Abstract
The aim of this study was to determine the relationship between the closure stage of the spheno-occipital synchondrosis and the maturational stage of the cervical vertebrae (CVM) in growing and young adult subjects using cone beam computed tomography (CBCT). CBCT images with an extended field of view obtained from 315 participants (148 females and 167 males; mean age 15.6 ±7.3 years; range 6 to 23 years) were analyzed. The fusion status of the synchondrosis was determined using a five-stage scoring system; the vertebral maturational status was evaluated using a six-stage stratification (CVM method). Ordinal regression was used to study the ability of the synchondrosis stage to predict the vertebral maturation stage. Vertebrae and synchondrosis had a strong significant correlation (r = 0.89) that essential was similar for females (r = 0.88) and males (r = 0.89). CVM stage could be accurately predicted from synchondrosis stage by ordinal regression models. Prediction equations of the vertebral stage using synchondrosis stage, sex and biological age as predictors were developed. Thus this investigation demonstrated that the stage of spheno-occipital synchondrosis, as determined in CBCT images, is a reasonable indicator of growth maturation.
Highlights
To estimate accurately the skeletal maturity of both growing subjects and young adults has been a challenging task in different areas of dentistry, most commonly in orthodontics and surgery
Individual scores of cervical vertebrae and spheno-occipital synchondrosis maturational stages are given in S1 Table
There was some controversy about the use of cone beam computed tomography (CBCT) scans to assess CVM stages [24], recent studies showed a good relationship between skeletal maturation assessed by cervical vertebrae maturational method as seen on CBCT, and lateral cephalogram [25], and later contemporary studies support these results and estimated skeletal maturation from cervical vertebrae images obtained from CBCT scans [26,27,28]
Summary
To estimate accurately the skeletal maturity of both growing subjects and young adults has been a challenging task in different areas of dentistry, most commonly in orthodontics (e.g. for planning the appropriate time for rapid maxillary expansion or functional treatments) and surgery (e.g. for planning treatment timing for orthognathic surgery or endosseous implants). Spheno-Occipital Synchondrosis and Cervical Vertebrae Maturation [1,2,3] This methodology presents several drawbacks, including the additional amount of radiation required. To address these limitations, an alternate method has been developed to analyse patient age through the maturation of the cervical vertebra, termed the CVM method. The size and shape of the 2nd, 3rd and 4th cervical vertebrae can be used to estimate the stage of maturational development of the craniofacial region, eliminating the need for an additional radiograph [4, 5]. Middle phalanx maturation (MPM) of the third finger has been proposed as a valid indicator of the pubertal growth spurt in individual subjects; both the MPM and CVM methods have demonstrated an overall satisfactory diagnostic agreement, with a slight disagreement at stage 5, in which the third middle phalanx appears to mature earlier than the cervical vertebrae [6]
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