Abstract
The aim of this study was to investigate the reproducibility of the Cervical Vertebral Maturation (CVM) method and the potential for chronological age estimation using this method. The sample consisted of 474 lateral cephalometric radiographs, from orthodontic patients aged 6.4–22.4 years. Six raters were trained to the CVM method (Baccetti). All images were assessed twice. Intra- and inter-rater agreements were assessed by Cohen’s weighted kappa and intraclass correlation coefficient, respectively. Analysis of variance was performed to investigate the correlation between cervical maturation stages and chronological age. The age prediction potential of the method was tested by general linear model regression analysis. Intra-rater reliability ranged from 0.857 to 0.931. Intra-rater absolute agreement ranged from 77% to 87% however inter-rater absolute agreement was lower than 50%. Inter-rater reliability was higher than 0.9. The 3rd Cervical Maturation Stage (CS3) showed the lowest reproducibility. The mean age differences among the 6 CS stages were statistically significant and increased as the CS increased. CS and gender could roughly explain the 60% (adjusted R2 = 0.61) of the age variance of the sample. This CVM method proved able to show high reliability; however, it cannot predict accurately the pubertal growth spurt. A direct correlation was found between cervical stages and chronological age. This method provides a broad estimation of chronological age.
Highlights
The sample included digital lateral cephalometric radiographs from 474 Caucasian subjects, 217 males and 257 females
The Cervical Vertebral Maturation (CVM) method has gained popularity in orthodontics since the cervical vertebrae are often visible in the lateral cephalometric radiograph, which is part of the standard documentation used in orthodontic diagnosis [31,32,33,34,35,36,37,38]
Absolute agreement among the examiners was lower than 50%, and the reproducibility of CS3, the stage that marks the beginning of pubertal growth, was the lowest among all stages [1]. These findings suggest that this CVM method may be unreliable to predict the pubertal spurt [2,45]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Skeletal maturation is important in orthodontics in order to predict growth peak and completion as well as growth acceleration and deceleration periods. This information is useful mainly in cases of skeletal discrepancies and for clinical decisions regarding timing for orthognathic surgery or treatment initiation time [1,2,3,4,5,6]. Skeletal maturation may be useful for age estimation in living individuals or human cadavers
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