Association of the mid-palatal suture morphology to the age and to its density: A CBCT retrospective comparative observational study

Objective: The twofold aim of the present investigation was to: 1. evaluate the degree of mid-palatal suture (MPS) maturation via CBCT in relation to patient age, and 2. to determine whether there was a correlation between quantitative (i.e., suture density) and qualitative (i.e., suture morphology) analysis. Materials and methods: The stage of mid-palatal suture maturation and suture density ratio were assessed for 160 subjects on CBCTs using five qualitative stages proposed by Angelieri with the addition of three additional stages (i.e., B/C, C/D and D/E) and quantitative grey density scores of Grünheid MPS1,2,3,4 with the addition of parasutural bone and soft palate. The repeatability of both methods was evaluated using Cohen's K.The relationship between midpalatal suture maturation and age was assessed using ANOVA and Classification and Regression Trees (CART) analysis and tabulation and a χ2 test for quantitative and qualitative analysis respectively. Statistical significance was assessed using a 5% threshold. Results: The final sample included 160 CBCTs (80 male,80 female; mean age 23.2 ± 13.5). Both methods were found to be correlated and highly repeatable. In addiction they showed an age-related correlation in MPS morphology. Conclusion: The mid-palatal suture density ratio and the stage of mid-palatal suture maturation has the potential to become useful in clinical practice. In fact, despite the correlation between MPS maturation stage and age, the latter parameter cannot be used as a clinical discriminator due to the great variability between subjects. It is therefore advisable to assess each patient individually on CBCT scans in order to determine treatment choices.