Maturation of the palatine median suture: A literature review

The maturation of the midpalate suture (MPS) is a progressive process that evolves from a fibrous joint to complete bone fusion, which directly influences orthodontic planning for maxillary transverse expansion. The purpose of this review was to analyze the biological mechanisms, diagnostic methods, and clinical applicability associated with MPS in order to optimize therapeutic choices according to the stage of maturation. Histological characteristics, structural changes, and advances in imaging techniques such as cone beam computed tomography (CBCT) were reviewed, which have allowed classifications such as Angeli Eri’s to be established, useful for guiding the selection between conventional orthopedic expansion, micro-screw-assisted (MARPE), or surgically assisted (SARPE). Sutural maturation is highly variable and does not depend exclusively on chronological age, but also on genetic, biomechanical, and functional factors. In addition, an inadequate diagnosis can lead to undesirable side effects such as pain, gingival recession, root resorption, or limitations in treatment stability. In conclusion, correct assessment of the degree of sutural maturation is essential for personalizing the orthodontic approach, minimizing risks, and ensuring the long-term stability of the results obtained.