Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study

Muskan Chanduka; Shweta Nagesh; Lalitha Ch; Balaram Kolasani; Ravindranath Dhulipalla; Ramanarayana Boyapati

doi:10.15311/selcukdentj.1736080

Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study

Abstract

Background: Rapid maxillary expansion (RME) is used for correcting transverse discrepancies by splitting the mid-palatal suture (MPS), but the amount of skeletal expansion varies with MPS maturation and qualitative staging systems are subjective. The primary aim of this study is to quantify the FD values across MPS stages in a South Indian cohort and to correlate FD with MPS, cervical vertebral maturation stages (CVM) stages and age. Methods: This observational study analysed 50 CBCT scans of patients aged between 8–20 years. A standardized region of interest (ROI) along the MPS was processed in ImageJ software via the box-counting method for assessment of the FD. MPS stages A–E and CVM stages 1–6 was assessed. Statistical analyses included one-way ANOVA with Scheffé post hoc tests, Spearman’s correlation, ROC curve analysis, Intra-class correlation co-efficient (ICC) for FD reliability, and weighted κ for staging reproducibility. Results: FD correlated strongly with MPS stage (r= –0.966), CVM stage (r= –0.928), and age (r= –0.883; all p < 0.001). ROC analysis yielded an AUC of 0.997. The FD value cut-off of 1.03 achieved 75% sensitivity and 100% specificity for distinguishing early (A–C) versus late (D–E) maturation of the MPS. Intra- and inter-rater ICCs for FD were 0.78 and 0.71, respectively; weighted κ values for MPS and CVM staging ranged from 0.73 to 0.82. Conclusion: Fractal analysis provided a quantitative, reproducible measure of MPS maturation. An FD threshold of 1.03 reliably differentiates early (A-C) and late (D-E) MPS stages and correlates with CVM stage and chronological age, offering a valuable adjunct to conventional qualitative assessments for optimizing RME timing. Key Words: Cone beam computed tomography, Fractal analysis, Maxilla, Palatal expansion, Orthodontics.

Keywords

Supporting Institution

Saveetha Dental College and Hospitals

Ethical Statement

The present study commenced following approval from the institutional review board (SRB/SDC/ORTHO-2306/24/430).

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Details

Primary Language

English

Subjects

Orthodontics and Dentofacial Orthopaedics

Journal Section

Research Article

Authors

Muskan Chanduka
0009-0004-5217-7294
India

Shweta Nagesh ^*
0000-0002-1921-1604
India

Lalitha Ch
0000-0002-0609-7590
India

Balaram Kolasani
0009-0009-2025-4773
United States

Ravindranath Dhulipalla
0000-0003-4103-455X
India

Ramanarayana Boyapati
0000-0002-9196-0183
India

Publication Date

April 27, 2026

Submission Date

July 8, 2025

Acceptance Date

October 16, 2025

Published in Issue

Year 2026 Volume: 13 Number: 1

DOI

https://doi.org/10.15311/selcukdentj.1736080

IZ

https://izlik.org/JA57UR94AG

Cite

RIS / Bibtex

APA

Chanduka, M., Nagesh, S., Ch, L., Kolasani, B., Dhulipalla, R., & Boyapati, R. (2026). Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study. Selcuk Dental Journal, 13(1), 134-138. https://doi.org/10.15311/selcukdentj.1736080

AMA

1.Chanduka M, Nagesh S, Ch L, Kolasani B, Dhulipalla R, Boyapati R. Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study. Selcuk Dent J. 2026;13(1):134-138. doi:10.15311/selcukdentj.1736080

Chicago

Chanduka, Muskan, Shweta Nagesh, Lalitha Ch, Balaram Kolasani, Ravindranath Dhulipalla, and Ramanarayana Boyapati. 2026. “Fractal Dimension As a Tool for Mid-Palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study”. Selcuk Dental Journal 13 (1): 134-38. https://doi.org/10.15311/selcukdentj.1736080.

EndNote

Chanduka M, Nagesh S, Ch L, Kolasani B, Dhulipalla R, Boyapati R (April 1, 2026) Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study. Selcuk Dental Journal 13 1 134–138.

IEEE

[1]M. Chanduka, S. Nagesh, L. Ch, B. Kolasani, R. Dhulipalla, and R. Boyapati, “Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study”, Selcuk Dent J, vol. 13, no. 1, pp. 134–138, Apr. 2026, doi: 10.15311/selcukdentj.1736080.

ISNAD

Chanduka, Muskan - Nagesh, Shweta - Ch, Lalitha - Kolasani, Balaram - Dhulipalla, Ravindranath - Boyapati, Ramanarayana. “Fractal Dimension As a Tool for Mid-Palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study”. Selcuk Dental Journal 13/1 (April 1, 2026): 134-138. https://doi.org/10.15311/selcukdentj.1736080.

JAMA

1.Chanduka M, Nagesh S, Ch L, Kolasani B, Dhulipalla R, Boyapati R. Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study. Selcuk Dent J. 2026;13:134–138.

MLA

Chanduka, Muskan, et al. “Fractal Dimension As a Tool for Mid-Palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study”. Selcuk Dental Journal, vol. 13, no. 1, Apr. 2026, pp. 134-8, doi:10.15311/selcukdentj.1736080.

Vancouver

1.Muskan Chanduka, Shweta Nagesh, Lalitha Ch, Balaram Kolasani, Ravindranath Dhulipalla, Ramanarayana Boyapati. Fractal Dimension as a Tool for Mid-palatal Suture Maturation Assessment- A Cone Beam Computed Tomography Study. Selcuk Dent J. 2026 Apr. 1;13(1):134-8. doi:10.15311/selcukdentj.1736080