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

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.