Cervical Vertebral Maturation Stage Research Articles

Evaluating the Feasibility of Cervical Vertebral Maturation Stages as an Alternative to Risser Sign in Assessing Skeletal Maturity in Adolescent Idiopathic Scoliosis Patients

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 adolescent idiopathic scoliosis (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 two 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.

Evaluation of Upper Airway Growth Patterns With Cephalometric Analysis Based on Cervical Vertebral Maturation in the Japanese: A Cross-Sectional Study.

Objective This study aims to establish standard values for the upper airway cross-sectional area and evaluate growth patterns using the cervical vertebral maturation stage (CVMS) in a Japanese population. Methods A cross-sectional sample of 400 patients, aged 6-20 years, was selected randomly from the Orthodontic Clinic at Tokyo Medical and Dental University (TMDU) dental hospital. Cervical vertebral maturation stages (CVMS I-V) guided the classification of participants into five equal groups. Lateral cephalometric radiographs taken prior to orthodontic treatment were used to measure the upper airway's cross-sectional area. The growth spurt and sex differences in growth patterns were assessed through these measurements. Results Standard values for the upper airway dimensions at each CVMS stage were established. Significant growth spurts were noted between CVMS II-III and CVMS III-IV in males and at CVMS II-III in females. The weighted kappa coefficient (κ) demonstrated almost perfect intra- and inter-evaluator agreement, confirming the reliability of CVMS in growth assessment. Conclusion CVMS provides a reliable framework for assessing growth patterns of the upper airway, with distinct variations between sexes noted. These findings support the utility of CVMS in clinical growth evaluation and orthodontic treatment planning.

Classification of cervical vertebral maturation stages with machine learning models: leveraging datasets with high inter- and intra-observer agreement

ObjectivesThis study aimed to assess the accuracy of machine learning (ML) models with feature selection technique in classifying cervical vertebral maturation stages (CVMS). Consensus-based datasets were used for models training and evaluation for their model generalization capabilities on unseen datasets.MethodsThree clinicians independently rated CVMS on 1380 lateral cephalograms, resulting in the creation of five datasets: two consensus-based datasets (Complete Agreement and Majority Voting), and three datasets based on a single rater’s evaluations. Additionally, landmarks annotation of the second to fourth cervical vertebrae and patients’ information underwent a feature selection process. These datasets were used to train various ML models and identify the top-performing model for each dataset. These models were subsequently tested on their generalization capabilities.ResultsFeatures that considered significant in the consensus-based datasets were consistent with a CVMS guideline. The Support Vector Machine model on the Complete Agreement dataset achieved the highest accuracy (77.4%), followed by the Multi-Layer Perceptron model on the Majority Voting dataset (69.6%). Models from individual ratings showed lower accuracies (60.4–67.9%). The consensus-based training models also exhibited lower coefficient of variation (CV), indicating superior generalization capability compared to models from single raters.ConclusionML models trained on consensus-based datasets for CVMS classification exhibited the highest accuracy, with significant features consistent with the original CVMS guidelines. These models also showed robust generalization capabilities, underscoring the importance of dataset quality.

Correlation of Clivus Length and Angle with Chronological Age, Gender, Sagittal Growth Pattern of the Jaws, and Skeletal Maturation Using Lateral Cephalometry.

Determination of remaining growth potential of patients is the most important factor in orthodontic treatment. This study aimed to assess the correlation of clivus length and angle with age, gender, sagittal growth pattern of the jaws, and skeletal maturation using lateral cephalometry. This cross-sectional study was conducted on 390 lateral cephalograms (Vatech, paX-i3D Green, South Korea) of patients aged 6 to 25 years. The patients were assigned to three groups of skeletal class I, II, III (n=130) with equal gender distribution. The clivus length and angle, Welcher angle, maxillary and mandibular effective length, sella turcica to Nasion (SN), and the angles between SN and point A (SNA), between SN and point B (SNB), and between NA and NB (ANB )were measured. Correlations of variables with age and gender, and cervical vertebral maturation stage (CVMS) were analyzed using the Pearson and Spearman's correlation tests, independent t-test, and one-way ANOVA at 0.05 level of significance. Clivus length had a significant correlation with SNA (r= 0.103, p= 0.042), SNB (r= 0.108, p= 0.033), maxillary (r= 0.547, p< 0.001) and mandibular (r= 0.589, p< 0.001) effective lengths, SN length (r= 0.586, p< 0.001), and CVMS (r= 0.697, p< 0.001). Clivus angle had a significant correlation with SNA (r= 0.105, p= 0.039), SNB (r= 0.155, p= 0.002), maxillary (r= 0.507, p< 0.001) and mandibular (r= 0.596, p= 0.001) effective lengths, SN length (r= 0.566, p< 0.001), and CVMS (r= 0.699, p< 0.001). The mean clivus length (p= 0.006) and angle (p= 0.002) were significantly higher in males, and had a significant correlation with age (r= 0.636 and r= 0.718, p< 0.001). The mean clivus length and angle were not significantly different in class I, II, III (p> 0.05). All parameters were greater in males, and increased with age (except Welcher angle). Clivus length and angle had significant correlations with position of both jaws but not with sagittal relationship.

Morphologic predictors of mandibular changes induced by Sander's Bite Jumping Appliance.

This study aimed to identify pretreatment cephalometric variables as possible predictors of the mandibular length increase in Class II patients with mandibular retrusion, treated by means of the Bite Jumping Appliance (BJA). Forty-three subjects (22 males and 21 females) with Class II malocclusion, treated with a BJA, were selected on the basis of the following inclusion criteria: full Class II molar relationship, Overjet (OVJ) ≥ 6 mm and a skeletal Class II malocclusion with mandibular retrusion at the start of the treatment (T0); cervical vertebral maturation stage 2 or 3 at time 0 (T0). The following mandibular structural features were measured on lateral cephalograms at time 0 and time 1 (15 months of treatment): the width and height of the mandibular symphysis and its width/height ratio, the width and height of the mandibular ramus and its width/height ratio, the antegonial notch depth and the Condilion-Gonion-Menton (Co-Go-Me) angle. Post-treatment changes were assessed by Pancherz's cephalometric analysis, evaluating the increases in mandibular length. A regression statistical model was used to test the association between morphologic variables and mandibular length changes. At T1, a significant increase in mandibular length (7.1 + 3.4 mm, p < .001) was measured. A significant negative association between the pretreatment Co-Go-Me angle and mandibular length change was found (p < .05). IMPA angle was negatively associated with mandibular length change. All the others morphological feature were not statistically related to mandibular length change. Co-Go-Me angle and IMPA angle at T0 can be used as predictors for mandibular response to the treatment with BJA.

Appraisal of skeletal maturity indicators with respect to non-invasive biomarkers

Non-invasive salivary biomarkers are being investigated as they may be helpful in predicting skeletal age. This study was conducted to evaluate the correlation between salivary insulin-like growth factor-1, salivary alkaline phosphatase, cervical vertebrae maturation stages and chronological age in the assessment of skeletal age during the growth period. This study also aims to find associations with mandibular base length and maxillary base length. Total 80 eligible subjects aged 7 to 21 years were selected and divided into two gender-specific groups (41 males, 39 females). A further subdivision was made on the basis of six cervical vertebral maturation stages from the lateral cephalogram. The chronological age was given for each subject, and The maxillary base length and the length of the mandibular base was calculated from the impressions on the lateral cephalogram. Saliva samples were collected from each subject to determine salivary IGF-1 and ALP levels using an enzyme-linked immunosorbent assay (ELISA). The data obtained was statistically analysed using SPSS (20.0) software. It was found that the mean IGF-1 activity in saliva was highest at CVMI stage 3 and the highest mean ALP levels in saliva occurred in males at CVMI stage 3 and in females at CVMI stage 4. Mean salivary ALP and IGF-1 levels correlate well with . Salivary ALP levels show a correlation with chronological age and could also be used as a diagnostic model to predict cervical stage. The diagnostic levels of certain biomarkers that appear in human saliva are representative of an individual's circumpubertal growth spurt. The collective pattern of increase and decrease in the sample during the circumpubertal stages is essential to study for orthodontic diagnosis and treatment planning.

DC-YOLOv5-based target detection algorithm for cervical vertebral maturation.

The cervical vertebral maturation (CVM) method is essential to determine the timing of orthodontic and orthopedic treatment. In this paper, a target detection model called DC-YOLOv5 is proposed to achieve fully automated detection and staging of CVM. A total of 1800 cephalometric radiographs were labeled and categorized based on the CVM stages. We introduced a model named DC-YOLOv5, optimized for the specific characteristics of CVM based on YOLOv5. This optimization includes replacing the original bounding box regression loss calculation method with Wise-IOU to address the issue of mutual interference between vertical and horizontal losses in Complete-IOU (CIOU), which made model convergence challenging. We incorporated the Res-dcn-head module structure to enhance the focus on small target features, improving the model's sensitivity to subtle sample differences. Additionally, we introduced the Convolutional Block Attention Module (CBAM) dual-channel attention mechanism to enhance focus and understanding of critical features, thereby enhancing the accuracy and efficiency of target detection. Loss functions, precision, recall, mean average precision (mAP), and F1 scores were used as the main algorithm evaluation metrics to assess the performance of these models. Furthermore, we attempted to analyze regions important for model predictions using gradient Class Activation Mapping (CAM) techniques. The final F1 scores of the DC-YOLOv5 model for CVM identification were 0.993, 0.994 for mAp0.5 and 0.943 for mAp0.5:0.95, with faster convergence, more accurate and more robust detection than the other four models. The DC-YOLOv5 algorithm shows high accuracy and robustness in CVM identification, which provides strong support for fast and accurate CVM identification and has a positive effect on the development of medical field and clinical diagnosis.

Effect of mandibular third molar tooth germ extraction on mandibular development: a retrospective study

Objective: To investigatethe effect of extraction of mandibular third molar (M3) tooth germon the development of the mandible in orthodontic patients, with a view to providing a reference for clinical M3 tooth germ extraction. Methods: One hundred and twenty-nine Angel class Ⅰ patients aged 10-16 years who attended the Department of Orthodontics Division 1, School & Hospital of Stomatology, Wuhan University from 1 January 2013 to 30 December 2021 and fulfilled the criteria for nativity were included. Those who had their M3 extracted in the Department of Oral and Maxillofacial Surgery were included in the study group, with a total of 66 cases; and those who did not have their M3 extracted were included in the control group, with a total of 63 cases. The average annual growth was calculated by tracing point measurements on cephalometric films before and after orthodontic treatment according to the Jarabak and McNamara methods, with measurements of the mandibular ramus height (Ar-Go'), mandibular body length (Go'-Me), and overall mandibular length (Co-Gn) values, respectively. The average annual growth of Ar-Go', Go'-Me, and Co-Gn were compared between the two groups for the overall sample of patients, patients of the same sex (male/female), patients of the same age group (A, B, and C), and patients of the same cervical vertebral maturation stage (stages Ⅱ, Ⅲ, and Ⅳ), respectively, to see if there was any difference in the average annual growth of Ar-Go', Go'-Me, and Co-Gn. Results: There was no statistically significant difference in the average annual growth of Ar-Go', Go'-Me, and Co-Gn between the study group [0.88 (0.40, 1.80), 0.67 (0.15, 1.18), and 0.86 (0.40, 1.90) mm, respectively] and the control group [1.08 (0.45, 1.60), 0.53 (0.25, 1.13), and 1.20 (0.46, 2.28) mm, respectively] (P>0.05). In addition, there was no significant difference in the average annual growth in the Ar-Go', Go'-Me, and Co-Gn between the groups for patients of the same sex group (male/female), patients of the same age group (A, B, and C), and patients of the same cervical vertebral maturation stage group (stages Ⅱ, Ⅲ, and Ⅳ) (P>0.05). Conclusions: Extraction of the mandibular third molar tooth germ has no significant effect on the development of the mandible in Angle class Ⅰ orthodontic patients.

Estimating mandibular growth stage based on cervical vertebral maturation in lateral cephalometric radiographs using artificial intelligence

IntroductionDetermining the right time for orthodontic treatment is one of the most important factors affecting the treatment plan and its outcome. The aim of this study is to estimate the mandibular growth stage based on cervical vertebral maturation (CVM) in lateral cephalometric radiographs using artificial intelligence. Unlike previous studies, which use conventional CVM stage naming, our proposed method directly correlates cervical vertebrae with mandibular growth slope.Methods and materialsTo conduct this study, first, information of people achieved in American Association of Orthodontics Foundation (AAOF) growth centers was assessed and after considering the entry and exit criteria, a total of 200 people, 108 women and 92 men, were included in the study. Then, the length of the mandible in the lateral cephalometric radiographs that were taken serially from the patients was calculated. The corresponding graphs were labeled based on the growth rate of the mandible in 3 stages; before the growth peak of puberty (pre-pubertal), during the growth peak of puberty (pubertal) and after the growth peak of puberty (post-pubertal). A total of 663 images were selected for evaluation using artificial intelligence. These images were evaluated with different deep learning-based artificial intelligence models considering the diagnostic measures of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). We also employed weighted kappa statistics.ResultsIn the diagnosis of pre-pubertal stage, the convolutional neural network (CNN) designed for this study has the higher sensitivity and NPV (0.84, 0.91 respectively) compared to ResNet-18 model. The ResNet-18 model had better performance in other diagnostic measures of the pre-pubertal stage and all measures in the pubertal and post-pubertal stages. The highest overall diagnostic accuracy was also obtained using ResNet-18 model with the amount of 87.5% compared to 81% in designed CNN.ConclusionThe artificial intelligence model trained in this study can receive images of cervical vertebrae and predict mandibular growth status by classifying it into one of three groups; before the growth spurt (pre-pubertal), during the growth spurt (pubertal), and after the growth spurt (post-pubertal). The highest accuracy is in post-pubertal stage with the designed networks.

Is hand-wrist radiography still necessary in orthodontic treatment planning?

The aim of our study is to compare the relationship between hand-wrist and cervical vertebra maturation stages with chronological age and to investigate the effect of malocclusion type on the relationship between these methods. Hand-wrist and cephalometric radiographs of 1000 patients (526 females, 474 males) with a mean age of 13.41 ± 1.83 were analyzed. The methods of Bacetti et al. were used for the cervical vertebra maturation stage, and Björk, Grave and Brown's methods were used for the hand-wrist maturation stage. One-way ANOVA test was applied to compare skeletal classes between them. Tukey post hoc test was used to determine the differences. The relationship between the malocclusion type, cervical vertebra and hand-wrist maturation stages was evaluated with the Spearman correlation test. Spearman's correlation coefficient was 0.831, 0.831 and 0.760 in Class I, II and III females, respectively. In males, it was calculated as 0.844, 0.889 and 0.906, respectively. When sex and malocclusion were not differentiated, the correlation was found to be 0.887. All were statistically significant (P < 0.001). The highest correlation was observed in class III males, while the lowest was found in class III females. Cervical vertebrae can be used safely to assess pubertal spurt without hand-wrist radiography. Diagnosing growth and development stages from cephalometric images is important in reducing additional workload and preventing radiation risk.

Mapping an intelligent algorithm for predicting female adolescents' cervical vertebrae maturation stage with high recall and accuracy.

The present study was designed to define a novel algorithm capable of predicting female adolescents' cervical vertebrae maturation stage with high recall and accuracy. A total of 560 female cephalograms were collected, and cephalograms with unclear vertebral shapes and deformed scales were removed. 480 films from female adolescents (mean age: 11.5 years; age range: 6-19 years) were used for the model development phase, and 80 subjects were randomly and stratified allocated to the validation cohort to further assess the model's performance. Derived significant predictive parameters from 15 anatomic points and 25 quantitative parameters of the second to fourth cervical vertebrae (C2-C4) to establish the ordinary logistic regression model. Evaluation metrics including precision, recall, and F1 score are employed to assess the efficacy of the models in each identified cervical vertebrae maturation stage (iCS). In cases of confusion and mispredictions, the model underwent modification to improve consistency. Four significant parameters, including chronological age, the ratio of D3 to AH3 (D3:AH3), anterosuperior angle of C4 (@4), and distance between C3lp and C4up (C3lp-C4up) were administered into the ordinary regression model. The primary predicting model that implements the novel algorithm was built and the performance evaluation with all stages of 93.96% for accuracy, 93.98% for precision, 93.98% for recall, and 93.95% for F1-score were obtained. Despite the hybrid logistic-based model achieving high accuracy, the unsatisfactory performance of stage estimation was noticed for iCS3 in the primary cohort (89.17%) and validation cohort (85.00%). Through bivariate logistic regression analysis, the posterior height of C4 (PH4) was further selected in the iCS3 to establish a corrected model, thus the evaluation metrics were upgraded to 95.83% and 90.00%, respectively. An unbiased and objective assessment of the cervical vertebrae maturation (CVM) method can function as a decision-support tool, assisting in the evaluation of the optimal timing for treatment in growing adults. Our novel proposed logistic model yielded individual formulas for each specific CVM stage and attained exceptional performance, indicating the capability to function as a benchmark for maturity evaluation in clinical craniofacial orthopedics for Chinese female adolescents.

Evaluation of reliability of salivary alkaline phosphatase in comparison to other methods of assessing the skeletal maturation

Evaluation of skeletal maturation is crucial to growth determination which in turn influences orthodontic treatment planning. Various methods employed for assessment are chronological age, hand wrist maturation, cervical vertebral maturation, and dental calcification. Recently, salivary Bone specific alkaline phosphatase (BALP) have been introduced due to its role in the bone mineralization process. To test the alternate hypothesis that salivary alkaline phosphatase is a reliable indicator of skeletal maturity in comparison with other methods of assessment of skeletal maturation. Total 112 subjects were selected out of 150 subjects on the basis of inclusion and exclusion criteria, for participation in the study. For each subject, personal details including chronological age was noted. Height and weight measurements were done for calculation of body mass index (BMI). Further, Lateral Cephalogram and Orthopantomogram were obtained for assessment of cervical vertebrae maturation stages and Demirjian index. Then, an unstimulated salivary sample was collected for evaluation of alkaline phosphatase activity by colorimetric method. The data obtained was analyzed using SPSS software. The results of the present study showed that the highest correlation for skeletal maturation assessment was found with alkaline phosphatase activity. The hypothesis is accepted. Salivary Alkaline Phosphatase proved to be reliable biomarker for assessment of skeletal maturation.

Inter-observer and intra-observer agreement of cervical vertebral maturation staging: A systematic review and meta-analysis

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. This study aims to assess inter-observer (reliability) and intra-observer agreement (reproducibility) for CVM staging. 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. 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. 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. PROSPERO registration (CRD42023468521). Data is openly available at https://doi.org/10.5281/zenodo.10599129.

Assessment of mandibular trabecular structure and cervical vertebral maturation using fractal analysis.

Changes in bone trabeculae occur during skeletal maturation. Fractal analysis is a technique for assessing changes in the internal structure of the bone. The aim of this study was to investigate correlation of bone trabeculation measured on panoramic and lateral cephalometric radiographs with cervical vertebral maturation stages (CVMS). CVMS was evaluated on lateral cephalometric radiographs of 120 individuals aged 6 to 18 years. The subjects were divided into 6 groups (n= 20 each) according to CVMS. On panoramic and lateral cephalometric radiographs, fractal dimension (FD) analyses were performed in mandibular corpus, gonial and condylar regions and cervical vertebral bodies (C2, C3, C4). FD measurements from the mandibular corpus region bilaterally and C2-C4 vertebral bodies showed significant positive correlations with CVMS (r= 0.418, r= 0.412, r= 0.324, r= 0.304, r= 0.263, respectively). Significant differences were found in the FD values of the right/left mandibular corpus and C2 and C3 vertebrae compared to CVMS (P< 0.001, P< 0.001, P= 0.005, P= 0.019, respectively). Significant positive moderate correlations between the FD values of the right and left mandibular corpus and CVMS suggest that fractal analysis may be useful in determining skeletal maturity stage. The significant FD values obtained from the right/left mandibular corpus, and C2 and C3 vertebra indicate that the complexity of the internal trabecular structure increases with maturation.

Interobserver Reliability of Cervical Vertebral Maturation Staging

Background: the accurate identification of a patient's maturation stage, particularly during the pubertal growth spurt, takes on heightened importance, particularly when addressing cases of dentoskeletal problem Active growth determination is crucial for orthodontic treatment. Objectives: The objective of this study was to determine interobserver reliability of Cervical Vertebrae Maturation (CVM) stagingMaterial and Methods: This cross-sectional correlational study, conducted in the Department of Orthodontics on 70 subjects. Ten orthodontic clinicians, including 4 orthodontists and 6 orthodontic residents, with no prior experience in CVM staging, underwent comprehensive training. The study involved assessing 70 lateral cephalograms with clear visibility of cervical vertebrae, evaluated by two independent examiners using the Baccetti et al. staging system. The collected data were analyzed using R programming, including descriptive statistics for age, Spearman's correlation, and Cohen's Kappa for assessing interobserver agreement, with stratification by gender. Results: The mean age of participants was 12.60±3.93 years, with 38 females (54.29%) and 32 males (45.71%). The study revealed varying levels of agreement between two observers for different CVM stages, ranging from perfect agreement in CS1 to strong agreement in CS3. CS4, CS5, and CS6 also showed varying agreement rates. Additionally, there was robust and statistically significant agreement (p&lt;0.001) between observers in cervical maturation staging, supported by a high Spearman's rho value (r=0.927). Furthermore, substantial agreement was observed with a Kappa value of 0.748, indicating a strong consensus in cervical staging assessments.Conclusion: Cervical vertebral maturation staging is reliable in term of inter-observers agreement. Keywords: Cervical vertebral maturation, Interobserver agreement, Growth assessment

Evaluation of Bone Thickness and Density Values in Resistance Regions in Rapid Maxillary Expansion Using Computed Tomography.

This study used computed tomography (CT) to compare the bone thickness and density values around the zygomaticomaxillary, zygomaticotemporal, and pterygomaxillary sutures that are resistant to rapid maxillary expansion (RME) treatment according to age, sex, and cervical vertebrae maturation (CVM) stage. The study included 200 paranasal sinus records obtained for medical diagnosis and examination in a radiology clinic. The records provided data on 110 males and 90 females aged between 4 and 28 years. Bone thickness and density values around the zygomaticomaxillary, zygomaticotemporal, and pterygomaxillary sutures were measured using CT imaging. The correlations of bone thickness and density values with the variables of age, sex, and CVM stage were evaluated. No statistically significant difference was revealed between the bone thickness values around the zygomaticomaxillary and zygomaticotemporal sutures and age, sex, CVM stage, and the right and left regions of the same individual ( P >0.05). A strong correlation was identified between Hounsfield units (Hu) values on bone density in all 3 regions and age and sex ( P <0.001). No correlation was found between the CVM stage and density values around the zygomaticomaxillary, zygomaticotemporal, and pterygomaxillary sutures ( P >0.05). The Hu values of the records from females were higher than those of males in all age groups. It was observed that with increasing age, bone density values increased in all 3 regions, and thus circummaxillary region's Hu value increased.

Dento-Alveolar Changes after Maxillary Hybrid Expansion and Multi-Bracket Therapy: A Comparative Study at Three Different (Vertebral) Maturation Stages

Background: Rapid maxillary expansion is a common therapy when a palatal transversal discrepancy occurs. Different anchorage solutions have been proposed to obtain an effective skeletal expansion, even for adult patients. The aim of the present research was to evaluate the dentoskeletal effects of a hybrid expander and multi-bracket therapy, considering three groups of patients with different cervical vertebral maturation (CVM) stages. Materials and Methods: The study evaluated 68 consecutively treated patients. The age of the patients varied from 7 to 27 years old (mean age 13.45). The sample was divided into the following three groups based on CVM stage at the start of treatment: Group 1 (CS1–CS2) included 21 patients (mean age 10.21, SD 1.34), Group 2 (CS3–CS4) included 28 patients (mean age 13.37, SD 1.37) and Group 3 (CS5–CS6) was composed of 19 patients (mean age 17.14, SD 3.48). Each patient underwent orthodontic therapy where the first step was a palatal expansion by means of a hybrid expander; afterwards, the therapy was completed with a multi-bracket appliance. Expansion and torque values were observed at the end of treatment on digital models. Results: Significant intragroup differences in transversal expansion were found over time for all parameters in all groups. No significant differences were found among groups for longitudinal changes. No significant differences were found among groups for longitudinal changes of torque. Conclusions: The tooth–bone-borne maxillary expander and multi-bracket produced a significant clinical expansion with negligible dental compensation. The effect of the maxillary expansion and multi-bracket therapy showed no differences among the maturation groups in regard to transversal diameter changes and torque values.

The effect of vertical skeletal proportions, skeletal maturation, and age on midpalatal suture maturation: a CBCT-based study

BackgroundMidpalatal suture (MPS) maturation may be influenced by a range of parameters including age, gender, and vertical skeletal pattern. We therefore aimed to evaluate the effect of Frankfurt-mandibular angle (FMA), skeletal maturation, and age on the timing of MPS maturation.MethodsIn this cross-sectional study, cone-beam computed tomography (CBCT) and lateral cephalograms were used to assess the MPS and cervical vertebral maturation (CVM) stage. A proportional odds logistic regression model was used to assess associations between age adjusted for gender and MPS maturation, and a regression analysis was performed to analyze the effect of vertical pattern on these associations.ResultsA total of 201 patients (84 male and 117 female) with a mean age of 13.48 (SD 1.94) were included. With increasing age, the odds of belonging to a higher maturation stage increased (OR: 2.14; 95% CI 1.789; 2.567; P < 0.001); however, no association between FMA and MPS maturation was observed (OR: 1.01; 95% CI 0.964; 1.051; P = 0.76). A strong correlation between MPS maturation and CVM stage was not reported. Males had a higher probability of belonging to a lower MPS maturation stage (OR: 0.24; 95% CI 0.136; 0.415; P < 0.001).ConclusionsBased on this cross-sectional analysis, midpalatal sutural maturation classification is associated with chronological age and occurs later in males. Neither CVM staging nor variation in vertical skeletal proportions were useful predictors of midpalatal maturation stage.

Impact of initial lip competence on the outcome of class II functional appliances therapy

ObjectivesThe aim of this prospective clinical study was to evaluate the impact of initial lip position on class II functional appliance therapy.Materials and methodsIn total, 34 class II division 1 patients (23 females, 19 males; mean age 12.4 ± 0.9 years) that met the inclusion criteria (> ½ class II molar relationship, overjet > 6 mm, ANB > 4°, neutral or horizontal growth pattern, cervical vertebral maturation stage (CVMS) II – III, mean wear-time > 10 h/day) were consecutively divided into two groups (lip incompetence (LI); lip competence (LC)). All patients were treated with the Sander bite jumping appliance (BJA). Wear time was microelectronically measured. Lateral cephalograms were taken at the beginning (T0) and after 1 year of treatment (T1). An untreated class II group served as a control (CG). Inter-group comparisons were determined with Mann–Whitney U tests for independent samples.ResultsSignificant skeletal treatment effects were found in both treated groups when compared to the CG with significantly more pronounced mandibular skeletal effects in the LI than in the LC group (mandibular base length p < 0.001, composite mandibular base length p < 0.001, condylar head growth p = 0.002, co-pg p < 0.00, go-pg p = 0.003, reduction of the ANB angle p = 0.009, and Wits appraisal p < 0.001).ConclusionThe more pronounced mandibular effects in the LI group were composed of the functional orthopedic effect plus harmonization of the lip competence.Clinical relevanceFunctional harmonization of lip incompetence with BJA enhances mandibular growth stimulation. Lip incompetence seems to impede mandibular growth and its harmonization seems to be a preventive approach.

To Evaluate Correlation Between Cervical Vertebral Maturation Stages and Third Molar Maturation Stages in North Maharashtrian Population

Introduction Assessment of growth is crucial in the diagnosis and treatment planning in orthodontics. Skeletal development can be assessed by using hand-wrist radiographs and lateral cephalograms. The advantage of the panoramic radiograph over hand wrist radiograph is that patient exposure is reduced following the ALARA principle. Aim The aim of this study was to investigate the correlation between third molar calcification stages and skeletal maturity using the CVM stages in North Maharashtrian population. Methods Dental panoramic and lateral cephalograms of subjects ranged in age from 9 to 20 years were selected. Demirjians method was used to assess the dental maturation stages of third molars on both the sides. Hassel and Farman classification was used for classifying into cervical vertebral maturation indicator stages. The collected data were statistically analyzed. Result There was a statistically significant correlation between cervical maturation stages and third molar calcification stages in North Maharashtrian population.