Determining the most suitable technique for maxillary expansion hinges heavily on the developmental stage of the midpalatal suture. A CBCT-based classification proposed by Angelieri et al. shifted the focus away from chronological age toward the evaluation of individual morphology. Yet questions have been raised about the diagnostic reliability of relying solely on axial CBCT sections, owing to inter-examiner inconsistency and the inherent challenge of judging intermediate stages (C and D). By revealing morphological features that a single-plane assessment might miss, the addition of standardized coronal sections to the conventional axial evaluation could heighten diagnostic fidelity—especially in uncertain cases—and this study sets out to examine that possibility. existing CBCT scans were subjected to retrospective review. Two approaches were employed to assess each midpalatal suture: the established axial-plane method outlined by Angelieri and a coronal-plane analysis performed over three standardized cuts (anterior, middle, posterior). The work prioritized measuring agreement between the two viewing planes, locating regional mismatches, and characterizing patterns of ossification, with a specific focus on intermediate maturational stages. Axial and coronal readings matched fully in 23 of the 34 examined cases, a finding that upholds the overall robustness of the axial perspective. Divergences, however, were clustered notably in stage C, which accounted for 8 of the 11 mismatched instances. In the majority of these, ossification appeared more advanced on at least one coronal section than what the axial view indicated. In addition, a small subset of cases showed an atypical anterior-to-posterior direction of ossification. Rather than disputing the broad legitimacy of Angelieri’s staging, our data point to a potential pitfall of viewing only the axial plane: it may, on occasion, underrate how far suture maturation has progressed. Bringing coronal slices into the evaluation can refine diagnostic detail during transitional phases, furnishing a clearer depiction of the suture’s three-dimensional architecture. Adopting this multimodal perspective could help temper subjective judgment and perhaps narrow the gap between different examiners’ interpretations.
