33- Is the Midpalatal Suture Ready for Expansion
Show notes
Discover how orthodontists can pinpoint the perfect timing for rapid maxillary expansion using a CBCT-based classification system. This method evaluates mid-palatal suture maturation, allowing for:
- Stages A & B: Ideal for conventional rapid expansion, mostly skeletal change.
- Stage C: Borderline phase, window for expansion closing.
- Stages D & E: Advanced fusion, requiring surgical intervention or skeletal anchorage.
This new approach surpasses age as a predictor, providing a tailored diagnostic tool for maxillary deficiency treatment.
…………………….
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Show transcript
00:00:00: Did you know that expanding the maxilla too early or too late can completely change your treatment results?
00:00:08: Hello everyone!
00:00:10: Today we're looking at how orthodontists can determine perfect timing for rapid maxillary expansion.
00:00:17: This episode explores a new classification method, for evaluating mid-palatal suture maturation helping clinicians make more precise patient specific decisions.
00:00:30: When I talk to colleagues about rapid maxillary expansion, one question always comes up when is it still feasible to expand non-surgically?
00:00:39: We've all seen that age alone as a poor predictor.
00:00:43: Some seventeen year olds expand beautifully while others show almost no skeletal response at all.
00:00:51: A few years ago Fernanda Arheliere and her team offered the decisive step forward In their twenty-thirteen paper in the American Journal of Orthodontics and Dentifacial Orthopedics, they proposed a CBCT based classification for evaluating the midpalatal suture before expansion.
00:01:08: Their logic was simple but brilliant.
00:01:10: if we can visualize this suture in three dimensions We actually see whether it's open partially ossified or completely fused And plan accordingly.
00:01:22: The study included one hundred and forty subjects between about six-and fifty eight years of age, so a very broad spectrum.
00:01:31: All cone beam scans were standardized And the authors defined five maturation stages labeled A through E. In stage A this suture appears as straight high density line almost pristine with no interdigitation.
00:01:45: In stage B it starts to scallop showing those first small interlocking shapes.
00:01:53: Stage C marks the transition two scalloped parallel lines with low density areas between them, small bony islands forming along the gap.
00:02:02: then comes stage D where fusion has occurred in the palatine bone posteriorly while the anterior part of this suture remains visible.
00:02:12: And finally, stage E – complete fusion through the maxilla.
00:02:16: No visible switch at all!
00:02:17: The reproducibility of this method was excellent with kappa values around zero point eight to zero dot nine comma meaning that trained examiners could consistently classify the stages.
00:02:30: Now what did they find?
00:02:32: Stages A and B were seen almost exclusively in children under thirteen.
00:02:37: Stage C dominated from about eleven to seventeen years Fusion, the D and E stages began in girls after eleven.
00:02:45: And then boys only after fourteen.
00:02:48: among adults over half were fully fused but interestingly a small proportion still showed open sutures even beyond their twenties and thirties.
00:02:59: so age alone completely unreliable.
00:03:03: some thirteen year olds had fused sutures while others In there thirtys.
00:03:07: we're still open.
00:03:09: From a clinical standpoint, the message is clear.
00:03:12: Stages A and B go ahead with conventional rapid expansion.
00:03:16: You'll get mostly skeletal change.
00:03:19: Stage C you're at the borderline.
00:03:21: The window was closing.
00:03:23: Stages D & E fusion has advanced posteriorly or completely Meaning that conventional RME will likely fail And cause tipping pain Or periodontal damage.
00:03:35: In those cases, surgically assisted expansion or skeletal anchorage systems become the more rational choice.
00:03:44: I find the elegance of this classification in its practicality.
00:03:48: with a simple CBCT we can now make a truly individualized decision avoiding both unnecessary surgery and the frustration over failed expansion attempt.
00:03:58: Of course This was across sectional study.
00:04:01: It didn't test treatment outcomes directly but it provided a reproducible anatomical framework that we've been missing for decades.
00:04:12: Since then, this method has become foundational to individualized diagnosis in transverse maxillary
00:04:19: deficiency.".
00:04:20: It reminds us that orthodontic decisions should follow biology not birth dates!
00:04:25: Thanks for watching.
00:04:26: I'm Dr.
00:04:27: Martin Baxman.
00:04:28: Let's bring science back.
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