{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:50:44Z","timestamp":1792785044928,"version":"4.5.0"},"reference-count":59,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":93,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"American Association of Orthodontists Foundation","id":[{"id":"https:\/\/ror.org\/03d9g2g58","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-57709-6","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T17:26:22Z","timestamp":1783963582000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial intelligence for comprehensive skeletal maturity assessment: a unified CBCT-based deep learning framework"],"prefix":"10.1038","volume":"16","author":[{"given":"Amanda","family":"Nikho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Mills","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid Halimi","family":"Milani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marouane","family":"Tliba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veerasathpurush","family":"Allareddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet Enis","family":"Cetin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed H.","family":"Elnagar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"5","key":"57709_CR1","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1007\/s11832-010-0289-z","volume":"4","author":"RP Calfee","year":"2010","unstructured":"Calfee, R. P., Sutter, M., Steffen, J. A. & Goldfarb, C. A. Skeletal and chronological ages in American adolescents: current findings in skeletal maturation. J. Children\u2019s Orthop. 4(5), 467\u2013470. https:\/\/doi.org\/10.1007\/s11832-010-0289-z (2010).","journal-title":"J. Children\u2019s Orthop."},{"issue":"Suppl 1","key":"57709_CR2","doi-asserted-by":"publisher","first-page":"S63","DOI":"10.4103\/2230-8210","volume":"18","author":"V De Sanctis","year":"2014","unstructured":"De Sanctis, V. et al. Hand x-ray in pediatric endocrinology: Skeletal age assessment and beyond. Indian J. Endocrinol. Metabol. 18(Suppl 1), S63\u2013S71. https:\/\/doi.org\/10.4103\/2230-8210 (2014).","journal-title":"Indian J. Endocrinol. Metabol."},{"issue":"Suppl. 2","key":"57709_CR3","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1159\/000058096","volume":"57","author":"J Karlberg","year":"2002","unstructured":"Karlberg, J. Secular trends in pubertal development. Horm. Res. 57(Suppl. 2), 19\u201330. https:\/\/doi.org\/10.1159\/000058096 (2002).","journal-title":"Horm. Res."},{"issue":"2","key":"57709_CR4","first-page":"88","volume":"52","author":"LS Fishman","year":"1982","unstructured":"Fishman, L. S. Radiographic evaluation of skeletal maturation: a clinically oriented method based on hand-wrist films. Angle Orthod. 52(2), 88\u2013112 (1982).","journal-title":"Angle Orthod."},{"key":"57709_CR5","unstructured":"Lamparski, D. G. Skeletal Age Assessment Utilizing Cervical Vertebrae. PhD thesis, University of Pittsburgh (1972). https:\/\/books.google.com\/books?id=3orOtgAACAAJ"},{"issue":"1","key":"57709_CR6","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/S0889-5406(95)70157-5","volume":"107","author":"B Hassel","year":"1995","unstructured":"Hassel, B. & Farman, A. G. Skeletal maturation evaluation using cervical vertebrae. Am. J. Orthod. Dentofac. Orthop. 107(1), 58\u201366. https:\/\/doi.org\/10.1016\/S0889-5406(95)70157-5 (1995).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"issue":"3","key":"57709_CR7","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1067\/mod.2000.107009","volume":"118","author":"L Franchi","year":"2000","unstructured":"Franchi, L., Baccetti, T. & McNamara, J. A. Mandibular growth as related to cervical vertebral matu-ration and body height. Am. J. Orthod. Dentofac. Orthop. 118(3), 335\u2013340. https:\/\/doi.org\/10.1067\/mod.2000.107009 (2000).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"issue":"6","key":"57709_CR8","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1016\/j.oooo.2011.11.018","volume":"113","author":"V Joshi","year":"2012","unstructured":"Joshi, V. et al. Skeletal maturity assessment with the use of cone-beam computerized tomography. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 113(6), 841\u2013849. https:\/\/doi.org\/10.1016\/j.oooo.2011.11.018 (2012).","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"issue":"2","key":"57709_CR9","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.ortho.2020.01.001","volume":"18","author":"G Echevarria-Sanchez","year":"2020","unstructured":"Echevarria-Sanchez, G. et al. Reliability of cephalograms derived of cone beam computed tomography versus lateral cephalograms to estimate cervical vertebrae maturity in a Peruvian population: A retrospective study. Int. Orthod. 18(2), 258\u2013265. https:\/\/doi.org\/10.1016\/j.ortho.2020.01.001 (2020).","journal-title":"Int. Orthod."},{"issue":"2","key":"57709_CR10","doi-asserted-by":"publisher","first-page":"139","DOI":"10.5005\/jp-journals-10015-1705","volume":"11","author":"M Vyshyambath","year":"2020","unstructured":"Vyshyambath, M., Rao, R. N. & Hurkadle, J. A comparison of accuracy of skeletal maturity indicators using cone-beam computed tomography, lateral cephalogram, and hand-wrist radiograph in circumpubertal dravidian population. World J. Dentistry. 11(2), 139\u2013145. https:\/\/doi.org\/10.5005\/jp-journals-10015-1705 (2020).","journal-title":"World J. Dentistry"},{"issue":"3","key":"57709_CR11","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1111\/j.1556-4029.2011.01705.x","volume":"56","author":"R Natalie","year":"2011","unstructured":"Natalie, R., Shirley, Richard, L. & Jantz Spheno-occipital synchondrosis fusion in modern americans. J. Forensic Sci. 56(3), 580\u2013585. https:\/\/doi.org\/10.1111\/j.1556-4029.2011.01705.x (2011).","journal-title":"J. Forensic Sci."},{"issue":"1","key":"57709_CR12","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1002\/ar.1091470104","volume":"147","author":"TV Powell","year":"1963","unstructured":"Powell, T. V. & Brodie, A. G. Closure of the spheno-occipital synchondrosis. Anat. Rec. 147(1), 15\u201323. https:\/\/doi.org\/10.1002\/ar.1091470104 (1963).","journal-title":"Anat. Rec."},{"issue":"2","key":"57709_CR13","doi-asserted-by":"publisher","first-page":"72","DOI":"10.4103\/0975-1475.119764","volume":"5","author":"K Krishan","year":"2013","unstructured":"Krishan, K. & Kanchan, T. Evaluation of spheno-occipital synchondrosis: A review of literature and considerations from forensic anthropologic point of view. J. Forensic Dent. Sci. 5(2), 72\u201376. https:\/\/doi.org\/10.4103\/0975-1475.119764 (2013).","journal-title":"J. Forensic Dent. Sci."},{"issue":"1","key":"57709_CR14","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1002\/ajpa.22687","volume":"157","author":"N Lottering","year":"2015","unstructured":"Lottering, N., MacGregor, D. M., Alston, C. L. & Gregory, L. S. Ontogeny of the spheno-occipital synchondrosis in a modern Queensland, Australian population using computed tomography. Am. J. Phys. Anthropol. 157(1), 42\u201357. https:\/\/doi.org\/10.1002\/ajpa.22687 (2015).","journal-title":"Am. J. Phys. Anthropol."},{"issue":"8","key":"57709_CR15","doi-asserted-by":"publisher","first-page":"e0183305","DOI":"10.1371\/journal.pone.0183305","volume":"12","author":"A Alhazmi","year":"2017","unstructured":"Alhazmi, A. et al. Timing and rate of spheno-occipital synchondrosis closure and its relationship to puberty. PLoS One. 12(8), e0183305. https:\/\/doi.org\/10.1371\/journal.pone.0183305 (2017).","journal-title":"PLoS One"},{"issue":"3","key":"57709_CR16","doi-asserted-by":"publisher","first-page":"186","DOI":"10.4274\/TurkJOrthod.2022.2022.65","volume":"36","author":"N Tashayyodi","year":"2023","unstructured":"Tashayyodi, N., Kajan, Z. D., Ostovarrad, F. & Khosravifard, N. Relationship of the fusion stage of spheno-occipital synchondrosis with midpalatal and zygomaticomaxillary sutures on cone-beam computed tomography scans of patients aged between 7 and 21 years. Turkish J. Orthod. 36(3), 186. https:\/\/doi.org\/10.4274\/TurkJOrthod.2022.2022.65 (2023).","journal-title":"Turkish J. Orthod."},{"issue":"4","key":"57709_CR17","doi-asserted-by":"publisher","first-page":"538","DOI":"10.2319\/062920-596.1","volume":"91","author":"A Alhazmi","year":"2021","unstructured":"Alhazmi, A. et al. Correlation of spheno-occipital synchondrosis fusion stages with a hand-wrist skeletal maturity index: a cone beam computed tomography study. Angle Orthod. 91(4), 538\u2013543. https:\/\/doi.org\/10.2319\/062920-596.1 (2021).","journal-title":"Angle Orthod."},{"issue":"8","key":"57709_CR18","doi-asserted-by":"publisher","first-page":"e0161104","DOI":"10.1371\/journal.pone.0161104","volume":"11","author":"MJ Fernandez-Perez","year":"2016","unstructured":"Fernandez-Perez, M. J. et al. Spheno-occipital synchondrosis fusion correlates with cervical vertebrae maturation. PLoS One. 11(8), e0161104  (2016).","journal-title":"PLoS One"},{"issue":"6","key":"57709_CR19","doi-asserted-by":"publisher","first-page":"641","DOI":"10.2319\/041224-295.1","volume":"94","author":"E Booth","year":"2024","unstructured":"Booth, E. et al. Correlations of spheno-occipital synchondrosis, cervical vertebrae, midpalatal suture, and third molar maturation stages. Angle Orthod. 94(6), 641\u2013647  (2024).","journal-title":"Angle Orthod."},{"issue":"11","key":"57709_CR20","doi-asserted-by":"publisher","first-page":"2774","DOI":"10.3390\/diagnostics12112774","volume":"12","author":"A Shayani","year":"2022","unstructured":"Shayani, A., Vidal, P. S., Carrasco, I. G. & Gerlach, M. M. Midpalatal suture maturation method for the assessment of maturation before maxillary expansion: A systematic review. Diagnostics 12(11), 2774. https:\/\/doi.org\/10.3390\/diagnostics12112774 (2022).","journal-title":"Diagnostics"},{"issue":"1","key":"57709_CR21","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.coms.2019.08.003","volume":"32","author":"JP Jones","year":"2020","unstructured":"Jones, J. P., Elnagar, M. H. & Perez, D. E. Temporary skeletal anchorage techniques. Oral Maxillofacial Surg. Clin. 32(1), 27\u201337. https:\/\/doi.org\/10.1016\/j.coms.2019.08.003 (2020).","journal-title":"Oral Maxillofacial Surg. Clin."},{"issue":"1","key":"57709_CR22","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/0889-5406(87)90202-2","volume":"91","author":"SE Bishara","year":"1987","unstructured":"Bishara, S. E. Staley. Maxillary expansion: Clinical implications. Am. J. Orthod. Dentofac. Orthop. 91(1), 3\u201314. https:\/\/doi.org\/10.1016\/0889-5406(87)90202-2 (1987).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"issue":"1","key":"57709_CR23","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/0002-9416(77)90123-3","volume":"72","author":"M Persson","year":"1977","unstructured":"Persson, M. & Thilander, B. Palatal suture closure in man from 15 to 35 years of age. Am. J. Orthod. 72(1), 42\u201352. https:\/\/doi.org\/10.1016\/0002-9416(77)90123-3 (1977).","journal-title":"Am. J. Orthod."},{"issue":"1","key":"57709_CR24","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/0002-9416(75)90158-X","volume":"68","author":"B Melsen","year":"1975","unstructured":"Melsen, B. Palatal growth studied on human autopsy material: a histologic microradiographic study. Am. J. Orthod. 68(1), 42\u201354. https:\/\/doi.org\/10.1016\/0002-9416(75)90158-X (1975).","journal-title":"Am. J. Orthod."},{"issue":"5","key":"57709_CR25","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1007\/s00056-007-0729-7","volume":"68","author":"H Korbmacher","year":"2007","unstructured":"Korbmacher, H., Schilling, A., P\u00fcshel, K. & Amling, M. Kahl-Nieke. Age-dependent three-dimensional microcomputed tomography analysis of the human midpalatal suture. J. Orofac. Orthop. 68(5), 364\u2013376. https:\/\/doi.org\/10.1007\/s00056-007-0729-7 (2007).","journal-title":"J. Orofac. Orthop."},{"issue":"3","key":"57709_CR26","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/S0889-5406(94)70123-7","volume":"105","author":"B Revelo","year":"1994","unstructured":"Revelo, B. & Fishman, L. S. Maturational evaluation of ossification of the midpalatal suture. Am. J. Orthod. Dentofac. Orthop. 105(3), 288\u2013292. https:\/\/doi.org\/10.1016\/S0889-5406(94)70123-7 (1994).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"issue":"6","key":"57709_CR27","doi-asserted-by":"publisher","first-page":"345","DOI":"10.4041\/kjod.2016.46.6.345","volume":"46","author":"HI Jang","year":"2016","unstructured":"Jang, H. I. et al. Relationship between maturation indices and morphology of the midpalatal suture obtained using cone-beam computed tomography images. Korean J. Orthod. 46(6), 345\u2013355. https:\/\/doi.org\/10.4041\/kjod.2016.46.6.345 (2016).","journal-title":"Korean J. Orthod."},{"key":"57709_CR28","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1186\/s40001-024-02058-1","volume":"29","author":"Y Hezenci","year":"2024","unstructured":"Hezenci, Y. & Bulut, M. Correlation of skeletal development and midpalatal suture maturation. Eur. J. Med. Res. 29, 461. https:\/\/doi.org\/10.1186\/s40001-024-02058-1 (2024).","journal-title":"Eur. J. Med. Res."},{"key":"57709_CR29","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.ejwf.2020.05.004","volume":"9","author":"A Mahdian","year":"2020","unstructured":"Mahdian, A., Safi, Y., Dalaie, K., Kavousinejad, S. & Behnaz, M. Correlation assessment of cervical vertebrae maturation stage and mid-palatal suture maturation in an iranian population. J. World Federation Orthodontists. 9, 112\u2013116. https:\/\/doi.org\/10.1016\/j.ejwf.2020.05.004 (2020).","journal-title":"J. World Federation Orthodontists"},{"issue":"2","key":"57709_CR30","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.ajodo.2011.04.013","volume":"140","author":"TS Nestman","year":"2011","unstructured":"Nestman, T. S., Marshall, S. D., Qian, F., Holton, N. & Franciscus, R. G. Southard. Cervical vertebrae maturation method morphologic criteria: Poor reproducibility. Am. J. Orthod. Dentofac. Orthop. 140(2), 182\u2013188. https:\/\/doi.org\/10.1016\/j.ajodo.2011.04.013 (2011).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"issue":"2","key":"57709_CR31","doi-asserted-by":"publisher","first-page":"229","DOI":"10.2319\/051511-333.1","volume":"82","author":"XG Zhao","year":"2012","unstructured":"Zhao, X. G., Lin, J., Jiang, J. H., Wang, Q. & Ng, S. H. Validity and reliability of a method for assessment of cervical vertebral maturation. Angle Orthod. 82(2), 229\u2013234. https:\/\/doi.org\/10.2319\/051511-333.1 (2012).","journal-title":"Angle Orthod."},{"issue":"7","key":"57709_CR32","doi-asserted-by":"publisher","first-page":"316","DOI":"10.3390\/bioengineering9070316","volume":"9","author":"L Gao","year":"2022","unstructured":"Gao, L., Chen, Z., Zang, L., Sun, Z. & Wang, Q. Yu. Midpalatal suture cbct image quantitative characteristics analysis based on machine learning algorithm construction and optimization. Bioengineering 9(7), 316. https:\/\/doi.org\/10.3390\/bioengineering9070316 (2022).","journal-title":"Bioengineering"},{"issue":"1","key":"57709_CR33","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1186\/s12903-024-04163-3","volume":"24","author":"S Chhatwani","year":"2024","unstructured":"Chhatwani, S. et al. Performance of dental students, orthodontic residents, and orthodontists for classification of midpalatal suture maturation stages on cone-beam computed tomography scans: a preliminary study. BMC Oral Health. 24(1), 373. https:\/\/doi.org\/10.1186\/s12903-024-04163-3 (2024).","journal-title":"BMC Oral Health"},{"issue":"4","key":"57709_CR34","doi-asserted-by":"publisher","first-page":"570","DOI":"10.3348\/kjr.2017.18.4.570","volume":"18","author":"J-G Lee","year":"2017","unstructured":"Lee, J-G. et al. Deep learning in medical imaging: general overview. Korean J. Radiol. 18(4), 570\u2013584. https:\/\/doi.org\/10.3348\/kjr.2017.18.4.570 (2017).","journal-title":"Korean J. Radiol."},{"key":"57709_CR35","doi-asserted-by":"publisher","first-page":"128","DOI":"10.25259\/APOS_73_2024","volume":"15","author":"N Ameli","year":"2024","unstructured":"Ameli, N., Lagravere, M. O. & Lai, H. Deep learning models to classify skeletal growth phase on 3d radiographs. APOS Trends Orthod. 15, 128\u2013133. https:\/\/doi.org\/10.25259\/APOS_73_2024 (2024).","journal-title":"APOS Trends Orthod."},{"issue":"2","key":"57709_CR36","doi-asserted-by":"publisher","first-page":"187","DOI":"10.3724\/zdxbyxb-2021-0131","volume":"50","author":"X Feng","year":"2021","unstructured":"Feng, X., Lu, S., Li, Y. & Lin, J. Establishment of an intelligent cervical vertebrae maturity assessment system based on cone beam ct data. J. Zhejiang Univ. (Medical Sciences). 50(2), 187\u2013194. https:\/\/doi.org\/10.3724\/zdxbyxb-2021-0131 (2021).","journal-title":"J. Zhejiang Univ. (Medical Sciences)"},{"key":"57709_CR37","doi-asserted-by":"publisher","first-page":"104808","DOI":"10.1016\/j.jdent.2023","volume":"141","author":"M Zhu","year":"2024","unstructured":"Zhu, M. et al. Convolutional neural network-assisted diagnosis of midpalatal suture maturation stage in cone-beam computed tomography. J. Dent. 141, 104808. https:\/\/doi.org\/10.1016\/j.jdent.2023 (2024).","journal-title":"J. Dent."},{"key":"57709_CR38","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1111\/ocr.70018","volume":"28","author":"OH Milani","year":"2025","unstructured":"Milani, O. H. et al. Elnagar. An artificial intelligence system for staging the spheno-occipital synchondrosis. Orthod. Craniofac. Res. 28, 998\u20131007. https:\/\/doi.org\/10.1111\/ocr.70018 (2025).","journal-title":"Orthod. Craniofac. Res."},{"key":"57709_CR39","doi-asserted-by":"publisher","unstructured":"Milani, O. H. et al. Automated staging of spheno-occipital synchondrosis fusion via landmark-guided knowledge distillation. In Proceedings of the 33rd European Signal Processing Conference (EUSIPCO 2025), Isola delle Femmine, Palermo, Italy, Conference presentation (2025). https:\/\/doi.org\/10.23919\/EUSIPCO63237.2025.11226660","DOI":"10.23919\/EUSIPCO63237.2025.11226660"},{"key":"57709_CR40","doi-asserted-by":"publisher","unstructured":"Milani, O. H. et al. Knowledge distillation approach for SOS fusion staging: Towards fully automated skeletal maturity assessment. arXiv preprint arXiv:2505 21561. https:\/\/doi.org\/10.48550\/arXiv.2505.21561 (2025).","DOI":"10.48550\/arXiv.2505.21561"},{"issue":"1","key":"57709_CR41","doi-asserted-by":"publisher","first-page":"18783","DOI":"10.1038\/s41598-025-03778-y","volume":"15","author":"OH Milani","year":"2025","unstructured":"Milani, O. H. et al. Automated classification of midpalatal su-ture maturation stages from cbcts using an end-to-end deep learning framework. Sci. Rep. 15(1), 18783. https:\/\/doi.org\/10.1038\/s41598-025-03778-y (2025).","journal-title":"Sci. Rep."},{"issue":"3","key":"57709_CR42","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1053\/j.sodo.2005.04.005","volume":"11","author":"T Baccetti","year":"2005","unstructured":"Baccetti, T., Franchi, L. & McNamara, J. A. The cervical vertebral maturation (cvm) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin. Orthod. 11(3), 119\u2013129. https:\/\/doi.org\/10.1053\/j.sodo.2005.04.005 (2005).","journal-title":"Semin. Orthod."},{"issue":"1\u20133","key":"57709_CR43","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.forsciint.2010.04.009","volume":"200","author":"RB Bassed","year":"2010","unstructured":"Bassed, R. B., Briggs, C. & Drummer, O. H. Analysis of time of closure of the spheno-occipital synchondrosis using computed tomography. Forensic Sci. Int. 200(1\u20133), 161\u2013164. https:\/\/doi.org\/10.1016\/j.forsciint.2010.04.009 (2010).","journal-title":"Forensic Sci. Int."},{"issue":"06","key":"57709_CR44","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1590\/2177-6709.21.6.115-125.sar","volume":"21","author":"F Angelieri","year":"2016","unstructured":"Angelieri, F. et al. Prediction of rapid maxillary expansion by assessing the maturation of the midpalatal suture on cone beam ct. Dent. Press. J. Orthod. 21(06), 115\u2013125  (2016).","journal-title":"Dent. Press. J. Orthod."},{"key":"57709_CR45","doi-asserted-by":"publisher","unstructured":"Liu, Z. et al. A convnet for the 2020s. In Proceedings of the IEEE\/CVF Conference on Computer Vision and Pattern Recognition (CVPR) 11976\u201311986  (2022). https:\/\/doi.org\/10.1109\/CVPR52688.2022.01167","DOI":"10.1109\/CVPR52688.2022.01167"},{"key":"57709_CR46","doi-asserted-by":"crossref","unstructured":"He, K., Zhang, X., Ren, S. & Sun, J. Deep residual learning for image recognition. In Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 770\u2013778  (2016).","DOI":"10.1109\/CVPR.2016.90"},{"key":"57709_CR47","unstructured":"Vaswani, A. et al.  Attention is all you need. CoRR, abs\/1706.03762, (2017). http:\/\/arxiv.org\/abs\/1706.03762"},{"key":"57709_CR48","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1016\/j.procs.2022.01.135","volume":"199","author":"P Jiang","year":"2022","unstructured":"Jiang, P., Ergu, D., Liu, F., Cai, Y. & Ma, B. A review of yolo algorithm developments. Procedia Comput. Sci. 199, 1066\u20131073. https:\/\/doi.org\/10.1016\/j.procs.2022.01.135 (2022).","journal-title":"Procedia Comput. Sci."},{"key":"57709_CR49","doi-asserted-by":"publisher","unstructured":"Selvaraju, R. R. et al. Grad-cam: Visual explanations from deep networks via gradient-based localization. In Proceedings of the IEEE international conference on computer vision 618\u2013626  (2017). https:\/\/doi.org\/10.1109\/ICCV.2017.74","DOI":"10.1109\/ICCV.2017.74"},{"key":"57709_CR50","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s10462-025-11198-7","volume":"58","author":"DM Juan Terven","year":"2025","unstructured":"Juan Terven, D. M. et al. A comprehensive survey of loss functions and metrics in deep learning. Artif. Intell. Rev. 58, 195. https:\/\/doi.org\/10.1007\/s10462-025-11198-7 (2025).","journal-title":"Artif. Intell. Rev."},{"key":"57709_CR51","doi-asserted-by":"publisher","first-page":"e2245","DOI":"10.7717\/peerj-cs.2245","volume":"10","author":"M Sivakumar","year":"2024","unstructured":"Sivakumar, M., Parthasarathy, S. & Padmapriya, T. Trade-off between training and testing ratio in machine learning for medical image processing. PeerJ Comput. Sci. 10, e2245. https:\/\/doi.org\/10.7717\/peerj-cs.2245 (2024).","journal-title":"PeerJ Comput. Sci."},{"issue":"6","key":"57709_CR52","doi-asserted-by":"publisher","first-page":"925","DOI":"10.3233\/BMR-210003","volume":"34","author":"M Ferrillo","year":"2021","unstructured":"Ferrillo, M. et al. Reliability of cervical vertebral maturation compared to hand-wrist for skeletal maturation assessment in growing subjects: A systematic review. J. Back Musculoskelet. Rehabil. 34(6), 925\u2013936. https:\/\/doi.org\/10.3233\/BMR-210003 (2021).","journal-title":"J. Back Musculoskelet. Rehabil."},{"issue":"3","key":"57709_CR53","doi-asserted-by":"publisher","first-page":"100874","DOI":"10.1016\/j.ortho.2024.100874","volume":"22","author":"U Hussain","year":"2024","unstructured":"Hussain, U. et al. Inter-observer and intra-observer agreement of cervical vertebral maturation staging: A systematic review and meta-analysis. Int. Orthod. 22(3), 100874. https:\/\/doi.org\/10.1016\/j.ortho.2024.100874 (2024).","journal-title":"Int. Orthod."},{"issue":"3","key":"57709_CR54","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1097\/PRS.0000000000000419","volume":"134","author":"JA Goldstein","year":"2014","unstructured":"Goldstein, J. A. et al. Earlier evidence of spheno-occipital synchondrosis fusion correlates with severity of midface hypoplasia in patients with syndromic craniosynostosis. Plast. Reconstr. Surg. 134(3), 504\u2013510. https:\/\/doi.org\/10.1097\/PRS.0000000000000419 (2014).","journal-title":"Plast. Reconstr. Surg."},{"issue":"6","key":"57709_CR55","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1016\/j.joms.2013.11.015","volume":"72","author":"Y Tahiri","year":"2014","unstructured":"Tahiri, Y., Paliga, J. T., Vossough, A., Bartlett, S. P. & Taylor, J. A. The spheno-occipital synchondrosis fuses prematurely in patients with Crouzon syndrome and midface hypoplasia compared with age- and gender-matched controls. J. Oral Maxillofac. Surg. 72(6), 1173\u20131179. https:\/\/doi.org\/10.1016\/j.joms.2013.11.015 (2014).","journal-title":"J. Oral Maxillofac. Surg."},{"issue":"6","key":"57709_CR56","doi-asserted-by":"publisher","first-page":"822","DOI":"10.2319\/013021-86.1","volume":"91","author":"R Leonardi","year":"2021","unstructured":"Leonardi, R. et al. Three-dimensional assessment of the spheno-occipital synchondrosis and clivus after tooth-borne and bone-borne rapid maxillary expansion: a retrospective cbct study using voxel-based superimposition. Angle Orthod. 91(6), 822\u2013829. https:\/\/doi.org\/10.2319\/013021-86.1 (2021).","journal-title":"Angle Orthod."},{"key":"57709_CR57","unstructured":"Proffit, W. R., Fields, H., Larson, B. & Sarver, D. M. Contemporary Orthodontics. (2018)."},{"issue":"6","key":"57709_CR58","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1016\/j.ajodo.2006.02.021","volume":"129","author":"DG Garib","year":"2006","unstructured":"Garib, D. G. et al. Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed tomography evaluation. Am. J. Orthod. Dentofac. Orthop. 129(6), 749\u2013758. https:\/\/doi.org\/10.1016\/j.ajodo.2006.02.021 (2006).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"issue":"3","key":"57709_CR59","doi-asserted-by":"publisher","first-page":"488","DOI":"10.2319\/060411-367.1","volume":"82","author":"A Baysal","year":"2012","unstructured":"Baysal, A. et al. Evaluation of root resorption following rapid maxillary expansion using cone-beam computed tomography. Angle Orthod. 82(3), 488\u2013494. https:\/\/doi.org\/10.2319\/060411-367.1 (2012).","journal-title":"Angle Orthod."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57709-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57709-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57709-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:28:50Z","timestamp":1791980930000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57709-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":59,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["57709"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-57709-6","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"assertion":[{"value":"31 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"32166"}}