Application of fractal analysis of the midpalatal suture for estimation of pubertal growth spurts

Abstract

Objective

To evaluate the potential clinical application of fractal analysis of midpalatal suture fusion for prediction of pubertal growth spurts.

Methods

Cone-beam computed tomography (CBCT) scans and hand-wrist radiographs were obtained for 165 subjects (81 males, 84 females; mean age 15.5 ± 7.6 years). From the CBCT image of the midpalatal suture, the region of interest was obtained according to a previously described protocol. The fractal dimension (FD) of the midpalatal suture was calculated. Spearman's correlation coefficients were estimated to investigate the associations among age, skeletal maturation index (SMI), and FD of the midpalatal suture. Receiver-operating characteristic curves were used to determine the cutoff values for identification of pubertal growth spurts.

Results

Significant correlations were observed among age, SMI, and FD of the midpalatal suture (P < 0.05). The optimal cutoff value of the FD for evaluation of a pubertal growth spurt was 0.9484 in males and 1.1205 in females. Fractal analysis of the midpalatal suture on CBCT images might be a clinically meaningful, objective, and quantitative method for evaluating pubertal growth spurts.

Conclusions

The present results suggest that fractal analysis of the midpalatal suture could be useful for decision-making on treatments involving growth modification in growing children with a skeletal discrepancy.

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