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Radiographic methods for evaluating skeletal maturity traditionally include the Risser sign and the hand-wrist maturation method. While the cervical vertebral maturation (CVM) stage is widely recognized in orthodontics, its application in assessing spinal growth, particularly in adolescent idiopathic scoliosis (AIS), has been less explored. This study explores the correlation between CVM, chronological age, and the Risser sign to evaluate the feasibility of CVM in assessing skeletal development in adolescents. This prospective study included AIS patients and asymptomatic adolescents, aged 7–15 years, who underwent full-spine imaging with clear visibility of the cervical and pelvic regions. The correlation between CVM and the Risser sign was analyzed. The height of the cervical C3-7 vertebral body was measured, and its growth trend with age was examined. Differences between AIS patients and asymptomatic adolescents were compared. A total of 85 AIS patients (mean age 11.44 ± 2.36 years) and 47 asymptomatic adolescents (mean age 11.48 ± 3.14 years) were included. No statistically significant differences were observed in age, Risser sign grading, CVM staging, or C3-7 vertebral body height between the 2 groups. Chronological age showed a stronger correlation with CVM stages than with the Risser sign in both the AIS group (r = 0.93 vs. r = 0.82, P < 0.01) and the asymptomatic group (r = 0.81 vs. r = 0.72, P < 0.01). The CVM stage, which shows a strong correlation with Risser sign grading, could serve as a reliable alternative for assessing skeletal maturity in adolescent subjects, particularly in clinical scenarios where minimizing radiation exposure is a priority. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of our study is to determine the relationship between MPS maturation and CVM stage determined from CBCTs. Materials and methods CBCT images of 130 individuals (75 females, 55 males) with a mean age of 15.04 ± 3.11 (9.56–25.05 years) were analyzed. Images were analyzed using the i-CAT Vision software program. The cephalometric images to be examined were also obtained from the same CBCT images with the ImageJ program. The correlation between MPS and CVM stages was evaluated using the Spearman correlation test. The relationship between the skeletal developmental stage and MPS maturation, as assessed by the CVM method, was evaluated with the positive likelihood ratio. Results Significant correlations were found between CVM and MPS maturation stages. Positive LHR values of cervical vertebral stages were obtained to define the maturation stages of the midpalatal suture. LHR values greater than ten were found between CS2, CS5, and CS6 and maturation stages B, D, and E, respectively. A 15–30% correlation was observed between CS3 and CS4 maturation stages B and C, respectively. A positive correlation of 15% was found between CS3 and stage C. Conclusion MPS fusion is more likely to occur after CS4. The correlation between the CVM and MPS maturation stages is significant (r = 0.858). CVM stages CS2, CS4, and CS6 can be a preliminary indicator for MPS stages B, D, and E, respectively. CS5 shows that MPS fusion has occurred partially or completely. Clinical relevance A significant relationship exists between skeletal developmental stages and suture maturation.

Objectives: The aim of our study is to determine the relationship between MPS maturation and CVM stage determined from CBCTs. Materials and methods: CBCT images of 130 individuals (75 females, 55 males) with a mean age of 15.04 ± 3.11 (9.56–25.05 years) were analyzed. Images were analyzed using the i-CAT Vision software program. The cephalometric images to be examined were also obtained from the same CBCT images with the ImageJ program. The correlation between MPS and CVM stages was evaluated using the Spearman correlation test. The relationship between the skeletal developmental stage and MPS maturation, as assessed by the CVM method, was evaluated with the positive likelihood ratio. Results: Significant correlations were found between CVM and MPS maturation stages. Positive LHR values of cervical vertebral stages were obtained to define the maturation stages of the midpalatal suture. LHR values greater than ten were found between CS2, CS5, and CS6 and maturation stages B, D, and E, respectively. A 15–30% correlation was observed between CS3 and CS4 maturation stages B and C, respectively. A positive correlation of 15% was found between CS3 and stage C. Conclusion: MPS fusion is more likely to occur after CS4. The correlation between the CVM and MPS maturation stages is significant (r = 0.858). CVM stages CS2, CS4, and CS6 can be a preliminary indicator for MPS stages B, D, and E, respectively. CS5 shows that MPS fusion has occurred partially or completely. Clinical relevance: A significant relationship exists between skeletal developmental stages and suture maturation. [ABSTRACT FROM AUTHOR]

Copyright of Revista ADM is the property of Asociacion Dental Mexicana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background The aim of this study was to evaluate an objective method for Cervical Vertebral Maturation (CVM) staging. Methods An initial sample of 647 Lateral Cephalometric Radiographs (LCR) were staged according to the CVM (Baccetti et al.) by 4 examiners. The final sample (n = 394) included LCR on which the staging of the 4 investigators matched. The objective staging was performed by a single operator. The sample was divided according to the maturational stages into pre-pubertal, pubertal and post-pubertal groups. Measurements were performed on the cervical vertebrae (C2, C3 and C4). The angle between posterior and superior borders for C3 and C4 was the Superior Wall Inclination Angle (SWIA). Concavity Depth (CD) for C2, C3 and C4, and Body Shape (BS) (ratio of width to height of C3 and C4). Measurements of the 3 groups were compared. Results Reliability of subjective staging was high (intra-observer reliability, 0.948; inter-observer reliability, 0.967). Good agreement was observed for the outcomes measured. Intra-observer reliability was good (0.918, 0.885 and 0.722 for CD, BS and SWIA, respectively). The same was for the inter-observer reliability results (0.902, 0.889 and 0.728 for CD, BS and SWIA, respectively). Significant differences were observed for mean values of SWIA and BS and median values of CD within maturational stage. Similar findings were observed when the outcomes were compared at different phases (P

Abstract Background To investigate whether fractal dimension (FD) measurements from hand-wrist radiographs and lateral cephalometric radiographs are correlated with each other and with skeletal maturation stages. Methods In this retrospective study conducted on hand-wrist and lateral cephalometric radiographs obtained from patients between 2017 and 2023, hand-wrist maturation stages (HWMS) and cervical vertebral maturation stages (CVMS) of 144 subjects (6 to 17 years of age) were assessed radiographically. The participants were divided into nine groups (n = 16 each) based on HWMS. Fractal analysis was performed on the radiographs of the radius, the middle finger phalanges (proximal, medial and distal), and the cervical vertebral bodies (C2, C3, C4). Mean and standard deviation values, Spearman’s and Pearson correlation analyses, one-way ANOVA, Kruskal-Wallis H tests and Mann-Whitney-U test were used to evaluate the data. Results Positive correlations were found between the FD values of the radius and HWMS or CVMS (r = .559, P = .001, r = .528 P = .001 respectively). The FD values of the radius were positively correlated with those of all cervical vertebrae (C2, C3, C4), proximal and medial phalanges as well as age. FD values measured from the proximal phalanx, medial phalanx and radius showed significant differences among both HWMS and CVMS (P

Background: To investigate whether fractal dimension (FD) measurements from hand-wrist radiographs and lateral cephalometric radiographs are correlated with each other and with skeletal maturation stages. Methods: In this retrospective study conducted on hand-wrist and lateral cephalometric radiographs obtained from patients between 2017 and 2023, hand-wrist maturation stages (HWMS) and cervical vertebral maturation stages (CVMS) of 144 subjects (6 to 17 years of age) were assessed radiographically. The participants were divided into nine groups (n = 16 each) based on HWMS. Fractal analysis was performed on the radiographs of the radius, the middle finger phalanges (proximal, medial and distal), and the cervical vertebral bodies (C2, C3, C4). Mean and standard deviation values, Spearman's and Pearson correlation analyses, one-way ANOVA, Kruskal-Wallis H tests and Mann-Whitney-U test were used to evaluate the data. Results: Positive correlations were found between the FD values of the radius and HWMS or CVMS (r =.559, P =.001, r =.528 P =.001 respectively). The FD values of the radius were positively correlated with those of all cervical vertebrae (C2, C3, C4), proximal and medial phalanges as well as age. FD values measured from the proximal phalanx, medial phalanx and radius showed significant differences among both HWMS and CVMS (P <.05). HWMS was strongly correlated with CVMS (r =.929, P =.001). Age was strongly correlated with HWMS (r =.795, P =.001) and CVMS (r =.756, P =.001). There was a significant difference in terms of age distribution among HWMS and CVMS (P <.05). Conclusions: FD measurements on hand-wrist radiographs can provide useful information for the assessment of skeletal maturation stage. Especially, FD measurements from the radius are important and more reliable to predict skeletal maturation stage. [ABSTRACT FROM AUTHOR]

Objective: To determine the correlation between circumpubertal dental maturation phase using mandibular canine and skeletal maturation phase for correct prediction of specific maturation phase in adults. Study Design: Cross sectional study. Place and Duration of Study: Department of Dentistry, Sandeman Provincial Hospital, Quetta Pakistan, from Jun to Dec 2019. Methodology: Fifty individuals with permanent mandibular canine, either gender were included. Dental maturity was measured by applying the estimation of calcification phases of the mandibular canines by using Demirjian et al., criteria. The skeletal maturity was determined by using method of maturation phase of cervical vertebra on lateral cephalograms. Results: The mean age of individuals was 12.34±6.55years. There were 11 males and 39 females. There was significantly strong correlation observed between skeletal maturity and dental maturation of mandibular third molar i.e., r=0.633 (p<0.001). Conclusion: Circumpubertal dental maturation phase is appropriate way for identification of individual specific maturation phase using mandibular canine. [ABSTRACT FROM AUTHOR]

OBJECTIVES To determine the correlation between skeletal maturity and mandibular second molar calcification. METHODOLOGY A descriptive cross-sectional study was conducted at the Saidu College of Dentistry from 15th January to 30th October 2022. One hundred participants of Pakistani descent, aged 8-16 years (both genders), with ANB greater than 50 and presence of all permanent teeth excluding 3rd molars, were included. Medically compromised, syndromic patients, those who had undergone previous orthodontic treatment, and cases with extracted permanent teeth were excluded. Skeletal maturity was determined by analyzing the cervical vertebrae maturation index (CVMI) on lateral cephalogram according to Baccetti et al. and mandibular second molar calcification according to the Demijian Index from panoramic radiographs. The Spearman correlation test was run for correlation assessment. RESULTS The mean age was 11.81±1.62 years. There were 49 (49%) males and 51 (51%) females. A perfect correlation (100%) was found between CVM stage I and dental stage C. The concordance between CVM stage II and dental stage D was found in 21 (91.30%). The correlation between tooth mineralization and CVM stages was very high and statistically significant (r=0.97, p

Abstract Background To examine the influence of mouth breathing on maxillofacial and airway development in children and adolescents with different cervical vertebral maturation stages. Methods Lateral cephalometric radiograph of a total of 120 children and adolescents, 64 girls and 56 boys (7–15 years old), diagnosed with mouth breathing were examined. Maxillofacial hard tissue, soft tissue and airway measurements were obtained using both manual and digital techniques. Independent samples t-test was performed to compare the difference between the measured indexes and the standard values. Results As for maxillofacial hard tissue, SNB (CS1–CS5), GoGn (CS1–CS5), ArGoNa (CS1–CS5), ArGo (CS1–CS2) and SNA (CS1–CS2) in mouth breathing children and adolescents were below the standard values (P

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: To examine the influence of mouth breathing on maxillofacial and airway development in children and adolescents with different cervical vertebral maturation stages. Methods: Lateral cephalometric radiograph of a total of 120 children and adolescents, 64 girls and 56 boys (7–15 years old), diagnosed with mouth breathing were examined. Maxillofacial hard tissue, soft tissue and airway measurements were obtained using both manual and digital techniques. Independent samples t-test was performed to compare the difference between the measured indexes and the standard values. Results: As for maxillofacial hard tissue, SNB (CS1–CS5), GoGn (CS1–CS5), ArGoNa (CS1–CS5), ArGo (CS1–CS2) and SNA (CS1–CS2) in mouth breathing children and adolescents were below the standard values (P < 0.05). NGoMe (CS1–CS5), SN-MP (CS1–CS4), SN-PP (CS1–CS4), PP-MP (CS1–CS3) and SN-GoGn (CS1–CS2) in mouth breathing children and adolescents were above the standard values (P < 0.05). As for maxillofacial soft tissue measurements, H angle (CS1–CS5), lower lip length (CS1–CS5), upper lip protrusion (CS1–CS5), upper lip length (CS1–CS4), lower lip protrusion (CS1–CS3), surface Angle (CS2–CS3) and nasolabial angle (CS2) in mouth breathing children and adolescents were above the standard values with statistically significance (P < 0.05). As for airway measurements, PAS (CS1, CS2, CS5) in mouth breathing children and adolescents was above the standard value with statistical significance (P < 0.05). Conclusions: Mouth breathing had a real effect on maxillofacial and airway development, which differed among mouth breathing children and adolescents with different cervical vertebral maturation. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study was conducted to investigate the relationship between dental development and cervical vertebral maturation stages in a group of Yemeni children and adolescents. Materials and Methods: The study included digital panoramic radiographs and lateral skull cephalograms obtained from 207 Yemeni subjects—122 females and 85 males aged between 8 to 18 years. Dental maturity was evaluated according to the method of Demirijian et al.,6 calcification stages of the left mandibular canines, first and second premolars and second molars were assessed. Skeletal maturity was assessed by the cervical vertebral maturation (CVM) stages according to the method of Baccetti et al.10. Correlation between CVM and dental maturation was evaluated by Spearman rank-order correlation coefficient (SROCC). Results: CVM and dental calcification stages were highly correlated (p

Introduction: The accurate assessment of active growth is pivotal for the correction of skeletal malocclusion in growing patients. Cervical vertebral maturation (CVM) staging is easy and devoid of unnecessary radiation, but its inter- and intra-observer agreement is still debatable., Objective: This study aims to assess inter-observer (reliability) and intra-observer agreement (reproducibility) for CVM staging., Methods: A comprehensive literature search across five databases up to October 2023 was conducted. Inclusion criteria comprised observational studies that specifically reported intra-rater, inter-rater, or both agreements as their primary objectives for cervical vertebral maturation (CVM) staging. Studies with a sample size exceeding 15 participants were considered for inclusion. After duplicate study selection, data extraction, and risk-of-bias assessment, random-effects meta-analyses of kappa (k)/correlation coefficient (r) and their 95% confidence intervals (CIs) were performed, followed by meta-regressions, sensitivity analyses, and subgroup analyses., Results: Seventeen observational studies (comprising 1437 lateral cephalograms and 110 assessors) were included. The reliability (8 studies; k=0.62 [95% CI: 0.44, 0.78]) and reproducibility (9 studies; k=0.708 [95% CI: 0.59, 0.82]) were substantial. The inter-observer correlation was almost perfect (in 9 studies; r=0.86 [95% CI: 0.82, 0.89]) while intra-observer correlation was substantial (in 2 studies; r=0.75 [95% CI: 0.62, 0.84]). Tracing of lateral cephalograms significantly increased inter-observer reliability (β=0.29 [0.57, 0.0031]) but cropping and time of assessment (initial vs. follow-up) had no significant impact. The reliability (P<0.001) and reproducibility (P=0.049) of high-quality studies were superior to those observed in low-quality studies., Conclusion: Assessment of the CVM staging is accurate and reproducible to a satisfactory level. The accuracy and reproducibility of CVM are higher in studies utilizing traced cephalograms and those with a low-risk of bias., Registration: PROSPERO registration (CRD42023468521). Data is openly available at https://doi.org/10.5281/zenodo.10599129., (Copyright © 2024 CEO. All rights reserved.)

Aim: The study was governed by two main goals: 1) To assess the skeletal maturation of young patients who were undergoing orthodontic treatment with rapid maxillary expansion; 2) To compare their chronological age with their skeletal maturation stage. Material and methods: Lateral cephalometric radiographs of 74 patients were randomly selected and analyzed. The sample included 51 girls and 23 boys in late mixed and permanent dentition, with an average age of 13.2 (± 2.24) in the range from 9 to 17 years. The assessment of skeletal maturation followed the cervical vertebral maturation (CVM) methods of Baccetti et al. and Lamparski. Results: The results showed 53% consistency and 47% discrepancy between the chronological and skeletal age of the patients. In the age group 9-13.5 years, the discrepancies reached 73.5%. The difference in percentages was statistically significant, p

The assessment of an individual's development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the chronological age in different bone development stages. The retrospective study was conducted based on lateral cephalometric radiographs belonging to patients with ages between 6 and 15.9 years, from Romania. For the assessment of skeletal maturity, the Cervical Vertebral Maturation (CVM) method was used. In total, 356 radiographs were selected, but after applying the exclusion criteria, 252 radiographs remained in the study (178 girls and 74 boys). Different mean chronological age values were obtained for the general sample, as well as for the two genders. The chronological age started to be significantly different at the CS4 stage. Patients with CS4, CS5, and CS6 stages had a significantly higher chronological age compared to patients with CS1, CS2, and CS3 stages. It was noted that patients with CS1 and CS2 stages were more frequently boys, while patients with the CS5 stage were more frequently girls. [ABSTRACT FROM AUTHOR]

Background: Cervical vertebral maturation (CVM) is widely used to evaluate growth potential in the field of orthodontics. This study is aimed to develop an artificial intelligence (AI) system to automatically determine the CVM status and evaluate the AI performance. Methods: A total of 1080 cephalometric radiographs, with the age of patients ranging from 6 to 22 years old, were included in the dataset (980 in training dataset and 100 in testing dataset). Two reference points and thirteen anatomical points were labelled and the cervical vertebral maturation staging (CS) was assessed by human examiners as gold standard. A convolutional neural network (CNN) model was built to train on 980 images and to test on 100 images. Statistical analysis was conducted to detect labelling differences between AI and human examiners, AI performance was also evaluated. Results: The mean labelling error between human examiners was 0.48 ± 0.12 mm. The mean labelling error between AI and human examiners was 0.36 ± 0.09 mm. In general, the agreement between AI results and the gold standard was good, with the intraclass correlation coefficient (ICC) value being up to 98%. Moreover, the accuracy of CVM staging was 71%. In terms of F1 score, CS6 stage (85%) ranked the highest accuracy. Conclusions: In this study, AI showed a good agreement with human examiners, being a useful and reliable tool in assessing the cervical vertebral maturation.

Neural networks for classification of cervical vertebrae maturation: a systematic review. Mathew R, Palatinus S, Padala S, Alshehri A, Awadh W, Bhandi S, Thomas J, Patil S. Angle Orthod. 2022 Nov 1;92(6):796-804. No financial support was reported. Systematic review. [ABSTRACT FROM AUTHOR]

Introduction: Radiographs are effective tools in assessing the stages of bone maturation in dentistry. The cervical vertebral maturation method is a proven effective tool in assessing the adolescent growth spurt than hand-wrist radiographs in an individual. Assessment of dental calcification stages are a reliable method for determining dental maturity. Panoramic imaging can be used as the primary imaging modality for assessing maturity if a correlation can be found out between tooth calcification stages and cervical vertebral maturation stages. This study was conducted to determine the correlation between dental maturity stage and cervical vertebral maturity stage and to estimate predictor variables for cervical vertebral maturation stages (CVMS) stratified by gender in a tertiary hospital setting. Materials and Methods: A descriptive study was conducted among patients accessing orthodontic care in radiology outpatient clinic, Oral Medicine and Radiology department, Government Dental College Thiruvananthapuram for a period of 15 months. Participants were selected between the ages of 8 and 16 years. Panoramic radiographs and lateral cephalograms were used to determine dental maturity stages using Demirjian method and CVMS using Bacetti and Franchi method, respectively. Results: One hundred patients (males = 46, females = 54) were included in the study; the spearman rank order correlation revealed significant relationship. The correlation ranged from 0.61 to 0.74 for females and 0.48 to 0.51 for males. Second premolar showed highest correlation and canine the lowest for both females and males. Stage G of mandibular second premolar signifies the pubertal growth period in this study population. By ordinal regression model, G stage of second premolar was found to be a significant predictor in males and stage H followed by G and F in females for the age group of 12–14 years. Conclusion: Dental maturation stages were significantly correlated with CVMS. The development stages of mandibular second premolar had the strongest correlation with cervical vertebral maturity in both males and females. G stage of mandibular second premolar can be clinically used as a maturity indicator in the pubertal growth period. Moreover, G stage of second premolar can be used as a significant predictor for the age group of 12–14 years in both males and females.

The assessment of an individual’s development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the chronological age in different bone development stages. The retrospective study was conducted based on lateral cephalometric radiographs belonging to patients with ages between 6 and 15.9 years, from Romania. For the assessment of skeletal maturity, the Cervical Vertebral Maturation (CVM) method was used. In total, 356 radiographs were selected, but after applying the exclusion criteria, 252 radiographs remained in the study (178 girls and 74 boys). Different mean chronological age values were obtained for the general sample, as well as for the two genders. The chronological age started to be significantly different at the CS4 stage. Patients with CS4, CS5, and CS6 stages had a significantly higher chronological age compared to patients with CS1, CS2, and CS3 stages. It was noted that patients with CS1 and CS2 stages were more frequently boys, while patients with the CS5 stage were more frequently girls.

Jamal Giri,1 Basanta Kumar Shrestha,2 Rajiv Yadav,2 Tika Ram Ghimire21Department of Orthodontics, BP Koirala Institute of Health Sciences, Dharan, 2Department of Dentistry, Institute of Medicine, Kathmandu, Nepal Background: Assessment of growth status of a patient is a key component in orthodontic diagnosis and treatment planning for growing patients with skeletal discrepancy. Skeletal maturation based on hand-wrist radiograph and cervical vertebral maturation (CVM) are commonly used methods of growth assessment. Studies have shown that stages of dental calcification can also be used to assess skeletal maturation status of an individual, whereas other studies have suggested that the relationship between dental calcification and skeletal maturation should be interpreted with caution owing to racial variation. Objective: To evaluate the relationship between permanent mandibular second molar calcification stages and skeletal maturity assessed by CVM among a group of Nepalese orthodontic patients. Materials and methods: One hundred and sixty-eight digital radiographs (84 orthopantomograms and 84 lateral cephalograms) were obtained from the records of 84 patients who sought orthodontic treatment in Orthodontic and Dentofacial Orthopaedic Unit, Department of Dentistry, Institute of Medicine, Kathmandu. Two parameters were used in this study, namely, CVM stages from lateral cephalogram and Demirjian index (DI) stages from orthopantomogram. The evaluation of digital radiographs was carried out on a computer screen with a resolution of 1,280×800 pixels. The association between DI stages of permanent mandibular second molar and CVM stages was assessed. Results: A statistically significant association was found between DI and CVM stages for both male and female subjects with Pearson's contingency coefficient value of 0.751 and 0.766 for male and female subjects, respectively. Conclusion: Skeletal maturation can be reliably assessed with dental calcification stages of permanent mandibular second molar for Nepalese orthodontic patients. Keywords: cervical vertebral maturation, Demirjian index, lateral cephalogram, orthopantomogram

Introduction: The cervical vertebral maturation (CVM) method is a vital tool for assessing the biological maturation of the orthodontic patient to evaluate the amount of mandibular bone growth left. Aim: To assess and visualize the cervical vertebral morphology (bone density) of orthodontic patients of the age group 9,16,27 years. Material and Methods: Twenty four subjects with age group of 9,16,27 who were randomly selected and subjected to 3d tomographic study to estimate the biological age of the orthodontic patients by analyzing c1 c2 and c3 vertebrae. Result: The results showed that bone density of males is lesser than females in 9 and 16 years, whereas they have more bone density than females in 27 years. Conclusion: The study provides qualitative method of assessing the biological age of the patient by using images of cervical vertebrae by three dimensional approach. Hence it can be useful for orthodontic diagnosis and treatment plan.

Objective:The present study aimed to determine whether there is a correlation between chronological age, skeletal maturation, dental maturation, and ANB angle.Methods:Lateral cephalometric, panoramic, and hand–wrist radiographs of 200 orthodontic patients were used (100 males and 100 females; mean age 13.00 and 13.70 years, respectively). Skeletal maturation was determined by two different methods: cervical vertebral maturation (CVM) and the hand–wrist radiography method of Grave–Brown. Dental maturation was defined by the Demirjian Index using the mandibular canine, premolars, and second molar on the left side. The ANB angle was measured on lateral cephalometric head films. The data were analyzed by Spearman’s rank correlation analysis.Results:Correlation coefficients of the male and female subjects were 0.825 and 0.802 between chronological age and hand–wrist evaluation; 0.744 and 0.778 between chronological age and CVM evaluation; 0.677 and 0.443 between chronological age and mandibular canine development; 0.722 and 0.458 between chronological age and mandibular first premolar development; 0.730 and 0.517 between chronological age and mandibular second premolar development; 0.701 and 0.531 between chronological age and mandibular second molar development; and −0.183 and −0.045 between chronological age and ANB, respectively. All the correlations mentioned above were statistically significant (p

Aims: This audit aimed to determine the common timing of treatment with twin block appliance, the success rate within the first 6 months of treatment and possible reasons of failure of twin block appliances treatment at a government orthodontic clinic in Kuala Lumpur. Methods: Class II division 1 patients treated with twin block appliances from the year 2014 to 2016 were assessed. The treatment was deemed successful if the overjet had reduced by at least 50% within the first 6 months of treatment. If the overjet had not reduced by 10% within 6 months of treatment, patients were classed as noncompliant. Inter-operator reliability for assessing the cervical vertebral maturation (CVM) was confirmed using intra-class correlation coefficient (ICC). Two standards were set, which included 100% of cases should start at CVM stage 3 or 4 and 100% of twin block functional appliance treatment should be successful. Results: Fourty-five samples were included. Majority of the patients had their treatment started at CVM 4 (51.1%), followed by CVM 3 (26.7%) and CVM 5 (15.6%). One patient had treatment started early at CVM 2. Two patients' CVM could not be determined as the cervical spine was cut off from the radiographic films. Of all patients included, 28 (62.2%) were successful and 16 (35.6%) were non-compliant. Among the 29 compliant subjects, one who was not successful had broken lower appliance. Among the non-compliant patients, seven (43.8%) had broken lower appliances and three (18.8%) did not attend the follow-up appointments. The mean pre-treatment overjet was 10.25mm (SD2.21) and post-treatment overjet was 3.13mm (SD 1.73). The mean differences of 7.13mm (SD 2.17) were statistically significant (p<0.001; 95%CI =6.28-7.97). Conclusion: Twin block appliances treatment were effective to reduce the overjet. Nonetheless, the standards set were not met. There is a need to address the problems relating to poor compliance such as improve laboratory work quality or offer alternative treatments. [ABSTRACT FROM AUTHOR]

Aims The present study was designed to evaluate the efficacy of using the developmental stages of the canines and third molars to predict the timing of skeletal maturity in the Saudi population. Material and methods The lateral cephalometric radiographs and orthopantograms of 239 Saudi patients, 106 males and 133 females, aged 9 to 21 years, were collected from several dental centers. Orthopantograms were used to assess the developmental stages of the upper and lower canine teeth and third molars using two popular methods: that of Nolla and that of Demirjian. Cervical vertebral maturation (CVM) stage was assessed on the lateral cephalometric images according to the method of Baccetti et al. Trained observers with no knowledge of patient age or gender performed assessments. Data were analyzed with Spearman’s rank correlation coefficient at a significance level of P  ≤ .05. Result Skeletal CVM stages III and IV had a stronger correlation with mandibular left canine developmental stage than with maxillary canine developmental stage in the two methods used (correlation with Nolla stage 10 and Demirjian stage H: root completely formed with apex closed), especially for male patients (r = 0.700, P  < .001). In contrast, the maxillary third molars at Nolla stages 5 and 7 (crown completed to 1/3 of the root formed) showed an association with CVM stages III and IV (r = 0.540 for females and r = 0.639 for males, P  ≤ .001 for both ) and with Demirjian stages D, E, and F. Males had slightly higher correlation values than females (r = 0.578 and 0.5010, respectively; P  ≤ .001) at CVM stages III and IV. Interestingly, canine teeth showed a stronger correlation than third molars with skeletal maturation in Saudi children. Conclusion Dental developmental stages were highly correlated with CVM stages III and IV among Saudi subjects. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to correlate the growth phase of skeletal tissues with the calcification stages of mandibular canine. Materials and Methods: It was a cross-sectional observational study. Anonymized digital orthopantomogram and lateral cephalogram records of 300 pretreatment orthodontic patients aged 8–15 years were collected and analyzed. The calcification stages of right mandibular canine were scored on panoramic radiographs in accordance to the Gleiser and Hunt modified method of assessing tooth mineralization. The growth phase of skeletal maturation was scored on lateral cephalogram in accordance to the cervical vertebral maturation (CVM) method proposed by Baccetti et al. Results: A positive significant correlation was attained relating CVM Stages 1, 2, and 3 with mandibular canine calcification Stages 2, 3, and 4, respectively. Conclusion: The calcification stages of mandibular canine can be implemented for assessing the skeletal maturity clinically. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the inter-observers level of agreement in interpreting cervical vertebral maturation (CVM) stages. This cross-sectional study was carried out at the Department of Orthodontics, Khyber College of Dentistry. The patient's lateral cephalograms present in the Department were used. Sixty randomly selected cephalograms were digitized by using Nikon camera L-830. The images were cropped to visualize only cervical vertebrae. Subsequently, the images were loaded into PowerPoint to prepare a presentation for rating. A PowerPoint presentation consisted of a detailed description of the CVM method along with the instructions how to rate, separately all stages of skeletal maturity. Two raters assessed the CVM stages according to Baccetti et al. The kappa statistics was used to assess inter-assessor agreement in assigning CVM scores. Out of 60 sample size twenty-eight (46.7%) were males and 32(53.3) were females. Frequencies of agreement between two raters for CVM1, CVM2, CVM3, CVM4, CVM5, and CVM6 were 100%, 100%, 50%, 100%, 46.1%, and 60% respectively. Frequencies of disagreement for CVM3 were 50%, CVM5 was 53.9% and CVM6 was 40%. The overall level agreement between two examiners was 49.1% with Kappa value of 0.491(moderate agreement) with statistical significance (P=0.000). The Spearman's rho correlation co-efficient was 0.886 for two observers. Within the limit of this study, it is recommended that CVM should be augmented with other biologic maturity indicators while assessing growth status. [ABSTRACT FROM AUTHOR]

One of the growth indicators that can be used to assess a child’s developmental growth is through skeletal maturation. Skeletal maturity can be evaluated by using anatomical changes of the cervical vertebral bones observed on the lateral cephalometric radiographs. The purpose of this study was to determine the stage of cervical vertebrae maturation of Hb E β thalassemia patients by comparing the shape changes of the second to fourth cervical vertebrae bodies with a control group. The design of this study was cross sectional. The subjects were children with Hb E β thalassemia aged 9 – 14 years. The results showed that the retarded maturation of the cervical vertebrae in Hb E β thalassemia was not found in the subjects of pre-puberty age (9 – 11 years old), but in those of puberty age (12 – 14 years old).

Purpose: To compare the state of bone maturation in a Colombian population with and without cleft lip palate (CLP), using cervical vertebral maturation (CVM) analysis. Methods: A previously calibrated examiner (kappa = 0.76) evaluated the CVM of 145 7-to-18-year-old individuals with and without CLP through lateral radiographs. 73 patients had CLP and 72 did not have the condition. Descriptive and inferential (chi2) statistical analyses were performed to the data (alpha = 0.05). Results: The 7-to-9-year-old group had the highest percentage of cervical vertebras in stage CS1 and none in stages CS5 and CS6. Patients in the group of 10-12 years of age showed the highest frequency in stage CS4 and none in CS6. The 13-15 year olds had the highest proportion in CS4. Among the 16-to-18-year-old patients, the highest percentage was found in stage CS5. When comparing the cervical vertebral development between the two groups, there were no signifcant differences (p = 0.8). Conclusion: The state of bone maturation in individuals with and without CLP showed similar results when analyzed regarding CVM in lateral radiographies. There was no evidence of earlier maturation in the 7-to-9-year-old patients. The highest level of growth was shown at ages 10-15 (CS3, CS4). [ABSTRACT FROM AUTHOR]

Objective: To analyze the long-term skeletal and dentoalveolar effects and to evaluate treatment timing of Class II treatment with functional appliances followed by fixed appliances. Materials and Methods: A group of 40 patients (22 females and 18 males) with Class II malocclusion consecutively treated either with a Bionator or an Activator followed by fixed appliances was compared with a control group of 20 subjects (9 females and 11 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start of treatment (mean age 10 years), end of treatment with functional appliances (mean age 12 years), and longterm observation (mean age 18.6 years). The treated sample also was divided into two groups according to skeletal maturity. The early-treatment group was composed of 20 subjects (12 females and 8 males) treated before puberty, while the late-treatment group included 20 subjects (10 females and 10 males) treated at puberty. Statistical comparisons were performed with analysis of variance followed by Tukey's post hoc tests. Results: Significant long-term mandibular changes (Co-Gn) in the treated group (3.6 mm over the controls) were associated with improvements in the skeletal sagittal intermaxillary relationship, overjet, and molar relationship (-3.0-3.5 mm). Treatment during the pubertal peak was able to produce significantly greater increases in total mandibular length (4.3 mm) and mandibular ramus height (3.1 mm) associated with a significant advancement of the bony chin (3.9 mm) when compared with treatment before puberty. Conclusion: Treatment of Class II malocclusion with functional appliances appears to be more effective at puberty. (Angle Orthod. 2013;83:334-340.) [ABSTRACT FROM AUTHOR]

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The accuracy and repeatability of computer aided cervical vertebra landmarking (CACVL) were investigated in cephalogram. 120 adolescents (60 boys, 60 girls) aged from 9.1 to 17.2 years old were randomly selected. Twenty-seven landmarks from the second to fifth cervical vertebrae on the lateral cephalogram were identified. In this study, the system of CACVL was developed and used to identify and calculate the landmarks by fast marching method and parabolic curve fitting. The accuracy and repeatability in CACVL group were compared with those in two manual landmarking groups [orthodontic experts (OE) group and orthodontic novices (ON) group]. The results showed that, as for the accuracy, there was no significant difference between CACVL group and OE group no matter in x-axis or y-axis ( P>0.05), but there was significant difference between CACVL group and ON group, as well as OE group and ON group in both axes ( P<0.05). As for the repeatability, CACVL group was more reliable than OE group and ON group in both axes. It is concluded that CACVL has the same or higher accuracy, better repeatability and less workload than manual landmarking methods. It's reliable for cervical parameters identification on the lateral cephalogram and cervical vertebral maturation prediction in orthodontic practice and research. [ABSTRACT FROM AUTHOR]

Abstract: Cervical vertebrae morphology has been used as a biological indicator for assessing skeletal maturation in orthodontic patients, while chronologic age is considered a poor indicator of adolescent development. The objective of the study was to investigate the relationship between the chronologic age and maturation of cervical vertebra. The study sample was 214 patients (104 males and 110 females) in the age range of 7–17years (mean age 12.31±2.9). The Baccetti modified version of CVS (Stage I–VI) was used in the study. The cervical vertebral stages depend on morphological evaluation of three cervical vertebrae (C2, C3, and C4). The spearman rank correlation between chronologic age and cervical vertebral maturation stages was 0.864 (P <0.001). CVS method is more predictable than chronological age alone in the establishment of appropriate timing and types of orthodontic treatment. [Copyright &y& Elsevier]

Cervical vertebrae shape has been proposed as a diagnostic factor for assessing skeletal maturation in orthodontic patients, while Chronologic age is considered a poor indicator of adolescent development. The aim of the study was to correlate the chronologic age with maturational changes in cervical vertebral morphology. The study was conducted on 100 patients (36 males and 64 females) in the age range of 9 to15 years (mean age 12.77 ± 1.54). To define vertebral stages, morphological evaluation of three cervical vertebrae (2nd to 4th) was done. The modified version of CVMS (Stage I-V) was used in the study. The spearman rank correlation between chronologic age and cervical vertebral maturation stages was 0.690 (P<.001). CVM method is more predictable than chronological age alone establishment of appropriate timing and types of orthodontic treatment. [ABSTRACT FROM AUTHOR]

Objective: To estimate and compare the duration of the pubertal growth peak in Class I and Class III subjects. Materials and Methods: The data examined consisted of pretreatment lateral cephalometric records of 218 skeletal Class I or Class IlI subjects (93 female and 125 male subjects) of white ancestry. The duration of the pubertal peak was calculated from the average chronological age intervals between stages CS3 and CS4 of the cervical vertebral maturation in Class I vs Class IlI groups (t-test). Results: In skeletal Class I subjects, the pubertal peak had a mean duration of 11 months, whereas in Class III subjects it lasted 16 months. The average difference (5 months) was statistically significant (P < .001). Conclusions: The growth interval corresponding to the pubertal growth spurt (CS3-CS4) was longer in Class Ill subjects than in subjects with normal skeletal relationships; the larger increases in mandibular length during the pubertal peak reported in the literature for Class Ill subjects may be related to the longer duration of the pubertal peak. [ABSTRACT FROM AUTHOR]

To investigate the longitudinal sagittal growth changes of maxilla and mandible according to the quantitative cervical vertebral maturation (QCVM) for adolescents with normal occlusion, mixed longitudinal data were used. The samples included 87 adolescents aged from 8 to 18 y old with normal occlusion (32 males, 55 females) selected from 901 candidates. Sequential lateral cephalograms and hand-wrist films were taken once a year, lasting for 6 y. The longitudinal sagittal growth changes of maxilla and mandible according to QCVM were measured. There were some significant differences between maxilla and mandible according to QCVM. The sagittal growth change of maxilla showed a trend towards high velocity→decelerating velocity→completing velocity from QCVM stage I to stage IV. The sagittal growth change of mandible showed a trend towards accelerating velocity→high velocity→decelerating velocity→completing velocity from QCVM stage I to stage IV. With sagittal relationship, growth magnitude was almost the same between maxilla and mandible at QCVM stage I. At stage II the growth of mandible exceeded that of maxilla and growth in mandible continued at stages III and IV, while the maxilla ceased to grow. Growth magnitude was greater and the growth duration was longer with male mandible. It is concluded that the longitudinal sagittal growth changes of maxilla and mandible on the basis of QCVM is of value in the orthodontic practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]