Facial Growth Patterns and Midpalatal Suture Maturation in Adults: A Retrospective CBCT-Based Observational Study

To investigate whether facial growth pattern is associated with the maturation stage of the midpalatal suture (MPS) in adults using cone-beam computed tomography (CBCT).

This retrospective study reviewed 300 full-skull CBCT scans acquired between January 2018 and May 2023, of which 120 met the eligibility criteria. Individuals aged 18 years or older were classified according to facial growth pattern (brachyfacial, mesofacial or dolichofacial) using Ricketts' VERT index. Age was categorised into < 30 and ≥ 30 years based on clinical evidence suggesting increased frequency of sutural fusion after the third decade of life. Exclusion criteria included craniofacial anomalies, syndromic conditions, systemic or hormonal disorders affecting skeletal growth, impacted teeth, previous maxillary surgery, trauma and inadequate image quality. MPS maturation was assessed using Angelieri's five-stage classification (A-E). Two calibrated examiners independently evaluated all cephalometric and tomographic records. Ordinal multinomial logistic regression was applied to analyse associations between facial growth pattern, age, sex and MPS maturation stage.

Facial growth pattern was significantly associated with MPS maturation stage (χ² = 20.65, p < 0.001), with dolichofacial individuals more frequently presenting earlier maturation stages (B or C). Age (p = 0.297) and sex (p = 0.870) were not significantly associated with MPS maturation in this adult sample. Reliability analysis demonstrated excellent intra- and inter-examiner agreement (ICC = 0.95; κ = 0.98).

Facial growth pattern was associated with MPS maturation stage in adults and may function as an adjunctive diagnostic parameter. Dolichofacial individuals more frequently exhibited earlier stages of sutural maturation, whereas age and sex showed no significant association. Although facial pattern analysis should not replace CBCT evaluation, it may contribute to a more individualised, anatomy-based diagnostic assessment. These findings should be interpreted cautiously due to the cross-sectional design and specific population studied.