Cervical Vertebral Maturation Stage Research Articles

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.

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.

Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls.

Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.

Estimation of Salivary Bone Specific Alkaline Phosphatase as a Biomarker for Assessing Skeletal Maturity Indicator

ABSTRACT Background: Evaluation of skeletal maturation plays a substantial role in selection of orthodontic treatment strategies. Recently, new noninvasive methods of assessing biological mediators have been introduced to assess skeletal maturity. There is a marked rise in the value of these mediators during pubertal growth spurts. When these mediators emerge as the assessment tool for skeletal maturity determination, it can reduce radiation exposure and beneficial to the patient. Hence, the goal of this study is to validate the calculation of salivary alkaline phosphatase (ALP) as a noninvasive skeletal maturity indicator by estimating the Bone Alkaline Phosphatase (B-ALP) level in whole unstimulated saliva at different stages of skeletal maturity and correlating B-ALP level with different stages of skeletal development using cervical vertebral maturation index (CVMI) and hand-wrist MP3 (third finger middle phalanx). Materials and Methods: The test group included 90 subjects aged between 8 and 18 years requiring orthodontic treatment. The salivary samples were collected and examined by ALP kit following the manufacturer’s instructions and assessed using photo-spectrometer at 405 nm. The skeletal age was assessed using handwrist radiographs; skeletal age was determined by modified MP3 staging. Lateral cephalograms of each individual were also collected and tracing done for assessing skeletal age with CVM staging. The collected data were analyzed statistically with analysis of variance for intergroup comparison of ALP levels and Kruskal–Wallis test for intergroup comparison of CVM and MP3 stages. Results and Conclusion: Salivary ALP activity during the peak pubertal period was markedly increased when compared to pre- and post-peak values. Salivary ALP activity was in correlation with the cervical vertebral maturation and MP3 stages showing peak values at the pubertal stages. Thus, salivary B-ALP can serve as a noninvasive method of skeletal maturity assessment as an adjunct to conventional skeletal maturity indicators.

Comparisons of soft tissue changes after Herbst appliance treatment in three different growth phases

This study aimed to compare the soft tissue effects of Herbst appliance in Class II malocclusion patients treated in three different craniofacial growth phases: prepubertal (PRE), circumpubertal (CIR), and postpubertal (POS). In total, 95 patients with Class II Division 1 malocclusion previously treated with a Herbst appliance were analyzed. Through the cervical vertebral maturation stages method, patients were allocated into three groups depending on the growth craniofacial phase at the beginning of treatment: PRE, CIR, and POS. Seventeen cephalometric measures were evaluated from each lateral radiograph before and after Herbst therapy using the Radiocef 2 software (Radio Memory, Belo Horizonte). Intragroup and intergroup treatment changes were compared statistically using a paired t test and MANOVA test, respectively. Soft tissue thickness changes were related only to mandible; all three mandibular measurements (L1_LL, B_B', and Pog_Pog') showed thickening for the PRE group ranging from 0.92 mm (Pog_Pog') to 2.02 mm (B_B'), and only lower lip thickened overtime for the POS group (L1_LL = 0.99 mm). Soft and hard tissue pogonion displaced anteriorly, but only the soft tissue showed differences among groups; PRE group presented more anterior displacement than POS group (3.61 mm and 1.39 mm, respectively). Hard and soft tissue facial convexity decreased more in the PRE and CIR groups than in the POS group. Mentolabial sulcus depth reduced more in the PRE (1.07 mm) and CIR (1.29 mm) groups than in the POS (0.55 mm) group. Horizontal movement of the skeletal and soft pogonion presented a moderate-high positive correlation (r = 0.783), and hard and soft facial convexity showed a moderate-low positive correlation (r = 0.403). Herbst appliance therapy produces soft tissue improvements in the three phases of craniofacial growth, being greater in patients in the PRE and CIR phases.

Evaluation of the Midpalatal Suture and its Correlation with the Cervical Vertebral Maturation Stages and Second Molar Mineralization Stages: A CBCT Study

Objectives To evaluate and correlate the maturation stage of the midpalatal suture, CVM stages, mandibular left second molar mineralization stages of the subjects by CBCT. Materials and Methods One hundred subjects (55 males and 45 females) with a mean age of 13.56 ± 4.46 years, were divided into five midpalatal suture maturational stage groups (A to E). Cervical vertebral maturational stages on lateral cephalograms and second molar mineralization stages on orthopantograms from the CBCT images obtained from Carestream CS 9300C 3D system were analyzed and correlation among them were calculated by Spearman’s coefficient of correlation and midpalatal suture maturation stage prediction accuracy estimated with sensitivity, specificity, positive predictive value, and likelihood ratio. Results Spearman’s correlation analysis showed a highly significant (p value &lt; .001) and positive correlation between MPS stage and CVM Stage (r = 0.930), MPS stage and mandibular left second molar mineralization stage (r = 0.757), and CVM stage and mandibular left second molar mineralization stage (r = 0.760). Conclusion Cervical vertebral maturation stages 1,2, and 3 can be used clinically to predict the midpalatal suture maturation stages A, B, and C, respectively, as their likelihood ratios were more than 10. Second molar mineralization stages had less predictive value for MPS stages.

Investigation of the correlation of midpalatal suture maturation stage with chronological age and cervical vertebral maturation stage

Objectives: The first aim of this study was to investigate the correlation between chronological age, cervical vertebral maturation (CVM) stage, and midpalatal suture (MPS) maturation stage. The second aim was to assess the relationship between the prognosis for rapid maxillary expansion (RME) and age, CVM stage, and MPS maturation stage. Material and Methods: We divided 109 participants into three age groups: &lt;15 years, 15–25 years, and &gt;25 years. The participants had undergone both cone-beam computed tomography (CBCT) and lateral cephalometric X-ray examination. Their MPS maturation stage was classified as A to E and CVM stage as cervical stage 1 (CS1) to CS6, according to a previously proposed method. We used the weighted kappa coefficient to assess intra-examiner agreement and Spearman’s correlation coefficient, to evaluate the correlations of MPS maturation stage with age and CVM stage. Results: The weighted kappa coefficients were 0.849 and 0.923 for the identification of MPS maturation stage and CVM stage, respectively. There were significant, but weak correlations between MPS maturation stage and age (r = 0.313, P = 0.001) and, CVM stage (r = 0.287, P = 0.002). MPS stage C was the most prevalent across all age groups and all CVM stages. Conclusion: Chronological age and CVM stage may not accurately predict MPS maturation stage, especially in older patients. Further, the prognosis for RME may not be strongly related to either CVM or MPS maturation stage. We recommend using CBCT X-rays for individual MPS assessments before selecting the type of maxillary expansion treatment.

Assessment of correlation between hand-wrist maturation and cervical vertebral maturation: a fractal analysis study

BackgroundTo investigate whether fractal dimension (FD) measurements from hand-wrist radiographs and lateral cephalometric radiographs are correlated with each other and with skeletal maturation stages.MethodsIn 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.ResultsPositive 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).ConclusionsFD 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.

CURRENT NEURAL NETWORKS DEMONSTRATE POTENTIAL IN AUTOMATED CERVICAL VERTEBRAL MATURATION STAGE CLASSIFICATION BASED ON LATERAL CEPHALOGRAMS

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.

The psc-CVM assessment system: A three-stage type system for CVM assessment based on deep learning

BackgroundMany scholars have proven cervical vertebral maturation (CVM) method can predict the growth and development and assist in choosing the best time for treatment. However, assessing CVM is a complex process. The experience and seniority of the clinicians have an enormous impact on judgment. This study aims to establish a fully automated, high-accuracy CVM assessment system called the psc-CVM assessment system, based on deep learning, to provide valuable reference information for the growth period determination.MethodsThis study used 10,200 lateral cephalograms as the data set (7111 in train set, 1544 in validation set and 1545 in test set) to train the system. The psc-CVM assessment system is designed as three parts with different roles, each operating in a specific order. 1) Position Network for locating the position of cervical vertebrae; 2) Shape Recognition Network for recognizing and extracting the shapes of cervical vertebrae; and 3) CVM Assessment Network for assessing CVM according to the shapes of cervical vertebrae. Statistical analysis was conducted to detect the performance of the system and the agreement of CVM assessment between the system and the expert panel. Heat maps were analyzed to understand better what the system had learned. The area of the third (C3), fourth (C4) cervical vertebrae and the lower edge of second (C2) cervical vertebrae were activated when the system was assessing the images.ResultsThe system has achieved good performance for CVM assessment with an average AUC (the area under the curve) of 0.94 and total accuracy of 70.42%, as evaluated on the test set. The Cohen's Kappa between the system and the expert panel is 0.645. The weighted Kappa between the system and the expert panel is 0.844. The overall ICC between the psc-CVM assessment system and the expert panel was 0.946. The F1 score rank for the psc-CVM assessment system was: CVS (cervical vertebral maturation stage) 6 > CVS1 > CVS4 > CVS5 > CVS3 > CVS2.ConclusionsThe results showed that the psc-CVM assessment system achieved high accuracy in CVM assessment. The system in this study was significantly consistent with expert panels in CVM assessment, indicating that the system can be used as an efficient, accurate, and stable diagnostic aid to provide a clinical aid for determining growth and developmental stages by CVM.

Novel Machine Learning Algorithms for Prediction of Treatment Decisions in Adult Patients With Class III Malocclusion

Management of Class III (Cl III) dentoskeletal phenotype is often expert-driven. The aim is to identify critical morphological features in postcircumpubertal Cl III treatment and appraise the predictive ability of innovative machine learning (ML) algorithms for adult Cl III malocclusion treatment planning. The Orthodontics Department at the University of Illinois Chicago undertook a retrospective cross-sectional study analyzing Cl III malocclusion cases (2003-2020) through dental records and pretreatment lateral cephalograms. Forty features were identified through a literature review and gathered from pretreatment records, serving as ML model inputs. Eight ML models were trained to predict the best treatment for adult Cl III malocclusion. Predictive accuracy, sensitivity, and specificity of the models, along with the highest-contributing features, were evaluated for performance assessment. Demographic covariates, including age, gender, race, and ethnicity, were assessed. Inclusion criteria targeted patients with cervical vertebral maturation stage 4 or above. Operative covariates such as tooth extraction and types of orthognathic surgical maneuvers were also analyzed. Demographic characteristics of the camouflage and surgical study groups were described statistically. Shapiro-Wilk Normality test was employed to check data distribution. Differences in means between groups were evaluated using parametric and nonparametric independent sample tests, with statistical significance set at <0.05. The study involved 182 participants; 65 underwent camouflage mechanotherapy, and 117 received orthognathic surgery. No statistical differences were found in demographic characteristics between the two groups (P>.05). Extreme values of pretreatment parameters suggested a surgical approach. Artificial neural network algorithms predicted treatment approach with 91% accuracy, while the Extreme Gradient Boosting model achieved 93% accuracy after recursive feature elimination optimization. The Extreme Gradient Boosting model highlighted Wit's appraisal, anterior overjet, and Mx/Md ratio as key predictors. The research identified significant cephalometric differences between Cl III adults requiring orthodontic camouflage or surgery. A 93% accurate artificial intelligence model was formulated based on these insights, highlighting the potential role of artificial intelligence and ML as adjunct tools in orthodontic diagnosis and treatment planning. This may assist in minimizing clinician subjectivity in borderline cases.

Diagnostic value of cervical vertebral maturation stages for midpalatal suture maturation assessment: a study in the Chinese population

PurposeTo evaluate the correlation between cervical vertebral maturation stages (CVMS) and midpalatal suture maturation stages (MPSMS), and to analyze the diagnostic value of CVMS for the assessment of MPSMS.MethodsCone beam computed tomography (CBCT) images of 233 subjects (8–20 years) were selected. The CVMS was determined using the McNamara and Franchi method, while the MPSMS was evaluated using the Angelieri method. Spearman rank correlation was used to analyze the results, and positive likelihood ratios were calculated to evaluate the diagnostic value of CVMS in identifying MPSMS.ResultsSpearman rank correlation results showed a strong positive correlation (r = 0.867, P < 0.001) between CVMS and MPSMS. The positive likelihood ratios of CS12, CS4, and CS56 for the identification of stages AB, C, and DE were 12.17, 7.64, and 7.79, respectively. The values of the positive likelihood ratios of the other groups were less than five.ConclusionCS12 of the CVMS can be used as a reliable indicator for the assessment of MPSMS stage AB. From CVMS stage 4 forward, midpalatal suture maturation should be evaluated using CBCT.

Assessment of Skeletal Maturity in a Sample of the Saudi Population Using Cervical Vertebrae and Frontal Sinus Index: A Cephalometric Study Using Artificial Intelligence.

Aim This study aims toinvestigate the relationship between the frontal sinus index and different stages of cervical vertebral maturation and to determine whether these measurements can be used as accurate markers for evaluating skeletal maturity. Materials and methods The sample size was 120 subjects, with ages that ranged from 8 to 25 years. Standardized pretreatment digital lateral cephalograms were analyzed. Six groups representing different phases of cervical vertebral maturation were created from the entire sample. Each group had 20 subjects and was split into male and female groups. On the same radiograph, the cervical stages were assessed and the frontal sinus index was calculated. Correlations between the frontal sinus index and cervical vertebral maturation were assessed using statistical analysis. Results Sinus index values, which assess the ratio of frontal sinus dimensions to cervical stages, were found to be comparable between the two adjacent cervical stages. However, the patterns of sinus index values differed between males and females, suggesting potential variations in sinus development between the sexes. Conclusion Frontal sinus height and width were significantly correlated with cervical vertebral maturationstagesin both sexes. The frontal sinus index, on the other hand, was not significant.