A comparison of hand-wrist bone and cervical vertebral analyses in measuring skeletal maturation

OBJECTIVE: To compare skeletal maturation as measured by hand-wrist bone analysis and by cervical vertebral analysis. MATERIALS AND METHODS: A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 30 patients (14 males and 16 females; 7-18 years of age) were examined. The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral analysis was assessed by the cervical vertebral maturation stage (CVMS) method. To define vertebral stages, the analysis consisted of both cephalometric (13 points) and morphologic evaluation of three cervical vertebrae (concavity of second, third, and fourth vertebrae and shape of third and fourth vertebrae). These measurements were then compared with the hand-wrist bone analysis, and the results were statistically analyzed by the Cohen kappa concordance index. The same procedure was repeated after 6 months and showed identical results. RESULTS: The Cohen kappa index obtained (mean +/- SD) was 0.783 +/- 0.098, which is in the significant range. The results show a concordance of 83.3%, considering that the estimated percentage for each case is 23.3%. The results also show a correlation of CVMS I with Bjork stages 1-3 (interval A), CVMS II with Bjork stage 4 (interval B), CVMS III with Bjork stage 5 (interval C), CVMS IV with Bjork stages 6 and 7 (interval D), and CVMS V with Bjork stages 8 and 9 (interval E). CONCLUSIONS: Vertebral analysis on a lateral cephalogram is as valid as the hand-wrist bone analysis with the advantage of reducing the radiation exposure of growing subjects.     

An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth

The present study aimed to provide a version of the Cervical Vertebral Maturation (CVM) method for the detection of the peak in mandibular growth based on the analysis of the second through fourth cervical vertebrae in a single cephalogram. The morphology of the bodies of the second (odontoid process, C2), third (C3), and fourth (C4) cervical vertebrae were analyzed in six consecutive cephalometric observations (T1 through T6) of 30 orthodontically untreated subjects. Observations for each subject consisted of two consecutive cephalograms comprising the interval of maximum mandibular growth (as assessed by means of the maximum increment in total mandibular length, Co-Gn), together with two earlier consecutive cephalograms and two later consecutive cephalograms. The analysis consisted of both visual and cephalometric appraisals of morphological characteristics of the three cervical vertebrae. The construction of the new version of the CVM method was based on the results of both ANOVA for repeated measures with post-hoc Scheffé's test (P < .05) and discriminant analysis. The new CVM method presents with five maturational stages (Cervical Vertebral Maturation Stage [CVMS] I through CVMS V, instead of Cvs 1 through Cvs 6 in the former CVM method). The peak in mandibular growth occurs between CVMS II and CVMS III, and it has not been reached without the attainment of both CVMS I and CVMS II. CVMS V is recorded at least two years after the peak. The advantages of the new version of the CVM method are that mandibular skeletal maturity can be appraised on a single cephalogram and through the analysis of only the second, third, and fourth cervical vertebrae, which usually are visible even when a protective radiation collar is worn.     

Predicting mandibular growth potential with cervical vertebral bone age.

This study assessed the possibility of using cervical vertebral bone age determined from cephalometric radiographs to predict mandibular growth potential. The subjects were 2 groups of 20 Japanese girls and young women: one group to derive a formula for predicting mandibular growth potential, the other to compare predicted values with actual values. Each group included subjects in the initial stage of the pubertal growth period and the final stage of growth in early adulthood. A formula for predicting mandibular growth potential that included cervical vertebral bone age and the actual growth of the mandible (condylion-gnathion) was determined with regression analysis. Cervical vertebral bone age, bone age on hand-wrist radiographs, and chronological age were inserted into the formula, and actual values and values predicted with these parameters of the formula for mandibular growth potential were compared. The formula found mandibular growth potential (in millimeters) = -2.76 x cervical vertebral bone age + 38.68. The average error between the value predicted by cervical vertebral bone age and the actual value (1.79 mm) was significantly less (P <.001) than that between the actual value and the value predicted by chronological age (3.48 mm) and approximately the same as that between the actual value and the value predicted by bone age (2.09 mm). The formula derived from this study might be useful for treating orthodontic patients in the growth stage.     

Visual assessment of the cervical vertebral maturation stages: A study of diagnostic accuracy and repeatability

Objective:To evaluate the diagnostic accuracy and repeatability of the visual assessment of the cervical vertebral maturation (CVM) stages.Materials and Methods:Ten operators underwent training sessions in visual assessment of CVM staging. Subsequently, they were asked to stage 72 cases equally divided into the six stages. Such assessment was repeated twice in two sessions (T1 and T2) 4 weeks apart. A reference standard for each case was created according to a cephalometric analysis of both the concavities and shapes of the cervical vertebrae.Results:The overall agreement with the reference standard was about 68% for both sessions and 76.9% for intrarater repeatability. The overall kappa coefficients with the reference standard were up to 0.86 for both sessions, and 0.88 for intrarater repeatability. Overall, disagreements one stage and twp stage apart were 23.5% (T1) and 5.1% (T2), respectively. Sensitivity ranged from 53.3% for CS5 (T1) to 99.9% for CS1 (T2), positive predictive values ranged from 52.4% for CS5 (T2) to 94.3% for CS6 (T1), and accuracy ranged from 83.6% for CS4 (T2) to 94.9% for CS1 (T1).Conclusions:Visual assessment of the CVM stages is accurate and repeatable to a satisfactory level. About one in three cases remain misclassified; disagreement is generally limited to one stage and is mostly seen in stages 4 and 5.     

颈椎骨龄与牙龄推断上海地区儿童年龄的准确性比较

目的 ：评估并比较Willems牙龄推断法和上海地区特异性颈椎骨龄回归公式2种方法在推测上海地区儿童实足年龄上的适用性及准确性。方法：选取符合纳入标准的上海地区8～15岁儿童的全景片和头颅侧位片640张（男160名,女160名,全景片和头颅侧位片各320张）,分别运用Willems法和颈椎骨龄回归公式评估得到牙龄和颈椎骨龄。采用SPSS 25.0软件包中的配对t检验或Wilcoxon符号秩检验,评估实足年龄与推断年龄之间的差异;通过比较2种方法的标准差、平均绝对误差、可接受误差内的正确判断率,对2种方法的准确性进行评价。结果：相比实足年龄,男性牙龄平均低估（0.75±1.03）岁,女性平均低估（1.05±1.18）岁;男性颈椎骨龄平均低估（0.78±1.40）岁,女性平均低估（0.53±1.31）岁。Willems牙龄推断法的总平均绝对误差为1.15岁,上海地区颈椎骨龄回归公式的总平均绝对误差为1.20岁。临床可接受误差在±0.5岁内的正确判断率Willems法和颈椎骨龄回归公式分别为26.25%和27.19%。结论：相比上海地区特异性颈椎骨龄回归公式,Willems法在推断上海地区8...     

颈椎成熟法评估下颌骨骨龄的研究进展

早期功能矫治及矫形治疗是改善下颌骨发育差异的重要手段,因而通过骨龄评估下颌骨生长高峰期,以此确定矫治开始时间具有重要意义.颈椎成熟(CVM)法是根据颈椎在不同生长发育阶段形状、大小有规律性的改变来预测下颌骨生长发育时期的方法.在正畸常规检查的头颅侧位片中,颈椎形态清晰可见,采用CVM法评估骨龄方便实用,相较于手腕骨法不...     

颈椎骨龄系统预测青春期女性下颌骨生长发育的研究

目的：以颈椎骨龄为标准,建立适合本地区青春期女性下颌骨生长发育的百分位数曲线图,并对下颌骨生长发育进行预测。方法：选择10.0-17.9岁288名健康女性的数字化头颅侧位定位X线片,依据颈椎C3、C4椎体的测量指标由计算机得出颈椎骨龄值（CBAYK）,按骨龄进行分组,采用百分位数法进行统计学分析,绘制出随CBAYK变化的下颌骨长度、下颌支高度、下颌体长度的生长发育百分位数曲线图,探讨本地区女性下颌骨在10.0～17.9岁整个青春期的生长发育特点。结果：青春期女性下颌骨的生长发育从10.0岁已经开始进入加速期,增长速度达最大的时间在11～12岁,15岁以后生长速度明显减缓。其中下颌骨长度增长最多（10.0～17.9岁增长20.98cm）。结论：以颈椎骨龄为标准的青春期女性下颌骨生长发育百分位数曲线图是一种对下颌骨生长进行预测的合理、可靠的方法。     

Predicting the mandibular growth spurt:: The roles of chronological age,sex, and the cervical vertebral maturation method

ObjectivesTo develop a prediction model that combined information derived from chronological age, sex, and the cervical vertebral maturation (CVM) method to predict the pubertal spurt in mandibular growth.Materials and MethodsA total of 50 subjects (29 females, 21 males) were selected from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection, the University of Michigan Growth Study, and the Denver Child Growth study. A total of 456 lateral cephalograms were analyzed, and a multilevel logistic model was applied. The outcome variable was the presence or absence of the mandibular pubertal growth peak. The predictive variables were chronological age up to the third order, sex, presence or absence of CS 3 interactions between age and sex, age and CS 3, sex and CS 3.ResultsThe mean age ± standard deviation (SD) at the first cephalogram was 8.2 ± 0.5 years, whereas the mean age at the last cephalogram was 16.5 ± 1.1 years. The mean interval ± SD between two consecutive cephalograms was 1.0 ± 0.1 years. The mean age ± SD at the lateral cephalogram obtained immediately before the mandibular pubertal growth peak was 12.1 ± 1.1 years for females and 13.2 ± 0.8 years for males. The greatest increase in mandibular length occurred after CS 3 in 78% of the subjects. The presence of CS 3, age, second-order age, sex, and the interaction between age and sex were all statistically significant predictors of the mandibular pubertal growth spurt.ConclusionsCS 3, chronological age, and sex can be used jointly to predict the pubertal peak in mandibular growth.     

Correlation between chronological age, cervical vertebral maturation and Fishman's skeletal maturity indicators in southern Chinese

OBJECTIVE: To investigate the correlation between chronological age, cervical vertebral maturation (CVM), and Fishman's hand-wrist skeletal maturity indicators in southern Chinese. MATERIALS AND METHODS: Four hundred contemporary hand-wrist and lateral cephalometric radiographs of southern Chinese subjects were randomly selected and analyzed. The female subjects were between 10 and 15 years of age, and the male subjects were between 12 and 17 years of age; all subjects were within the circumpubertal period. The CVM was assessed using the method developed by Baccetti and coworkers, but the hand-wrist maturation was assessed using the method developed by Fishman. These two methods and the chronological age were correlated using the Spearman rank correlation analysis. RESULTS: The CVM was significantly correlated with the hand-wrist skeletal age (Spearman r male = 0.9206, female = 0.9363). All patients in the cervical maturation stage (CS3) of CVM were discovered to be in the skeletal maturational indicator (SMI2 or SMI3) stages of hand-wrist maturation (HWM), which was around the peak of the growth spurt. Low correlations were found between the CVM and chronological age (male r = 0.7577; female r = 0.7877) and between the HWM and chronological age (male r = 0.7492; female r = 0.7758). CONCLUSIONS: CVM is a valid indicator of skeletal growth during the circumpubertal and has a high correlation with the HWM for the southern Chinese population. However, the low correlations found between the chronological age and both CVM and HWM showed that the chronological age was not suitable to measure skeletal maturity.     

腕骨骨龄与颈椎骨龄相关性的研究

目的研究腕骨骨龄与颈椎骨龄的相关性.方法随机抽取177名8～29岁临床正畸患者,同期拍摄左手腕骨片和头颅侧位片,分别进行腕骨骨龄与颈椎骨龄的评定,然后进行相关分析.结果腕骨骨龄与颈椎骨龄具有高度相关性,相互转化的回归方程为:Y=35.052 3.549X(Y:腕骨骨龄,X:颈椎骨龄).结论本研究完善了腕骨骨龄和颈椎骨龄的评定方法,实现了两种骨龄的相互转换,为进一步研究提供基础.     

青春发育期颈椎骨龄计算方法的探讨

目的探讨一种可客观、准确地计算青春发育期中国男女个体颈椎骨龄的方法。方法选择处于青春发育期的男女各90例,依据两川弘道的骨龄计算法计算腕骨骨龄,测量头颅侧位片上第三、四颈椎椎体各项测量项目。采用多元逐步回归分析得出颈椎骨龄计算方程。结果回归方程Y=-20·189+24·666X1+46·468X2+39·854X3(r=0·901)。Y为颈椎骨龄,X1为AH4/AP4,X2为AH3/AP3,X3为AH4/H4。方程的决定系数是0·81。各回归系数的均值和标准差如下:截距项=-20·19±4·89(t=-4·13,P<0·01),AH4/AP4=24·67±8·32(t=2·97,P<0·01),AH3/AP3=46·47±6·60(t=7·04,P<0·01),AH4/H4=39·85±7·04(t=5·66,P<0·01)。结论本方法计算颈椎骨龄可作为国人青春期各发育阶段的客观评估指标。