Automated classification of midpalatal suture maturation using 2D convolutional neural networks on CBCT scans.

Introduction: Accurate assessment of midpalatal suture (MPS) maturation is critical in orthodontics, particularly for planning treatment strategies in patients with maxillary transverse deficiency (MTD). Although cone-beam computed tomography (CBCT) provides detailed imaging suitable for MPS classification, manual interpretation is often subjective and time-consuming. Methods: This study aimed to develop and evaluate a lightweight two-dimensional convolutional neural network (2D CNN) for the automated classification of MPS maturation stages using axial CBCT slices. A retrospective dataset of CBCT images from 111 patients was annotated based on Angelieri's classification system and grouped into three clinically relevant categories: AB (Stages A and B), C, and DE (Stages D and E). A 9-layer CNN architecture was trained and evaluated using standard classification metrics and receiver operating characteristic (ROC) curve analysis. Results: The model achieved a test accuracy of 96.49%. Class-wise F1-scores were 0.95 for category AB, 1.00 for C, and 0.95 for DE. Area under the ROC curve (AUC) scores were 0.10 for AB, 0.62 for C, and 0.98 for DE. Lower AUC values in the early and transitional stages (AB and C) likely reflect known anatomical overlap and subjectivity in expert labeling. Discussion: These findings indicate that the proposed 2D CNN demonstrates high accuracy and robustness in classifying MPS maturation stages from CBCT images. Its compact architecture and strong performance suggest it is suitable for real-time clinical decision-making, particularly in identifying cases that may benefit from surgical intervention. Moreover, its lightweight design makes it adaptable for use in resource-limited settings. Future work will explore volumetric models to further enhance diagnostic reliability and confidence.