Novel methodologies and technologies to assess mid-palatal suture maturation: a systematic review
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RESEARCH
Open Access
Novel methodologies and technologies to assess mid-palatal suture maturation: a systematic review Darren Isfeld1, Manuel Lagravere2*, Vladimir Leon-Salazar3,4 and Carlos Flores-Mir5
Abstract Introduction: A reliable method to assess midpalatal suture maturation to drive clinical decision-making, towards non-surgical or surgical expansion, in adolescent and young adult patients is needed. The objectives were to systematically review and evaluate what is known regarding contemporary methodologies capable of assessing midpalatal suture maturation in humans. Methods: A computerized database search was conducted using Medline, PubMed, Embase and Scopus to search the literature up until October 5, 2016. A supplemental hand search was completed of references from retrieved articles that met the final inclusion criteria. Results: Twenty-nine abstracts met the initial inclusion criteria. Following assessment of full articles, only five met the final inclusion criteria. The number of subjects involved and quality of studies varied, ranging from an in-vitro study using autopsy material to prospective studies with in vivo human patients. Three types of evaluations were identified: quantitative, semi-quantitative and qualitative evaluations. Four of the five studies utilized computed tomography (CT), while the remaining study utilized non-invasive ultrasonography (US). No methodology was validated against a histological-based reference standard. Conclusions: Weak limited evidence exists to support the newest technologies and proposed methodologies to assess midpalatal suture maturation. Due to the lack of reference standard validation, it is advised that clinicians still use a multitude of diagnostic criteria to subjectively assess palatal suture maturation and drive clinical decision-making. Keywords: Cone-beam computed tomography, Palatal suture, Maxillary expansion
Background Rapid maxillary expansion (RME) is indicated for a number of clinical situations namely when a posterior crossbite exists (unilateral or bilateral) or limited buccal overjet in patients with constricted maxillary base [1]. Maxillary transverse deficiency may be skeletal, dental or both skeletal and dental in origin [1–3]. Expansion in the transverse dimension has not only been used to improve interdigitation of the occlusion and improved function but also to increase arch perimeter to resolve maxillary crowding [2]. Recently contemporary orthodontics * Correspondence: [email protected] 2 School of Dentistry, University of Alberta, Edmonton, 11405 - 87th avenue, Edmonton, AB T6G 1C9, Canada Full list of author information is available at the end of the article
has focused on smile esthetics with emphasis on transverse arch dimensions and minimizing buccal corridor visibility [1, 4]. Those patients with dentofacial deformity or cleft lip and palate with constricted maxillary segments are candidates for RME or possible surgical expansion [2] dependent upon the time of treatment intervention. Additionally, there has been increased
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