14.
16. Jimenez-Valdivia LM., Malpartida-Carrillo V., Rodríguez-Cárdenas YA., Dias-Da Silveira HL., Arriola-Guillén LE. Midpalatal suture maturation stage assessment in adolescents and young adults using cone-beam computed tomography. Prog Orthod 2019;20:38.
17. Castro ACR de, Kim H, Cho HJ, Nojima LI, Nojima M da CG, Kim H-J, et al. Three-dimensional micromorphology of human midpalatal suture and pterygomaxillary articular complex. J World Fed Orthod 2023;12(4):141–149.
18. Li Y, Li R, Shi J, Shan Y, Chen Z. Zygomaticotemporal suture maturation evaluation in Chinese population using cone-beam computed tomography images. Korean J Orthod 2023;53(4):232–240.
19. Angelieri F, Cevidanes LHS, Franchi L, Gonçalves JR, Benavides E, McNamara JA. Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2013;144(5):759–769.
20. Macrì M., Toniato E., Murmura G., Varvara G., Festa F. Midpalatal suture density as a function of sex and growth-pattern-related variability via CBCT evaluations of 392 adolescents treated with a rapid maxillary expander appliance. Applied Sciences 2022;12(4):2221.
21. Oliveira RDS, de Oliveira CJM, Panzarella FK, Cintra Junqueira JL. Maturation stages of the sutures in the median palatine evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2021;160(4):567–572.
22. Festa F, Festa M, Medori S, Perrella G, Valentini P, Bolino G, et al. Midpalatal suture maturation in relation to age, sex, and facial skeletal growth patterns: a CBCT study. Children 2024;11(8):1013.
23. Kajan ZD, Nasab NK, Eghrari N. Quantitative evaluation of midpalatal suture opening and its relation with zygomaticomaxillary suture status in patients aged 7-25 years using cone beam computed tomography images: in an Iranian population. Contemp Clin Dent 2018;9(Suppl 1):S89–S94.
24. Tashayyodi N, Kajan ZD, Ostovarrad F, Khosravifard N, Tashayyodi N, Kajan ZD, et al. Relationship of the fusion stage of spheno-occipital synchondrosis with midpalatal and zygomaticomaxillary sutures on cone-beam computed tomography scans of patients aged between 7 and 21 years. Turk J Orthod 2023;36(3):186-193.
25. Tonello DL, Ladewig V de M, Guedes FP, Ferreira Conti AC de C, Almeida-Pedrin RR, Capelozza-Filho L. Midpalatal suture maturation in 11- to 15-year-olds: a cone-beam computed tomographic study. Am J Orthod Dentofacial Orthop 2017;152(1):42–48.
26. Ferrillo M, Daly K, Pandis N, Fleming PS. The effect of vertical skeletal proportions, skeletal maturation, and age on midpalatal suture maturation: a CBCT-based study. Prog Orthod 2024;25(1):4.
27. Xu S, Liu Y, Hou Y, Li Y, Ge X, Wang L, et al. Maxillofacial growth changes after maxillary protraction therapy in children with class III malocclusion: a dual control group retrospective study. BMC Oral Health 2024;24(1):7.
28. Betlej A, Gandhi V, Upadhyay M, Allareddy V, Tadinada A, Yadav S. Variability of the maxillary suture maturation and density in the subjects with different sex and growth status. Clin Anat 2021;34(3):357–364.

Details

Primary Language

English

Subjects

Orthodontics and Dentofacial Orthopaedics

Journal Section

Research Article

Authors

Yasemin Tunca ^*
0000-0003-4933-1380
Türkiye

Sema Kaya
0000-0002-6306-3901
Türkiye

Publication Date

July 1, 2026

Submission Date

October 23, 2025

Acceptance Date

April 5, 2026

Published in Issue

Year 2026 Volume: 29 Number: 2

DOI

https://doi.org/10.7126/cumudj.1809697

IZ

https://izlik.org/JA26PD54ZF

Cite

RIS / Bibtex

APA

Tunca, Y., & Kaya, S. (2026). Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study. Cumhuriyet Dental Journal, 29(2), 261-269. https://doi.org/10.7126/cumudj.1809697

AMA

1.Tunca Y, Kaya S. Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study. Cumhuriyet Dent J. 2026;29(2):261-269. doi:10.7126/cumudj.1809697

Chicago

Tunca, Yasemin, and Sema Kaya. 2026. “Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study”. Cumhuriyet Dental Journal 29 (2): 261-69. https://doi.org/10.7126/cumudj.1809697.

EndNote

Tunca Y, Kaya S (July 1, 2026) Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study. Cumhuriyet Dental Journal 29 2 261–269.

IEEE

[1]Y. Tunca and S. Kaya, “Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study”, Cumhuriyet Dent J, vol. 29, no. 2, pp. 261–269, July 2026, doi: 10.7126/cumudj.1809697.

ISNAD

Tunca, Yasemin - Kaya, Sema. “Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study”. Cumhuriyet Dental Journal 29/2 (July 1, 2026): 261-269. https://doi.org/10.7126/cumudj.1809697.

JAMA

1.Tunca Y, Kaya S. Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study. Cumhuriyet Dent J. 2026;29:261–269.

MLA

Tunca, Yasemin, and Sema Kaya. “Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study”. Cumhuriyet Dental Journal, vol. 29, no. 2, July 2026, pp. 261-9, doi:10.7126/cumudj.1809697.

Vancouver

1.Yasemin Tunca, Sema Kaya. Evaluation of the Relationship Between the Maturation Stages of Pterygomaxillary, Midpalatal, and Circummaxillary Sutures in the Turkish Population: A CBCT Study. Cumhuriyet Dent J. 2026 Jul. 1;29(2):261-9. doi:10.7126/cumudj.1809697